If you are applying for Medicare, you’ll have premiums that need to be paid. There are several different payment options to consider. However, the these options vary depending on what type of Medicare premium you’re covering.

The team at Hyers & Associates is available to help you sort through any questions you might have regarding how to pay your premiums, and you are welcome to call us anytime for help – that’s what we are here for! Let’s break this question down by the different parts of Medicare coverage and the payment options that are available.

Medicare Part A Ways to Pay Your Premiums

Your Medicare Part A covers your hospitalization. If you worked for an employer, they would have taken payroll deductions from your paycheck to cover your Medicare Part A coverage. You would have paid enough taxes to have your Medicare Part A accounted for if you worked for approximately 10 years.

If you did not have sufficient work time to qualify for this coverage you can purchase it from the government. If that is the case you can pay for your Medicare Part A through any of the options detailed below. Several are automatic so you’ll need not worry about them, or you can still get a bill and send a check to cover your premium. There is no right or wrong here, so choose what suits you best. Take a look at these options and choose the one that makes the best sense to you.

Automatic Methods

Medicare’s Easy Pay service. Your premium payment will be made automatically from your checking or savings account the 20th of the month. All you need to do is sign up. It’s easy to access this form by clicking on this link. Print the form, fill in the information needed and mail it to the address on the form. After that, it’s on autopilot. Medicare will alert you the auto payment will be made with a letter reminding you of the deduction (it will say ‘This is not a Bill’) so you remember to account for it accordingly. You can’t make it much easier than that!
Online Bill Payment Option. Today’s banks offer an online bill payment option. Your bank can help you to set this up, or you may be able to do it yourself on your bank’s website. The online bill payment option gives you the ability to pay all of your bills electronically from one place – your bank account

Paper Methods

Paper Billing via US Mail. You can still do business the old fashioned way. Medicare will send you a paper bill in the mail. You write a check to them and mail it to them with their coupon. People have been using this method for years and years. It works, it just takes a little more work and effort. The only downside is the possibility of your check getting lost in the mail.
Paper Billing using a Debit or Credit Card. You can pay using a debit or credit card. Medicare will send a bill to you. On the lower part of the coupon enter your debit or credit card information, sign the form and return it to them via mail.

Medicare Part B Ways to Pay Your Premiums

Medicare Part B covers your preventive medicine and routine doctor bills. Everyone has a monthly premium. If you receive a Social Security check, your Part B premiums will be automatically deducted from your check. You don’t need to do a thing; they’ll take care of everything automatically.

If you do not receive a Social Security check Medicare will bill you quarterly for your premium and you’ll need to make the payment yourself, using any of the methods detailed above. In other words, you can pay by check, automatic bill pay, credit card, or Medicare Easy Pay.

Medicare Part D and Advantage Premium Payments

Your Medicare Part D prescription coverage is between a private insurance company and yourself. The choices available will depend on the company that you are getting your coverage through.

Most companies allow you to pay using Electronic Funds Transfer (EFT) directly from your bank, a coupon booklet (monthly or annual payments), or regular deductions from your Social Security check. Some will allow you to use a credit card as well. In our experience, it’s not advisable to deduct from your SS check. Chances are you will change your Part D plan somewhat regularly. Using the SS method can create hassles when you do change plans.

The same methods hold true for most Medicare Advantage plans. We find our clients select a EFT to keep current – and so that a bill does not get missed.

Medicare Supplement Insurance Billing

Paying your Medicare supplement premiums can be a little different. You have them deducted from your Social Security check (and most companies won’t allow for credit cards), but you can pay with a coupon booklet or EFT. Most insurance companies incentivize annual payments or EFT. You might see a $2 monthly reduction by using one of these two methods. There is usually a surcharge for quarterly, semi-annual, or monthly billing. It’s always a good idea to ask you agent about the cheapest ways to pay your Medicare supplement insurance.

There are many options, and depending on what type of premium you are paying the options may be different. So, if you have any questions you are welcome to give us a call. We are here to help you through the process and look forward to hearing from you.

Category: Medicare Advantage, Medicare Part D, Medicare Supplements

Tags: automatic medicare payments, social security income

If you are not sure whether you need to enroll in Medicare every year when the enrollment period is opened, the team at Hyers & Associates is here to help. We’ve detailed information below, however, we also welcome your call anytime.

In most cases, you do not need to enroll in Medicare each year. You do want to check your coverage elections to make sure you have the most suitable policies for the upcoming year. Our team is always available to take your call and help you with any questions or concerns you might have.

If You’re Already Enrolled in Medicare Part A & B

After your initial enrollment into Medicare you do not need to enroll in your Medicare A & B every year. However, the annual election period held from October 15 through December 7 is a good time for you to take a look at your current elections. You’ll want to decide whether you would like to add (or make changes) to your optional Part D Prescription Coverage – or consider a new Medicare Advantage Program.

Your Medicare Advantage Program and Part D Prescription

The Medicare Advantage Program and the Part D Prescription Drug coverage are both provided by private insurance companies. Every year these private companies take a look at changes they would like to make and submit their new plans to Medicare for their approval. If Medicare approves their proposed changes your Medicare options will usually automatically renew.

If their proposed does not meet approval or the insurance company removes the plan from your area, then you will be notified. In the event they are dropped from the program you will receive a ‘Plan Non-Renewal Notice’ through the mail letting you know that your current plan will no longer be available. The ‘Plan Non-Renewal Notices’ normally arrive by October of each year so you will know you need to shop for a new plan while the Medicare open enrollment period is open.

Other Reasons to Make A Change

There are other questions you should think about. Have you experienced changes in your health which will affect your choices? Do you want to consider trying the Medicare Advantage Program? Are your preferred doctors and hospitals still in network? Has your current Part D Prescription Coverage provider changed their pricing? And have they changed the prescriptions they will cover?

If you answered ‘yes’ to any of these questions you should take a closer look at whether you want to maintain your current program. It is possible they won’t cover drugs you currently take. Or have added new (or stopped taking) some medications and need to change your drug coverage list? This is your one opportunity to take a second look at your coverage before committing for another year.

If You’re Enrolling for the First Time

If you are already getting Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Parts A & B. You will know this has happened as you’ll find a ‘Welcome to Medicare’ packet in your mailbox. You may also receive automatic enrollment if:

If for any reason you don’t currently have Medicare coverage. This may have happened if you delayed starting your Social Security at age 65.
You have had Social Security Administration or Railroad Benefits for disability for 24 months or more.
You delayed enrolling in Medicare Part A or B.

Also, if you have any of the following health problems different enrollment rules apply:

If you have ALS, also known as Lou Gehrig’s disease, your Medicare enrollment begins as soon as your coverage for these diseases gains approval.
If you are younger than age 65, but have end-stage kidney failure, and need dialysis or a kidney transplant you may qualify for Medicare.

When you’re ready to enroll in Medicare you can do that by:

Go to your local Social Security office.
Enroll online over the internet at the Social Security website.
Call the Social Security Administration at 1-800-772-1213

Contact Us!

The team at Hyers & Associates would love to help you evaluate your current Medicare insurance plan and show you what is available in the upcoming year. You can only change plans once a year. You don’t want to end up with too little coverage or paying for more coverage than you need. Our team members are friendly, up to date on recent changes, and waiting for your call.

Compare Medicare Insurance Quotes Today →

Category: Medicare Advantage, Medicare Supplements

Tags: Medicare education, medicare open enrollment

What's The Difference Between Medicare Parts A, B, C, and D A, B, C & D. Sounds pretty basic, doesn’t it? Well, when it comes to Medicare parts A, B, C, & D it’s not always as obvious as you might expect. Each letter covers an entirely different part of your healthcare, so let’s break it down and take a look at what each letter covers, how it affects you, and what you need to know.

Medicare Part A Hospitalization

Medicare Part A coverage is your hospitalization insurance. Your Part A Medicare will cover inpatient patient care, a skilled nursing facility, hospice care, and home health care. Most hospitals accept Medicare, but it’s always a good idea to ask beforehand.

Most people qualify for Part A at age 65 simply through work credits. Other times, it’s because of a disability. Medicare Part A typically does not cost anything as you’ve paid the premiums through you (or your spouse’s) taxes your whole working life.

Medicare Part B Preventive Care

Medicare Part B covers doctor visits and items that are preventive in nature, such as flu shots, vaccinations, annual checkups and screenings for common diseases. It covers standard tests and supplies to diagnose or treat a medical condition. Ask your health care provider if they accept Medicare assignment. If so, you may still have some out of pocket exposure – usually 20%. That’s why you may consider a Medicare supplement policy to cover all or some of the 20% not covered by Medicare Part B.

However, if there is any concern about whether Medicare will cover an item you will be asked to sign a waiver stating you will cover the cost if Medicare does not. So again ask if your provider accepts Medicare.

Unlike Part A, Medicare Part B typically has monthly premiums. You can pay these through Social Security deductions, automatic bank draft or by sending in a quarterly check. Part B premiums are not the same for everyone. Those with higher incomes can be charged extra.

Medicare Part C Medicare Advantage Program

Medicare Part C refers to the optional Medicare Advantage Program. Medicare Advantage plans cover everything normal Medicare Parts A & B cover, but through a private insurance company. In this way, they might be considered as a replacement for Original Medicare A & B.

Advantage providers’ offer various rates and coverage, so be diligent before choosing the Advantage Program. Many will cover additional benefits beyond Parts A & B (like prescriptions for instance), but you need to make sure your preferred doctors and hospitals are in network.

These plans typically use HMO’s (Health Maintenance Organizations) & PPO’s (Preferred Providers). If this is something of interest check if your area has a Medicare Part C organization that accepts the Advantage Program.

Regular Medicare Enrollment Period is from October 15-Dec 7. However, the Medicare Advantage Program also has a Disenrollment period January 1-February 14 if you want to return to original Medicare.

Medicare Part D Prescriptions

Medicare Part D is optional prescription coverage. Just like Part C, Part D policies are sold by private insurance policies rather than provided through the government. Policies will offer various premiums, deductibles, copay and access to medications – so you want to make sure your agent knows all about your prescription needs. If you have daily prescriptions you use, make sure the policy covers your medication at a reasonable price at your preferred pharmacy.

Most policies cover many generics and brand name drugs. All plans must cover at least 2 prescriptions in every therapeutic category. Where these plans usually differ is how much they pay toward expensive brand and non-brand drugs.

You can check your coverage options with Medicare.gov. However, the easiest way to choose a policy is by talking to us. We are very familiar with Part D coverage insurance offerings.

You can deduct Part D premiums from your Social Security check or pay them directly. It’s usually easier to pay directly in case you want to switch plans the next year.

Let Us Help You

While A, B, C & D sound pretty basic there are a lot of choices to make, and trying to determine what is best may requires some assistance. The easiest way to navigate the process is by calling the Hyers & Associates team. We are familiar with the plans and the companies offering coverage.

We stay up to date on any changes to the programs. Make sure you’ve ‘got your bases covered’ and get the most coverage for your money. Our team can make this a relatively painless process. Don’t hesitate, give us a call and let us help. That’s what we are here for.

Category: Medicare Advantage, Medicare Part D, Medicare Supplements

Tags: medicare part a, medicare part b, medicare part c, medicare part d

Medicare OEP 2019 Medicare is restoring the Open Enrollment Period (OEP) for insurance changes. This enrollment window begins each year on January 1st and goes through March 31st. You will have options if you find yourself in a Medicare plan that does not meet your needs.

This window is much different than the Annual Election Period (AEP) that runs from October 15th through December 7th. There are only a few changes consumers can make during OEP, but it’s very important to know your options.

This enrollment period existed once before and Medicare officials have brought it back to help consumers find the insurance coverage that best suits their needs. There are only a couple of changes that can be made, so you don’t want to count on the OEP window for everything. It’s still very important that you make wise decisions during the AEP window in the fall.

Changes That Can Be Made During OEP

This new(ish) window primarily applies to Medicare Advantage plans – and they must be “like plans.” In other words, you would not be able to switch from a MAPD (Medicare Advantage Prescription Drug) plan to a MA (Medicare Advantage) plan because the MA plan does not offer prescription drug coverage and is therefore not the same.

These are the changes you can make during OEP:

MAPD to MAPD Plan
MA Only to MA Only Plan
Original Medicare to MA Only Plan (and vice versa)
Original Medicare and Part D drug plan to MAPD Plan (and vice versa)

Unlike the AEP window in the fall, you are only allowed one change during OEP in the winter. Your change will become effective the first of the next month. For example, if you made a coverage change in January, then it would become effective February 1st.

Part D Prescription Drug Coverage Changes

It’s very important to know you can’t change your Stand Alone Prescription Part D Drug plan during OEP. That window for Stand Alone Part D plan changes only applies to AEP. If you own a Part D drug plan, it’s usually because you have paired it with a Medicare supplement.

Many consumers discover (too late) that they’re drug plan changed year over year. If you do not shop for new coverage during the Annual Election Period (AEP) in the fall, then the OEP window is of no help. It’s very important to work with your agent and price your stand alone drug plan during the fall.

However, if your Part D plan is tied to a MAPD (Medicare Advantage Prescription Drug) policy, then you do have options. You can shop (one-time) for a new MAPD plan, or move back to Original Medicare and buy a Stand Alone Part D plan – and perhaps a Medicare supplement too.

And if you really want out of your Stand Alone Part D plan, you could move to a MAPD plan, but you would no longer be on Original Medicare and you would not be able to keep your Medicare supplement policy if you had one.

What About Medicare Supplement Insurance?

The new OEP window has little bearing on Medicare supplement insurance. In most states, there is no Open Enrollment for Medicare Supplement plans. However, if you’re dropping a MA or MAPD plan during the OEP window, you can apply for Medicare supplement insurance.

Depending on your circumstances, medical underwriting may be required, however. You could be turned down for poor health. You may want to secure approval for a Supplement (like Plans F, G or N) before making any changes.

What you see with these windows is they are somewhat strict. The government is careful to allow only for specific changes to your Medicare insurance. If you’re not sure you really want to talk with an expert. You can find yourself in a plan that does not suit your budget or needs.

Contact Us To Discuss Your Options

We understand that all of this can be somewhat confusing. Having back-to-back enrollment windows in the fall and the winter is a lot to ask. That’s why it’s so important to work with a knowledgeable, independent Medicare insurance broker.

Remember OEP runs from January 1st thru March 31st and has some limitations to what can and can’t be done.

Here at Hyers and Associates, we work extensively with Medicare supplements, Advantage plans, and Part D drug policies. Contact us today and we will help you navigate the Medicare maze.

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Category: Medicare Advantage

Important Medicare Facts Medicare isn’t always that simple, but with a little guidance you can make educated decisions from the beginning. Making good choices is the key to avoiding lifetime monetary penalties, enrollment delays and unnecessary medical underwriting. You can feel confident in your Medicare future by learning a few important items now.

Posted below are five critical and helpful facts about Medicare. After reading this article, you will possess much of the information needed to successfully navigate the Medicare maze.

1) Medicare Does Not Cover Everything

There’s a lot Medicare won’t cover. That’s why most people purchase secondary insurance. You have three options:

You can enroll in a Medicare Supplement and a Stand Alone Part D Prescription Drug plan
You can enroll in a Medicare Advantage Prescription Drug plan

There are pros and cons to each, but these different options help to close the gaps in Medicare. (You cannot enroll in both). So right from the start we know that Medicare has significant coverage gaps that should be filled with a secondary plan. We also know that Medicare does not cover routine prescription drugs. That’s why consumers take one of the two routes above. (It’s important to note that some people have employer sponsored group health insurance and retirement plans in lieu of the above.)

Medicare supplements, Advantage plans, and Part D drug coverage are only offered by private insurance companies – not the government. You have to seek these out through agents and decide which path is best for you assuming you don’t still have creditable group insurance through work or retirement.

Here’s the issue: Even with a Medicare supplement or Advantage plan, you still have holes in your insurance. Medicare does not cover certain hospital stays (Under Observation stays for example) and it also won’t help much with most long term care costs. Home health, assisted living and nursing home care costs are generally only covered for a 100 days maximum and only under certain examples when skilled care has been prescribed.

Consumers who wish to account for items beyond what Medicare and secondary insurance cover turn to Hospital Indemnity plans, short term care, hybrid life and annuities, and traditional long term care insurance. There are several impactful ways to protect yourself and your estate from what Medicare and secondary insurance won’t cover. However, you must purchase indemnity and long term care policies while you are healthy enough to qualify. Otherwise you can be turned down.

Finally, Medicare does not cover routine dental and vision needs. If you want dental and vision insurance, you’ll need to purchase those plans separately from a private insurance company. Some Medicare Advantage plans will include these benefits, but Medicare supplements will not. And many dental plans have waiting periods before major services are covered, so it’s best to get started early.

2) There Are Strict Timelines & Procedures

Once you enroll in Medicare Part B , the clock starts ticking. For most consumers, this is when they enroll in a secondary insurance policy. It might be a Medicare supplement (like popular Plans, F, G and N) or it might be a Medicare Advantage plan. If you miss or ignore your specific Open Enrollment Window, you can face late enrollment penalties, delays, medical underwriting and several other headaches.

However, you may not necessarily need to enroll in Medicare Part B at age 65. If you have group insurance at work, you may be able to defer your Medicare Part B enrollment until retirement. It depends on the size of your group. Having 20 or more employees is the threshold for Part B deferral.

But some people simply miss or ignore their window to enroll in Part B. This is a big mistake. If you miss it, you’ll have to wait until the General Enrollment Period and you’ll be assessed a 10% lifetime premium penalty for each year you were late. We see this happen most often with people who elect COBRA and then don’t enroll in Part B. This is called the COBRA Trap – and it’s bad. Very bad. Make sure you talk with Medicare experts if you’re not sure when to enroll in Medicare Part B.

There is also a penalty if you miss your Part D drug enrollment window. It’s a 1% penalty for each month you were without creditable coverage. This penalty will be assessed when you do choose a Medicare Drug Plan. Over time it can really add up. And like Medicare Part B, the Part D late enrollment penalty is also for life.

Finally, if you don’t purchase a Medicare supplement insurance policy (if that’s your choice) during your 7 month Open Enrollment window, then medical underwriting will be required and you can be turned down. Most consumers only get one chance to purchase a Medicare supplement without medical underwriting. So you must take advantage of your own specific open enrollment window when you’re new Medicare Part B.

In a nutshell, there are several penalties and delays associated with Medicare if you don’t act on time. Once you elect Medicare Part B (Part A is usually automatic), then make sure you explore all of your options. Talk with an experienced Medicare insurance agent, HR manager, friends & family. Just make sure you don’t miss your Open Enrollment window. The consequences are significant.

3) Your Choices Now Affects Your Future Options

Medicare is flexible, but it does have limitations. Choices you make now may impact what options you have in the future. If you only know one rule, you should know that by choosing a Medicare Advantage plan, you may have difficulty qualifying for a Medicare Supplement later.

The rule goes like this: If you enroll in a Medicare Advantage (MA) plan, you are afforded a one year trial period. During that one year window, you can drop your MA coverage, return to Original Medicare, enroll in a Part D Drug plan and then purchase certain Medicare supplements without medical underwriting.

After one year on a Medicare Advantage plan, your options become more limited. You can still drop your Advantage plan and return to Original Medicare. You can also purchase a Part D drug plan, but medical underwriting may be necessary to purchase a Medicare supplement. This means you can be turned down for a supplemental plan like F, G, N and all the rest.

Why might you want to switch back to a Supplement from an Advantage plan? There are a couple of reasons. You might be having difficulty with the network; maybe some doctors and hospitals don’t accept your Medicare Advantage policy. Or you might be running into the higher out of pocket costs associated with Advantage plans. They can be as high as $10,000 for in-network services while many out of network services are not covered at all.

The bottom line: If you’ve been in your Advantage plan longer than 12 months – and you’re in poor health – it can be very difficult to find an insurance company who will sell you a Supplement like Plan F, G or N.

It’s important to know that the opposite move is usually not very difficult. In other words, you can move from a Supplement to an Advantage plan with relative ease. There is only one medical underwriting question with Advantage plans: Do you have End Stage Renal Disease? If the answer is no, then they will accept you during the Annual Election Period each year. (More on the Annual Election Period below)

So this tells us that Supplements are harder to qualify for. You may only get one shot at it. But most importantly, you want to be aware of that 12 month rule. We see many consumers get ensnared in that rule.

4) Medicare Does Not Cost The Same For Everyone

The first thing to know is that Medicare is not free. You must pay your Medicare Part B premiums no matter what. But your Medicare Part B premiums can change based on your annual income.

Those who have income above certain levels will pay more based on a sliding scale. And those who are below certain poverty lines will pay less. If your income goes up or down in the future, your Part B premiums will adjust accordingly. These two programs are called LIS (Low Income Subsidy) and IRMAA (Income Related Monthly Adjusted Amount).

Not only do these two programs affect your Part B premiums you pay the government, they also affect your Part D drug premiums you pay to your chosen drug plan. You can more pay more/less than your neighbor for the exact same Part D drug plan based on your annual income. Medicare is means tested; those who make more will have to pay more.

LIS and IRMAA will not affect the cost of your Medicare supplement insurance should you purchase one. They can however affect the cost of your Medicare Advantage Prescription Drug plan since the Part D coverage is included. Even if you choose a $0 MAPD plan, your premiums and/or drug copays can be increased or decreased based on the sliding scales the government uses each year.

(This is also a good time to tell you that many individual states sometimes have their own Medicare rules. When your new to Medicare, it’s important to ask your agent about any unique rules your state might have. Some states have special Open Enrollment windows and others have rules about the policies available if you qualify for Medicare under age 65 due to disability.)

5) There Is A Limited Open Enrollment Each Year

Medicare Open Enrollment No matter where you live, Medicare provides a window each year from October 15th thru December 7th when you can make limited changes. This window of time is called AEP which stands for Annual Election Period.

You can only make some changes during this short 54 day window that don’t involve medical underwriting. First, it depends on what type of insurance you have and what you want to do.

If you have a Medicare Advantage plan, you can shop for a new Medicare Advantage plan and you’ll be accepted so long as you don’t have End Stage Renal Disease. During AEP you can also disenroll from your Advantage plan, return to Original Medicare and purchase a Part D drug plan no questions asked. However, the 12 month rule mentioned earlier applies if you want to enroll in a Medicare supplement policy. You may not be qualify if you have certain health conditions.

So what if you already have a Medicare supplement during AEP? Well, you can shop for a new Stand Alone Prescription Drug plan no questions asked, but you cannot automatically buy a new (lower cost) Medicare supplement just because it’s “Open Enrollment.”

This is one of the most commonly misunderstood rules with Medicare. AEP does not give you the right to buy a new supplement like Plans F, G & N. In almost all case, medical underwriting will be required if you want to switch supplements or insurance companies. You can’t count on a free pass during AEP for everything. And that’s why you need to choose wisely from the start.

Contact Us For Insurance Quotes And Coverage

While this article more than scratches the surface of Medicare, there is still more to know of course. We recommend that you always employ a knowledgeable agent when researching your Medicare insurance policies. There’s more to know than just the nuts and bolts above. And Medicare makes minor changes each year and major changes about once a decade – so you should have an agent who keeps you informed.

Hyers and Associates is a full-service, independent insurance brokerage. We help our clients with Medicare supplements, Advantage plans, Part D drug, long term care and hospital indemnity insurance policies. Contact us today!

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Category: Medicare Advantage, Medicare Part D, Medicare Supplements

When it comes to Medicare and Medicare Advantages plans, all of them are not equal. And this becomes confusing for seniors who just want the necessary coverage to see doctors and maintain their overall well-being. Each year, the possibilities change and evolve during the open enrollment period. So how do you know what to choose? Seniors need to research the differences, dive into the details, learn about out-of-pocket costs, and evaluate the networks. What works for one person might not for another – and this can change each year.

Medicare vs. Medicare Advantage

Medicare is provided by the government and Medicare Advantage is offered by private insurance companies. Medicare Advantage gives seniors the same type of coverage provided by Medicare, but it does so through a private insurance companies like Aetna, Humana, Cigna, United Healthcare and others.

The coverage is the same and provides services from physicians, hospitals, home health care agencies, laboratories, etc. About 90 percent of these plans offer drug coverage.

Medicare Advantage plans usually have a small premium due each month, but some can be found for $0. Comparisons of the benefits and costs will reveal which choice is better so the insured can get the most comprehensive coverage at the lowest cost.

The Medicare Advantage Alternative

Medicare Advantage is an alternative to Medicare. The plans are mostly PPOs (preferred provider organizations) and HMOs (health maintenance organizations). Your options will depend on what’s offered in the county where you reside. Recognized names offering Medicare Advantage plans include Humana, Aetna, United Healthcare, Anthem, Blue Cross and Blue Shield, WellCare, Cigna, Kaiser Permanente, and others.

These plans must provide the same benefits offered by Medicare, but all take a step further by limiting the insured’s out of pocket exposure. And keep in mind, you must be enrolled in Medicare Part A and Medicare Part B to qualify for a Medicare Advantage plan. You must still pay your Medicare Part B premiums even if you choose to enroll in an Advantage plan. But you are allowing a private insurance company to insure you for what Medicare normally would. In turn, you’ll want to use their networks of doctors and hospitals to realize the most cost savings.

Benefits of Medicare Advantage

Ultimately consumers must select the right insurance plan for his or her unique needs. With Medicare Advantage plans, there is a cap on out-of-pocket costs. That’s not the case with traditional Medicare unless a supplement like Plan F, G or N is purchased. Advantage plans are all in one coverage offered at a reasonable price. Since most include Part D drug coverage, there is no additional insurance plans to buy.

And extra benefits are offered that do not come with Medicare, such as dental exams, vision care, and hearing exams. In 2019, even more benefits will be offered like some long term care benefits, caregiver services, meals and much more. The government is incentivizing the enrollment in Advantage plans like never before.

Furthermore, many now offer networks that can be accessed across the country. That was a problem in years past, but the larger insurance companies have PPO options with access to care in most large metropolitan areas. This alleviates a major concern for those who have homes in multiple states and those who simply like to travel.

Concerns With Medicare Advantage

Along with the benefits come some concerns. Access to services is limited to doctors and hospitals in the plan’s network. Consumers must verify their preferred providers are in their plan. This is especially true of HMO plans. With an HMO you pay the full cost of care if you go out of the network – unless it’s deemed an emergency. And referrals from a primary care physician might be required to see a specialist.

With a few exceptions, most people are locked into the Medicare Advantage plan they choose for a year. You can always return to Original Medicare during the Annual Election Period each fall, but you may not qualify for a Medicare supplement policy. Once you’ve been in an Advantage plan for longer than one year, most Supplemental companies are allowed to medically underwrite you. In other words, you can be turned down for coverage if you’re in poor health.

And even though your out of pocket costs are capped with an Advantage plan, those caps are still much higher than with Supplement like Plans F, G, or N. So you’ll need to stay in network and know that a major health event can still cost you thousands with this type of coverage.

What to Think About

Before making a final decision, find out what providers are in the Medicare Advantage network. This is particularly important for people in rural areas who might get limited services or have to travel long distances for medical care and treatment. Determine if medications are covered by the plan. Find out if buying into the plan will limit your ability to get Medicare supplemental insurance in the future if you opt for Medicare. Be aware of the claims process, out-of-pocket expenses, and referral policy. Make sure the plan provides the exact coverage you need and makes it convenient to visit your treating physicians.

Work with a licensed insurance agent who understands all the differences in these policies. An agent can help you do the necessary shopping around and comparisons to get the best plan for your situation.

Thank you for reading our blog! How can we help you? Contact us today.

Category: Medicare Advantage

Every year, 4 million Americans turn 65, and many of them are looking forward to retirement. But not many of these retirees planned for their Medicare costs. Planning for Medicare costs in retirement starts early, so you feel confident about health care expenses after retiring.

The cost of health care becomes increasingly costly as we age. We become more prone to diseases, and our bodies get weaker, failing to fight off what used to be common illnesses that our bodies once warded off. Often, we are ill-prepared when the time for retirement comes. To plan for it carefully, you need to understand the costs of Medicare.

Medicare Part A

Medicare Part A is usually called hospital insurance. It covers items such as inpatient hospital care, skilled nursing facility stays, and some home care. You qualify for Part A if you have paid ten years’ worth of premiums through payroll deductions. In other words, you have likely already paid for this component through years of work. It’s not free, but there is no cost.

If you do not meet the ten year threshold, you can also qualify if you are the dependent of your spouse who has paid the premiums through his or her contributions. If you do not qualify through a spouse, your insurance premium will be $422 per month beginning 2018. This might apply to someone who is of Medicare age, but lived abroad most of their lives.

Part A hospitalization has a deductible of $1,340 for 2018. On top of this, you also pay for coinsurance costs. The price of this will vary, and this variation depends on the type of illness and the length of stay in the hospital. Part A has some gaps in it that can be filled with a Medigap policy, but you need to be enrolled in Part B in order to purchase said supplement.

Medicare Part B

Part B refers to care received at by a doctor. This might include services like a doctor’s office visit, outpatient care and preventive care, durable medical equipment, ambulance transportation and supplies necessary to treat your overall health.

Unlike Part A, Medicare Part B does have a monthly premium. You can pay the government directly or have your amount deducted from your Social Security benefits. In 2018, you will pay $134 per month if it’s your first time enrolling in Part B, or if you are not eligible to receive retirement benefits from Social Security or Railroad Retirement. In some cases, Medicaid will pay your premiums if you meet their financial criteria.

Medicare Part B is means tested using what they call a Income Related Monthly Adjustment Amount (IRMAA). This means high-income earners will pay more for this coverage. Medicare will use a sliding scale to determine your monthly premiums and it’s based on your modified adjusted gross income from 2 years ago. There are five levels altogether and you will receive a letter should this upcharge apply to you. Premiums will range from $134 to $428 per month.

Part B also has a deductible associated with it – that amount is $183 in 2018. Some Medicare supplements sold today can fill in this gap as well. It’s wise to speak with an agent to see if it’s a good value to buy a supplement that covers this deductible.

Medicare Part C

This plan is commonly known as the Medicare Advantage Plan. With this option, you are buying your insurance from a private institution, like Aetna, Anthem BCBS, Humana, United Healthcare or others. These institutions are accredited by the government, specifically Medicare.

You will receive your benefits and claims from a private company and not from the government. These institutions offer similar benefits as original Medicare, but they can also include prescription drug coverage as well – otherwise known as Part D. Advantage plans can also offer varying amounts of dental, vision and hearing insurance.

The catch here is that each Advantage plan varies in coverage, benefits and network availability. So you need to look at your options very carefully. It’s important to make certain your preferred doctors, hospitals and healthcare providers participate in the network.

Each company also has its list of prescription drugs that they can cover, both branded and generic. The cost of the plans varies from one company to another. As these plan receive reimbursement from the government, some can be as low as $0 a month.

Medicare Part D

Medicare Part D is focused solely on prescription drugs. If you buy this policy, you and the private insurance company will share the cost of the drugs. As mentioned earlier, each company has its list of the prescription drugs that they offer and at what cost. This is referred to as their formulary.

Part D drug plans will vary in cost and benefits depending on where you live, what you take, and where you fill your rx’s. One size does not fit all with these, so it’s important to be diligent when shopping for one. Make sure your agent knows all of your information.

If you choose to enroll in a Medicare Advantage plan, you may not need a Part D drug plan as this component is usually included. If you stay with Medicare Parts A & B (referred to as Original Medicare) then you likely want to purchase a Medicare supplement and stand alone Part D drug plan. We can walk you through it.

Talk to a knowledgeable insurance professional to learn more about your Medicare options in retirement. Gathering information ahead of time makes it easier to slip into the comfortable retirement you always dreamed of.

Thank you for reading our blog! How can we help you? Contact us today.

Category: Medicare Advantage, Medicare Part D, Medicare Supplements

Hospital Indemnity Insurance If you’re on Medicare or nearing eligibility, you know this insurance does not cover all of your out of pocket expenses. You can shore-up some gaps with a Medicare Supplement or Advantage plan, but they may not be enough either.

This is especially true if you’re on a Medicare Advantage policy. These policies have much more out of pocket exposure. Should you have a illness or injury resulting in a hospital stay, you can rack up big bills. That’s where hospital indemnity plans can help significantly.

Hospital Indemnity Plans Go Beyond Medicare

Medicare eligibility can be a great thing, but it’s important to know its limitations. This is especially true if you choose a Medicare Advantage plan over a traditional supplement. If you closely inspect your chosen Advantage plan, you will see there can be significant out-of-pocket costs if you have a hospital stay, accident or prolonged illness.

All Medicare Advantage plans have large daily copays if you’re admitted to the hospital. And these amounts can be even higher if you’re receiving care out of your insurance plan’s network. A hospital stay of just a few days can result in thousands of dollars you might owe before your plan pays the full amount. And your cost sharing will grow larger if you have a deductible that must be met first. You will also have doctor’s copays and coinsurance to pay as well.

Covering Medicare Under Observation Hospital Stays

Under Observation are the two worst words you can hear when you’re on Medicare. In a nutshell, it means Medicare is not paying for your stay. It’s a loophole in the system that allows doctors to place a patient “Under Observation” while confined in a hospital – and it happens more than you might think. When it does happen, Medicare will not pay the bill at all. This means your Medicare supplement or Advantage plan will not pay either.

An Under Observation stay of just a couple of days can cost thousands. If you’ve ever encountered this – or know anyone who has – you know owning a hospital indemnity insurance plan can be a financial lifesaver. Having an insurance policy covering the hundreds of dollars per day (you choose how much) can eliminate the high costs associate with an Under Observation hospital stay.

Hospitals have several reasons why they label a stay as Under Observation, but as you might imagine it’s to protect themselves while staying in the good graces of the Medicare system. As these stays have become more commonplace, it’s a good idea to have a backup to your Medicare insurance. And to avoid the shock of a very large, unforeseen expense after your release home.

How Do Indemnity Health Insurance Plans Work?

Hospital Indemnity plans can do a lot – and they are especially useful if you chose a Medicare Advantage plan over Medicare supplement insurance like, Plan F, G or N. Advantage plans usually have significant of out-of-pocket exposure. If you look closely at your insurance coverage, you’ll see there are large copays for you first few days in a hospital. There are also deductibles, coinsurance and copays for procedures. When you add this all up, you get your maximum out of pocket exposure.

Your out of pocket exposure will differ whether you’re in network or out of network. (It’s less for in-network claims.) However, when examining your Scope of Benefits, you’ll see your maximum out of pocket exposure is usually somewhere between about $3,500-$10,000 in any given year. A good Indemnity plan will significantly reduce or eliminate those amounts.

Do They Offer Any Additional Benefits?

Hospital indemnity plans aren’t just for those on Medicare. The Affordable Care Act has created significant changes in the health insurance marketplace. It’s not uncommon to see plans with high deductibles, large coinsurance amounts and significant out of the pocket exposure to the insured. Simply put, many ACA plans don’t offer benefits right away.

Whether you’re Medicare eligible or on a high deductible health insurance plan, it’s nice to know there are policies for sale that will provide benefits right away. So what do indemnity health plans cover? Quite a bit, actually – things like:

Deductibles, coinsurance and office copays
Lump sum hospital payments
Under Observation Stays for those on Medicare
Emergency room visits and ambulance rides
Outpatient rehab and surgeries
Skilled nursing care
Mental health benefits
Accidents, illness and injury
Cancer, heart attack and stroke benefits

These are just a few of the benefits hospital indemnity plans provide. You can tailor these plans in several ways to fit your needs and budget. Many also offer separate riders like dental and vision coverage.

Furthermore, some indemnity plans are available on a Guaranteed Issue basis. This applies more to those on Medicare nearing their 65th birthday, but our clients are pleased when policies offering great benefits can be purchased without medical underwriting.

Contact Us For Enrollment Advice & Insurance Rates

When you’re planning your Medicare enrollment, you’re just marching down the cafeteria line. You get your government run Medicare Parts A & B, then you have to work on the best and most affordable ways to supplement this coverage. We’re here to guide you through this process and to fill any and all gaps in the way the best suits your needs and budget. Certainly, a hospital indemnity plan is worth consideration.

Ready to get started? Contact us today!

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Category: Medicare Advantage, Medicare Supplements

when open enrollment Medicare Medicare open enrollment is currently underway from Oct. 15 to Dec. 7 of this year. This means that if you want to change your coverage or add a supplemental insurance plan, this is the time to do it. All new insurance policies take effect on Jan. 1, 2018. But, before they do, you have some time to learn about the different options and pick the one that works best for you.

During open enrollment, you can either join a new Medicare Advantage Plan or add on a stand-alone prescription drug plan (Medicare Part D). If you are enrolled in a Medicare Advantage Plan already, you have the option of switching to Original Medicare if you no longer need everything that plan offers. Wondering what exactly you should do when open enrollment for Medicare begins? Here are some essential steps to take:

1. Understand the Terminology

If you’re confused about the different terms being tossed around during this period or are unsure about what something means, this is the time for you to do some research and learn more about the different plans and terms used to describe Medicare options.

Medicare Advantage Plans are health insurance plans that are required by law to cover the benefits of Original Medicare Parts A and B. They also often offer extra coverage, such as prescription drug plans and dental, vision or hearing benefits. Medicare Advantage is administered privately. Although you will still get all of the coverage that Medicare Parts A and B offer, it will go through a private insurance company instead of the government. Medicare Part B premiums will still be paid to the state. Also, hospice care will be administered by the federal government if it is included in the policy.

Medicare Part D is a Medicare policy that subsidizes the cost of prescription drugs, which may be necessary if you have a condition that requires you to buy expensive prescriptions often. It can be purchased as a stand-alone policy, combined with Original Medicare or included in your Medicare Advantage plan. Most of the time, you can mix and match depending on what your other medical insurance needs are.

Original Medicare encompasses two policies: Medicare Part A and Medicare Part B. These offer different benefits with different deductibles, premiums, and copayments. For each plan, you will have to pay a deductible for your health care costs. This deductible is a minimum amount that you need to pay before the government covers the rest. For Medicare Part B, you also need to pay monthly premiums. For both kinds of plans, it’s common for you to have a copayment for health treatment once your deductible is paid.

Supplemental plans (also known as Medigap) cover the out-of-pocket costs that you may have to pay if you have Original Medicare. Some examples include cosmetic surgery, foreign health care, hearing aids and exams, long-term care, most eyeglasses, dental care, and dentures. You can buy these plans from private insurance companies. Any costs incurred that aren’t covered by Medicare are automatically forwarded to your Medigap policy.

2. Think About Your Needs

Which plan you choose, and thus how much you pay, will depend on your individual medical needs. For example, if you expect that you will be spending a lot out of pocket for prescription drugs in the upcoming year, you should consider enrolling in a Medicare Part D or Medicare Advantage plan that covers prescription drugs. If you plan to travel a lot and want an insurance plan that includes health care you receive abroad, Medicare Advantage might be the best choice for you.

3. Shop Around

There are many different policies offered that all cover various types of benefits at varying costs. As such, make sure to consider the overall price of each and which services you need the most. Because there are so many options, compare each carefully. In other words, shop around. Don’t just find the first policy you think looks right for you and stick with it — think critically, and look for something better and cheaper.

4. Don’t Be Hasty

You have all the way until Dec. 7 to make a decision, so take your time. Start doing research now, and don’t leave the application until the last minute. This way you can be sure that you’re making the choice that’s right for you (and not just made under pressure).

However, if you do make a decision that you’re unhappy with later, you do have a chance to change it. From Jan. 1 to Feb. 15, you can switch out of a Medicare Advantage plan and back to an Original Medicare plan if you regret signing up with the former during open enrollment.

Thank you for reading our blog! How can we help you? Contact us today.

Category: Medicare Advantage, Medicare Supplements

Reviewing and understanding your supplemental insurance options can be overwhelming when you are new to Medicare. There are several options to choose from and it’s hard to know which plans with which provider will be most suitable for the long haul.

In the following article, we provide tips and advice to help you navigate this somewhat complicated product category. With this knowledge, and our experience, you can form an educated plan of attack in order to find the supplemental plan that best fits your needs. (Note: Medicare supplements are sometimes referred to as Medigap plans and we will use these two terms interchangeably.)

Do You Prefer Medicare Supplements Or Advantage Plans?

For the purposes of this post, we’ll assume you have decided to enroll in a Medicare supplement over an Advantage plan. By rule you can’t have both – so you’ll want to decide which policy fits you best. Most of our clients prefer that Medicare supplements have no network restrictions and little out-of-pocket exposure, but one size does not fit all.

That’s not to say one is better than the other, they are just different. Advantage plans can be less expensive and usually include Part D drug coverage rolled into one bundle. We offer both types of policies and can help you compare and contrast them if you’re unsure which you prefer.

Medicare Supplements Are Regulated By The Government

When starting this process, you first want to know that Medicare supplements are very much a cookie-cutter type of product. Plan F from company A has to cover the exact same benefits as a Plan F from company B – while also providing the exact same network.

Insurance providers cannot monkey around with the benefit design. These policies simply piggyback off of Original Medicare and help fill in the leftover gaps depending on the level of coverage you choose. There’s no wiggle room for the insurance companies to deny claims. If you encounter a Medicare approved expense, your supplement will cover its designated gaps.

And with almost all Medicare supplements (the rarely purchased Select Plans being the only exception) there are no networks to worry about. You will have the same network of hospitals and doctors with Aetna as you would with Anthem BCBS, United Healthcare, Mutual of Omaha or any other provider you may or may not have heard of.

Medicare is your primary insurance and your permanent network. If your doctor or hospital accepts Medicare, then they will accept any traditional supplement you present them. You are never shopping networks with a supplement like you would with an Advantage plan.

Understanding Your Medigap Coverage Options

At present, there are ten different Medigap plans sold today – Plans A-N.

Medicare Supplement Plan:	A	B	C	D	F	G	K	L	M	N
Part A Hospital Coinsurance	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Lifetime Reserve Days	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
365 More Hospital Days	✔	✔	✔	✔	✔	✔	✔	✔	✔	✔
Parts A and B Blood	✔	✔	✔	✔	✔	✔	50%	75%	✔	✔
Part B Coinsurance	✔	✔	✔	✔	✔	✔	50%	75%	✔	✔*
Part A Hospice Coinsurance	✔	✔	✔	✔	✔	✔	50%	75%	✔	✔
Skilled Nursing Coinsurance			✔	✔	✔	✔	50%	75%	✔	✔
Part A Deductible ($1,288)		✔	✔	✔	✔	✔	50%	75%	50%	✔
Part B Deductible ($166)			✔		✔
Part B Excess Charges					✔	✔
Foreign Travel Emergency			✔	✔	✔	✔		✔	✔	✔

Key: A ✔ means the benefit on the left is covered. For example, Plan F checks all boxes and fills in all gaps in Medicare Parts A & B. The * denotes that Plan N has office copays.

You can see from the above that some plans are very similar. Plans F and C are very similar as are Plans G and D. In our experience, Plans F, G and N are the most commonly purchased policies. We see very little demand for Plans A, B, K, L and M as they are not as comprehensive.

It’s important to note that Plans C, F and N also come in “Select” versions which require network use for routine care. We don’t see much demand for Select plans either. Finally, there is also a High Deductible Plan F option that requires the insured to cover a $2,180 deductible before the supplement will pay its share.

Certain Medicare Supplements Offer More Value

Plan F is the most popular Medigap plan at present capturing an estimated 4 out of every 10 buyers. The reason: It’s the most comprehensive plan available. However, new legislation passed in 2015 states that beginning in 2020, no Medicare supplement plans can cover the Part B deductible. This means Plans F and C will no longer be for sale, but if you’ve enrolled previously, then you can keep your existing plan.

In our opinion, it’s important to consider policies other than Plan F. We’ve written extensively about the value Plan G provides in terms of cost, benefits and renewal history. In many cases, the lower monthly premiums Plan G provides more than make up for the small Part B deductible it does not cover.

And Plan G (as well as Plan N) are not Guaranteed Issue plans. This simply means they are more exclusive in their enrollment and do not have to accept as many applicants as Plan F. Therefore Plan G tends to have a healthier pool of applicants causing the premiums to rise more slowly. Our agency is regularly updated with rate increases and we see Plan F increasing more quickly than Plan G in many instances.

Don’t Buy The Least Expensive Plan

The temptation is to buy the cheapest Medicare supplement in the letter you prefer most. It pays to take it a step further. You’ll want to know how long said insurance company has been offering that line of supplements and their renewal history.

Many providers release new lines of supplements under a slightly different name every few years so as to offer lower premiums. This sometimes causes above-average rate increases for those stuck in the old, no-longer-for-sale line of business. You should ask your agent about the age of the supplement as well as the yearly renewal history.

In most cases, agents have access to about 4-5 year of rate increases. We can tell you which plans with which companies have been most stable. These Medigap plans may not be the least expensive, but they can save you money going forward if their rates are more stable. In other words, pay a little more now so you pay less later.

Don’t Put Too Much Stock In Any One Rating Class

We see a lot of demand for Issue Age Medicare supplement insurance plans over Attained Age coverage. Most of the time, it’s because these policies are misunderstood. Issue Age plans will usually increase in price each year just like Attained age plans, but not because you are a year older.

And most of the time, Issue Age plans are more expensive to begin with. Well, if the more expensive Issue Age plan passes along an 8% annual increase compared to, say a 4% increase with the Attained Age plan – it’s pretty clear which one is better.

Community rated plans offer the same rates to everyone no matter their gender or location. If I’m a female living in Pittsburg, why would I want to pay the same rate as a male in Philadelphia? The answer is you wouldn’t. Again, talk to your agent about rate increases before settling on a rating class.

Use an Agent When Purchasing Supplemental Coverage

You sometimes hear the saying, that if you are your own lawyer, doctor, accountant, etc – then you have a fool for a client. The same could be said for insurance broker. You don’t know what you don’t know and that lack of information can lead to poor decisions. Many of our clients have first spoken to friends, family and neighbors and come to us with a lot of conflicting and wildly inaccurate information.

Don’t miss out on important information, use an independent agent. Know that it does not, by law, cost you any additional money to place your business with us. By rule, we offer the same rates as if you called the insurance company yourself. But those of us who are independent can quote you the direct rates with several carriers at one time.

We can also talk about the experiences of our clients with various carriers, their rate increases and reputations, as well as other nuanced items like premium discounts and the like. Don’t go it alone. You are not saving any money and likely missing out on valuable information an agent can provide now – and in the future. Medicare changes yearly and sometimes significantly. It’s nice to have an unbiased agent in your back-pocket when you have questions.

Take Advantage Of Spousal & Household Discounts

Many carriers offer spousal and/or household discounts on their supplemental plans. In some cases, you don’t have to be married (just living with someone) to qualify for a premium reduction. Savings will vary between companies and by state regulations, but can be as much as 12% in some areas.

It’s important to bring your household makeup to the attention of your agent. Maybe you have a spouse who will be Medicare eligible in a few months, or maybe you live with an adult child, sibling or significant other. These factors will help agents make recommendations so you can maximize your savings.

In most cases, the least expensive way to pay is monthly (via automatic bank draft) or annually by check. If you choose to pay quarterly or semi-annually, your rates can be higher. And many companies will not bill you monthly – they’ll want to draft automatically in order to avoid higher administrative costs. We recommend that our clients consider bank draft – it’s safe, secure and reliable. It will also help to prevent policy cancellations if you are travelling or your invoice is lost in the mail. Most insurance companies offer several payment options, however.

Choose A Different Part D Prescription Drug Provider

Sometime our clients choose the same Part D prescription drug provider as the one offering their Medigap plan. Don’t do this without first comparing all drug plans for the prescriptions you take. There is no bundled savings by using the same provider and in many cases you’ll be paying more than you need to.

We help our clients compare their Part D plans at Medicare.gov. It’s a good website to see who offers you the most savings at the pharmacy (or mail order option) of your choice. Part D Rx plans can differ by wide margins, so it’s important to shop these plan independently of your Medicare supplement.

Contact Us To Learn More About Medigap Insurance Plans

We are an independent Medicare supplement brokerage and have been working in this market for several years. Using our knowledge and experience, you can find the supplemental coverage that best suits your needs and budget. You will also have us as a resource in the future when you want to discuss changes to your insurance plans.

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Category: Medicare Advantage, Medicare Supplements

When you’re new to Medicare, there are decisions to make. Most of our clients compare traditional supplements (Plans, F, G, N, etc.) to Advantage plans, but inevitably the questions arises, ‘What is a Medicare Advantage (MA) plan?’

Through the years, we have found there’s a lot confusion about Advantage plans. They are different from supplements – and it’s important to understand how. We answer several of the most common questions below so you will have a better understanding of what to expect from this type of insurance.

Simply Put, What Is a Medicare Advantage Plan?

CMS (Centers for Medicare and Medicaid Services) defines Medicare Advantage plans as, “a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.”

In other words, you are allowing a private insurance company (like Aetna, Humana or United Healthcare) to cover all of your normal Part A & B benefits instead of Original Medicare that is provided by the government. You still pay your Medicare Part B premiums each month, but your A & B benefits are covered privately from a chosen insurance company.

Medicare A & B Has Gaps. Do Medicare Advantage Plans Fill These Gaps?

Yes and no. There are several gaps associated with Original Medicare (Parts A & B) including deductibles, coinsurance, etc. That’s why consumers usually purchase supplemental insurance of some kind.

Advantage plans reduce these gaps so your out-of-pocket exposure is reduced. They do not eliminate all of the Part A & B gaps however. All MA plans detail their out of pocket exposure – both in and out of network. There are yearly maximums that limit the total amount the insured might face if healthcare is needed.

You will know upfront what a doctor’s office, ER or Urgent Care visit will cost as well as an extended hospital stay. All of these amounts will be carefully detailed in the Summary of Benefits and Evidence of Coverage documents provided by the insurance company.

Are There Different Types Of Advantage Plans To Choose From?

Yes, there are HMO, PPO, PFFS, Medical Savings Account, Cost Plans, Special Needs Plans and more. The two most common types are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans. Of the two, typically PPO plans have larger networks of doctors and hospitals to choose from.

Plan availability will differ from state to state and county to county. Your neighbors on the other side of the street may have access to different plans if they live in a different county than you.

It Sounds Like MA Plans Can Vary – Is There An Easy Way To Compare Them?

Yes, you can go to Medicare.gov and use their Plan Finder software. It will return all of the available MA plans in your county. You can enroll in an MA plan direct from the provider or through an insurance agent. The monthly cost (if there is one) will be the same no matter your source.

If you are not sure which plans might be best for you, then speaking to a licensed independent agent can be wise. We can help you compare and contrast your options in order to find the most suitable plans to fit for your needs.

What About Networks And/Or Network Restrictions?

Most (not all) Advantage plans use a network of doctors and hospitals to provide care. This is how they keep costs down. If you enroll in a Humana HMO plan, then you will need to use the Humana doctors and approved medical facilities for your care. You do not need to stay in-network for emergency care, however.

With most MA plans, you will need to choose a Primary Care Physician. This is different than if you stayed on Original Medicare and instead purchased a supplement – like Plan F, G or N. With almost all supplements, you can see any doctor who accepts Original Medicare.

In most cases, you may have a smaller network of medical providers with a Medicare Advantage plan. This is not an issue for many members – it’s just something to be aware of. Most doctors accept many different types of MA insurance plans from different providers.

Is Prescription Part D Drug Insurance Included?

Yes, most Medicare Advantage plans include prescription Part D insurance, but not all. And if your plan of choice does not include Part D coverage, you may not be able to enroll in one without cancelling your Advantage plan.

So it can be a little complicated – and it’s different than how Medicare supplements and Stand Alone Part D plans can be paired together. This is another instance when you may want to talk with a knowledgeable agent to make sure you’re aware of the rules and regulations with Medigap plans.

(Typically plans that do not include Part D drug coverage are designed for those who have prescription drug coverage elsewhere – like the VA.)

Are There Extra Benefits With Advantage Plans Like Dental, Vision & Hearing?

Yes, and this another area where they differ form Medicare supplement insurance. Advantage providers are allowed to bundle dental/vision/hearing packages if they wish. Some do and some don’t. Undoubtedly, it’s nice to get these extra benefits – especially if your MA premiums are low.

In this way, MA plans can be a total package if they include Part D drug coverage, dental, vision and hearing. Plans with these types of extra coverage may cost a little more however than plans without.

How Much Do MA Plans Cost? Why Do Many Plans Have No Monthly Premiums?

MA come in different shapes and sizes and will vary in cost. In most counties, there are a few plans offered for $0 a month. More robust and comprehensive plans can cost upwards of $150 a month. PPO plans typically cost more than HMO plans. A good rule of thumb is: the more expensive the plan, the better the network and the more comprehensive the coverage.

We are often asked about $0 premium plans and how they can exist. The primary reason is the federal government subsidizes these plans. They pay the insurance company a certain amount per member. Additionally, these plans may have a smaller network of doctors and hospitals that have agreed to set reimbursements from the insurance company. Those two factors allow for $0 Medicare Advantage plans.

I’m On Medicaid. Can I Still Enroll In a Medicare Advantage Plan?

Yes, you can. This can be a little complicated so it’s best to speak with your local Medicaid official as well as an agent before doing both. But many Medicaid eligible beneficiaries do choose to enroll in an Advantage plan while also maintaining their Medicaid eligibility.

Can I Enroll In Both A Medicare Supplement & Advantage Plan?

No. There’s not too much else to say. It’s one or the other and there are no circumstances where you can enroll in both. In some cases, you can enroll in both an Advantage and a separate Part D drug plan, but never a supplement like Plan F, G, N, etc.

Which Insurance Is Better – Medicare Supplements or Advantage Plans?

That’s the million dollar question. The answer: It varies from person to person. Typically Medicare supplements are more expensive, but they are also more comprehensive and usually don’t have network restrictions. And supplements are more portable for those who travel frequently or winter/summer in different states.

Conversely, Medicare Advantage plans can be less expensive and also bundle Rx, dental, vision and hearing. If your doctors accept your chosen insurance plan, then you need not worry about networks quite as much. For those under age 65, Advantage plans can be one of your only options. There’s not a right or wrong answer so long as you know the ins and outs of the two different options.

Are There Pitfalls/Concerns With Medicare Advantage Plans?

There can be. As an agent, the ones I hear about most are network issues. Extended care/rehab facilities are somewhat notorious for not accepting certain MA plans. And sometimes well-regarded hospitals like the Mayo Clinic are very selective in what they will accept. Additionally, the out-of-pocket costs can add up over time.

The other pitfall is that you only get a one year free-look with any Medicare Advantage plan. After one year, you can return to Original Medicare and purchase a guaranteed issue Medicare supplement (like Plan F) for the first time or re-enroll in a supplement with your old provider. After two years or more, supplemental providers are allowed to medically underwrite and decline coverage. There is no open enrollment window to purchase a supplement if you don’t like your Advantage plan.

What is The Annual Election Period – How Does It Affect MA Plans?

The Annual Election Period (AEP) occurs from October 15th through December 7th each year. Unless you are experiencing a special enrollment period (SEP), this is the only time of year when you can change Medicare Advantage plans.

If you are already enrolled in a MA plan, you can switch to another one. Conversely, you can disenroll from your Advantage plan, rejoin Original Medicare and apply for a Medicare supplement plan, but medical underwriting may be required to enroll in a supplement. There is no underwriting to enroll in a Part D drug plan however.

Are There Special Enrollment and Disenrollment Periods? What is a SEP?

The Medicare Advantage Disenrollment Period runs from January 1 through February 14th. During this window of time, you can disenroll from your MA plan, rejoin Original Medicare and purchase a Part D plan – no questions asked. The only other times to leave an MA plan are during the aforementioned AEP window or if you’re granted a Special Election Period.

SEP’s (Special Election Periods) are somewhat common and can occur when an insurance company discontinues your MA plan, when you leave their service area or when Medicare rates them as poor performing plans – to name a few. If you’re granted a SEP, then you want to explore all of your options right away.

Contact Us To Compare Medicare Advantage Plans

It goes without saying that there is a lot to think about when it comes to Advantage plans. We are here to help. We’ve been working with these policies for several years and in several states. If you would like to know more about your options, please feel free to contact us.

Compare Medicare Advantage Plans Today →

Category: Medicare Advantage

Welcome to Part II of our two-part series regarding the most frequently asked questions our agency encounters about Medicare Supplement insurance policies. In this installment, we discuss the nuances of these plans including: rates, underwriting, making changes and the agent’s role.

Click Here To Read Part I Med Supp FAQs →

Learning About Medicare Supplement Rates & Increases

Can My Rates Go Up Each Year? Why Do They Increase?

Yes, rates with most plans and most carriers increase each year. It does not matter which type of plan you choose (Attained Age, Issue Age or Community Rated) as rates usually increase on your yearly anniversary.

There are several reasons for increases including: changes to Medicare, overall claims experience, policyholder birthday, etc. It’s important to understand that each year CMS shifts more costs to Medicare supplement policies and that affects rates for all plans – both new and old.

With most supplements, your rates are locked in for 12 months. After your 12 month rate lock is over, then rates can increase at irregular times. Insurance companies are not obligated to stay on a 12 month cycle, but many do.

Can I Be Singled Out For A Rate Increase?

Insurance companies cannot single you out for a rate increase. Rates will increase equally for everyone in your block of business which could include several thousand people.

When rates increase, they are adjusted for all policyholders in your block. For instance, United Healthcare might announce a 4% increase on all plans next year for the state of Ohio and that would be that. Another carrier, Stonebridge Life, might announce an increase in that state of New Jersey of 6% on all plans except Plans G & N – which will increase by 4%. Insurance companies are not obligated to raise rates on all plans equally.

Are Some Carrier’s Rate Increases More Friendly Than Others?

Without a doubt, some carriers have a much better track record with rate increase history than others. In our experience, this is one of the most important aspects of Medicare supplement insurance – renewal rates.

You don’t want to shop on first year rates alone. You want to ask about renewal history with the carriers you are interested in. All plans experience rate increases – even Issue Age Medicare supplements. As it can be difficult to switch carriers in the future, buying a plan with stable rates is of utmost importance.

Is It Possible To Know What My Rates Are Going To Be In The Future?

No. If you’re age 65, you can ask about rates for an 80 year old, but that number would be for an 80 year old applying today. As agents, we only know new business rates and in some cases renewal history. We have no way of knowing what your rates will be in the future – no on does.

Can I Get Rated-Up Based On My Health?

There are a lot of factors that can affect your rates including: your state and zip code of residence, gender, age, tobacco use, height/weight, marital status, etc. These are all items you want to disclose to your broker when discussing rates.

If you’re in your open enrollment window, then some of these factors won’t matter. Very few carriers underwrite to your overall health. You are either accepted or declined if applying outside of open enrollment or guaranteed issue periods.

Are Issue Age Plans Better Than Attained Age? What About Community Rated Plans?

In our experience, you are simply shopping for a Medicare supplement carrier with a history of reasonable rate increases. It’s important to know that there really is no silver bullet here – all carriers raise rates to some extent.

Even though an Issue Age plan might not raise your rates because you are older, that does you no good if there normal rate increases are 5% above the next best Attained Age plan. In many cases, Issue Age plans increase rates just as quickly (if not more so) than Attained Age supplements.

On the other hand, Community Rated plans charge the same rate for everyone (male or female) who is the same age and living in the same state. That can be beneficial to males living in the most expensive zip codes, but detrimental to a female living in a less expensive zip code. In other words, Community Rates plans may only benefit a select few.

Thus, you may not want to put too much emphasis on how a plan is rated. It’s better to focus on an insurance company’s historical performance of rate increases.

What About Preexisting Conditions? Are They Covered?

If you are in an Open Enrollment or Guaranteed Issue window, then Medicare supplement carriers cannot ask about the status of your current health. They must accept you (not necessarily for all plans) and cover any conditions you have right away.

If you are outside of one of these windows, then you must go through medical underwriting by answering several yes/no health related questions. A phone interview may be required as well.

Typically one of two things will happen if medical underwriting is required: You will either be accepted or turned down for coverage. If you are accepted, then most carriers will cover any preexisting conditions assuming you have been truthful during the application process.

There is at least one insurance company that can adjust their rates based on medical underwriting. This is not the norm, but it means a healthier person will pay less than someone who has one of the conditions listed on the application. Again, this is a moot point during Open Enrollment & Guaranteed Issue windows of time.

Changing Medicare Supplement Insurance Carriers

Can I Be Turned Down If I Want To Switch Plans Or Carriers?

Yes. In most cases, medical underwriting will be required if you want to switch from one insurance company to another – or if you want to upgrade or downgrade your supplement (like moving from a Plan N to a Plan F, for instance.)

A few states have a few exceptions to these rules, but most don’t. There is no annual Open Enrollment for Medicare supplement insurance, so you want to choose a strong plan with a reputable carrier the first time. The Annual Election Period (AEP) that runs from October 15th through December 7th each year does not allow you to switch Medicare supplements no questions asked. Medical underwriting is still required at this time in almost all cases.

Are Discounts Offered If I’m Married Or I Pay A Certain Way?

Yes, several carriers offer marital discounts. These can range from 5% -12% for the policyholder. Some insurance companies require that both spouses apply while others do not. And in other cases, a discount will be made available so long as someone age 50 or older is living in the same household.

Usually the least expensive way to pay your premiums is monthly or annually. If you pay monthly, most carriers will require an automatic bank draft or credit card debit. Very few carriers will send a paper bill each month.

Other companies will bill you quarterly or semi-annually, but a a check for the first installment will be required with the application. In our experience, a monthly bank draft is the least expensive and most reliable way to pay for and keep your insurance in force.

Supplemental Insurance – An Agent’s Perspective

Do I Need A Medicare Supplement?

I can’t answer that. It’s insurance like any other – your home, your car, etc. Some insureds may access their policy infrequently, but that’s okay. We have a saying in this industry: The best kind of insurance is the kind you don’t use.

However most people buy a supplement for the proverbial rainy day. Anecdotally, I worked with a person recently who did not own a supplement. She had to pay a $3,000 bill after an emergency room visit and overnight hospital stay for what turned out to be a caffeine attack. The out of pocket costs she paid (after Medicare covered its portion) were a rude awakening. (She’s a client now.)

What Are The Most Popular Medicare Supplement Plans?

The policies purchased most often from our agency are Plans F, G, N and High Deductible F. We see some interest in the others, but these four are the most popular by far.

Plans F & C are very much alike, but more carriers offer F, it can be less expensive than C, and it covers Part B Excess Charges – so it might be a better choice. Plans G and D are also a lot alike, but Plan G is offered by more companies, has only one gap (the $183 Part B deductible), and can be less expensive than D.

Plan N is just a step below Plan G. It is the only plan that requires a copay at the doctor’s office ($20 maximum) and emergency room ($50), but it is very reasonably priced. Part B Excess Charges are very rare and disallowed in some states (Ohio for instance) and that can make Plan N a good choice.

High Deductible F is the least expensive Medicare supplement of them all. In many areas it can be around $30 a month for a 65 year old. It does have a $2,240 deductible (for 2018), but many of our healthier clients like the premium savings it offers. Additionally, it does not have network limitations like $0 Medicare Advantage plans sometimes do.

Which Medicare Supplement Insurance Plans Offer the Most Value?

In our opinion, the Medicare supplements that offer the most value are Plan G on the higher end and High Deductible Plan F on the lower end. Plan N is probably in that discussion as well.

In many cases, the difference in premium between Plan F and Plan G more than makes up for the one-time $183 Part B deductible that G does not cover. And Plan G is not a guaranteed issue plan. That can translate to smaller rate increases with Plan G – and stable rates are the holy grail of Medicare supplement insurance

As mentioned in the previous question, High Deductible F is very inexpensive. In fact, it has the lowest rates available in many areas of the country. And your premium savings can help to cover the deductible if it’s ever encountered. If there is one knock against HD Plan F, it’s that you may have trouble upgrading your coverage in the future if you have health issues.

Do I Pay An Agent To Help Me Enroll? Does It Add To The Cost?

No, you never pay an agent and it never adds to the cost. If you are a 65 year old female in Pennsylvania and you want a Plan G from Mutual of Omaha, then the cost will be the exact same no matter your source of purchase – even if you call Mutual of Omaha directly.

Prices are controlled by law and agents cannot mark-up or mark-down the rates – no matter how much we like you. We earn a commission on the sale if you buy from us – or someone at the insurance company gets compensated for the sale. Either way, someone wins.

In our opinion, you are much better off with a knowledgeable independent brokerage (like ours, of course) who can shop rates from several carriers. It’s much easier to learn the good, bad and the ugly from someone who has long term experience with several different insurance companies – and it does not cost you one penny extra!

Do I Really Need An Insurance Agent’s Help?

Here’s the primary issue: You don’t know what you don’t know. Working with Medicare beneficiaries daily, it’s amazing the amount of misinformation and misunderstanding that we encounter. We talk to people who have made decisions (sometimes bad ones) on something their doctor or their neighbor told them.

Trust us, it’s wise to consult a professional – someone who works in this industry daily and has years of experience. Almost every single prospective client we talk to says, “Oh, I didn’t know that” at least once during our educational conversations.

Again, it doesn’t cost you a thing and the vast majority of us are very helpful and easy to work with. Plus it’s always a good idea to have an agent at the ready when you have questions or need help with your policy(s) in the future.

Click Here To Compare Medicare Supplement Quotes →

Category: Medicare Advantage, Medicare Supplements

Medicare Questions If you’re shopping for coverage, you probably have several questions about Medicare supplement insurance plans.

We have been working with these policies for many years and answer the most common questions below. This way, you can make decisions that best fit your needs.

First: A Little About Medicare

What And When Is Open Enrollment For Medicare?

For most, open enrollment occurs when they turn age 65. For others, it’s when they first enroll in Medicare Part B. Not everyone enrolls in Part B at age 65. Some enroll early due to disability and other will defer if they have creditable group health insurance at work. The size of your employer group (20 employees or more) will determine whether you can wait to enroll in Part B.

When first enrolling in Medicare Part B, you’re in your personal Open Enrollment window. You have approximately 7 months to purchase a Medicare supplement plan. Some people enroll in Part B, but still keep their group insurance at work, but that’s not always the best move. Make sure you talk with a knowledgeable insurance broker when you’re making these decisions.

Most everyone has only one Open Enrollment window – either at age 65 – or when they enroll in Medicare Part B for the first time. This is the time to act. If you miss your open enrollment window, then medical underwriting may be required to purchase a Supplement.

No matter the supplemental insurance you choose, you will still need to pay your Medicare Part B premiums. Medicare supplement and Part B premiums are two separate expenses.

(Note: Open enrollment does not occur every year in the Fall. That window of time is called the Annual Election Period (AEP) and does not give you a free pass to purchase supplemental insurance without medical underwriting. More on this later.)

Understanding Guaranteed Issue Windows

I Received A Letter About My Guaranteed Medicare Rights. What Does It Mean?

You may receive a letter from your employer group coverage – or from an existing Medicare Advantage plan – that it’s terminating. Guaranteed issue windows are different than the Open Enrollment time period discussed above. They are shorter in duration and don’t always allow for the purchase of every Supplement available. (Plan N is not a guaranteed issue plan, for example.)

Only someone who is already eligible for Medicare and enrolled in both Medicare Parts A and B will receive (or can request) a letter of guaranteed Medicare rights. Your options will vary depending on your situation, but you can purchase most Medicare supplements. And you can usually enroll in any Part D drug plan during this window of time.

No matter your window, you need to be entitled to Part A (usually through work credits) and enrolled in Part B before you can purchase a Medicare supplement plan.

Understanding Supplemental Medicare Insurance Policies

What Are Medicare Supplements Insurance Plans?

Medicare supplements are private insurance plan that fill in some (or all) of the gaps in Original Medicare Parts A & B. Supplements and Original Medicare work in tandem. Medicare pays its share and then your supplement pays its portion. You present both your red, white and blue government issued Medicare card and your chosen Medicare supplement ID to your healthcare provider when receiving care.

There are ten standardized Medicare supplement plans A-N. There are some variations of certain plans as well. Some policies offer a High Deductible version while others come in a Select variety. View our chart here to better understand the benefits of each policy.

Who Offers Medicare Supplement Insurance?

There are several insurance companies offering Medicare supplement insurance policies – some you have heard of and others you have not. These are private insurance companies like Aetna, Anthem Blue Cross and Blue Shield, Humana, Mutual of Omaha, National General, United Healthcare and many, many others.

You do not purchase these plans from the government. You buy them direct through brokers and agents. You can also buy them from the insurance company. Your cost will be the same no matter your source of purchase. No agent or company can offer a sweetheart deal of any kind.

Why Haven’t I Heard Of Some Of These Insurance Companies?

The first thing to remember is that Medicare supplements work in tandem with Original Medicare Parts A & B. Insurance companies (both large and small) do not have to build any networks of doctors and hospitals. They simply have to pay their share after Medicare.

There are few barriers to entry into this market. It’s very competitive and full of several insurance companies. If your doctors accept Medicare, they will accept most any Medicare supplement you present to them.

This is not like traditional health insurance where certain doctors only accept certain plans. In other words, a United Healthcare Plan F gives you no more choice of healthcare providers than does a Plan F from Tumbleweed Life of New Mexico. (Please don’t go looking for Tumbleweed Life. That’s a joke, but you get the point.)

Are Their Network Limitations At All With Medicare Supplements?

With almost all plans, the answer is NO. The only two plans sold using networks are “Select Plans”. In our experience, Select Plans are not popular. They are easy to recognize and only offered by a few large insurance companies.

Most of our clients purchase traditional policies – not the Select version. Again, the vast majority of supplements have no network restrictions. A Plan G is a Plan G is a Plan G. If you’re unsure, ask if it’s a Select Plan.

I Called My Doc’s Office – They Don’t Take The Insurance Company I Like. No What?

We run into this more frequently than we should. The folks running the billing departments at some medical offices don’t always understand Medicare. Or they assume you’re asking about Medicare Advantage plans. Most Advantage plans do have network limitations and some doctors will be out of network with these plans.

Don’t worry – Medicare supplements don’t work that way. Explain to them you’re talking about a traditional Medicare supplement – not a Select Plan and not a Medicare Advantage plan. Trust us, they take it. They will bill your insurance company like all others. Sometimes, they just don’t always understand the process or your question.

Do Medicare Supplements Cover Prescription Drug Coverage?

No they don’t. There are no Medicare supplement plans sold today that cover prescription drugs. Some Medicare Advantage plans include Part D drug coverage, but by rule supplements cannot provide this benefit. Part D prescription drug plans are sold separately from a wide range of private insurance carriers.

We’ll help you for find the right Part D drug plan. We have software that allows us to compare all of your best options based on what you take. Your Part D drug coverage can be just as important as your supplemental insurance.

What Are Medicare Advantage Plans? Do I Need One Of Those Too?

You can learn more about Medicare Advantage (MA) plans here. They are network driven insurance plans that privately cover the benefits of Medicare Parts A & B and also some of the gaps left behind. MAPD plans usually include Part D drug coverage and oftentimes require the use of in-network facilities and a primary care physician.

MA plans are offered from carriers like Aetna, Anthem Blue Cross and Blue Shield, Humana, United Healthcare and others. Original Medicare (Parts A & B) is a public insurance program. Advantage plans are private and while highly regulated, they operate differently than what’s offered from the government.

By rule, you should not own both a Medicare supplement and a Medicare Advantage plan. It’s one or the other. We can help you understand which type of insurance might work best for you.

Does Original Medicare Only Cover 80%? Will A Supplement Pay The Rest?

Our clients ask about the 80% number often. It’s a bit of a misnomer. Your remaining bill after Medicare can be more, less or equal to 80% depending on what you’ve encountered. Part A (hospital inpatient services) is much different than Part B (doctor’s office) costs.

If you study a Medicare benefit grid, you’ll notice there are different deductibles, copays, coinsurance and cost sharing that will add up to more or less than 80% of a medical bill. So don’t make any decisions based on the 80% number you hear about so often.

How Does Billing Work? Do I Have To File Claims? What If It’s Not A Medicare Approved Expense?

Roughly 95% of doctor’s offices and hospitals handle the billing for you. You give them your ID card and they will bill your insurance company. Medicare coordinates with most Supplements directly. Insurance companies are very good about paying claims quickly. Medicare is very regimented; there is no wiggle room. Insurance co’s know their exact finacial responsibility and pay it accordingly.

If you seek medical care for something that is not a Medicare approved expense (homeopathic medicine, for example) then your supplement will not cover it. Medicare supplements only cover their portion after Medicare… and only for approved expenses. That’s all, nothing else.

Am I Covered When I Travel Domestically? How About Abroad?

Almost all Medicare supplement policies cover you domestically. The only ones that may not (other than for emergencies) are called Select Plans and as mentioned above. If you summer in Ohio and winter in Florida, these policies will travel with you. You purchase your supplement based on your state of residence, but you don’t need to notify your insurance company when travelling.

Plans C, D, F, G, M and N are the six plans sold today that cover Foreign Travel Emergency. There is a $250 deductible and $50,000 lifetime limit on this coverage gap. If you travel abroad frequently or for extended periods of time, then there are other affordable health insurance policies better designed to cover you during such trips.

What Happens If I Move To A New State?

Typically your Medicare supplement will travel with you when you move to a new state. You only need to call your insurance carrier (or contact your broker) so that your carrier is aware of your new address. Your rates might be adjusted based on your change of residence, but that’s all.

(It’s important to note here that prescription Part D drug plans do not typically travel from state to state. When you move, you may need to inform your insurance company and sign up for a new plan even though it’s the same plan as you had in your former state of residence.)

Do Some States Have Different Medicare Supplement Rules? What If I’m Under Age 65?

Yes, some states have different rules, but the plans themselves rarely differ. In other words, a Plan F is a Plan F in most places. What can differ is how the plans are rated, access to plans and rules about changing plans.

Some states only offer Issue Age rated plans. This does not mean your rates will never go up, but they won’t go up because you’re a year older in these states.

And some states allow those under age 65 to purchase a Medicare supplement if they are eligible for Medicare due to disability. Tennessee and Illinois are two examples. This rule is very much state specific. A Medicare Advantage plan may be the only option for those who reside in states where supplements are not for sale under age 65 – like Ohio and Indiana for instance.

And a couple of states – like Missouri and California for example – offer periods where the insured can switch plans (no questions asked) during an anniversary or birthday window of time. Consumers in these states can save money by switching to “like or lesser coverage” each year during their individual anniversary window.

When shopping for coverage it is smart to inquire about, and familiarize yourself with, any rules that are unique to your state or residence.

Do Medicare (and/or Supplements) Cover Long Term Care Expenses?

Not really and not for very long. Medicare pays the full cost for the first 20 days – and part of the cost of the next 80 days – for skilled care only. Most Medicare supplements fill in the skilled nursing facility coinsurance gap for those same 80 days . After day 100, neither Medicare or any Medicare supplement will pay for your long term care costs – period.

And it’s important to note that Medicare, when combined with supplemental insurance, only pays for the first 100 days of skilled care. That’s care administered by a doctor. Most people need intermediate or custodial care. That’s help with the activities of daily living.

The only policies that pay for skilled, intermediate and/or custodial care for significant periods of time are long term care insurance policies. In other words, you don’t want to rely on Medicare (or your supplement) to pay long term care expenses in the short or long run.

Can You Explain The So-Called “Open Enrollment” Window Each Fall? What Is It?

This is the yearly window of time that runs from October 15th through December 7th. People will refer to it as “Open Enrollment” but it’s actually called the Annual Election Period – or AEP for short.

During AEP, you can switch prescription Part D plans, change or move in and out of Medicare Advantage plans, but it has little bearing on Medicare supplement insurance. In other words, AEP gives you no free pass to purchase a Medicare supplement policy or change to a new one.

While a lot of consumers switch Medicare supplements during the AEP window, it’s not because there is no medical underwriting. It’s just a time of the year when people are actively thinking about their insurance plans and rates.

Click Here To Read Part II Med Supp FAQs →

Category: Medicare Advantage, Medicare Supplements

Aetna Medicare Supplement Insurance Our independent insurance agency offers Aetna Medicare insurance policies direct – at no additional cost. You can compare the lowest rates available on all Aetna plans in your state. This includes Medicare Supplements, Advantage plans, Part D Drug coverage, as well as dental, vision and hearing insurance.

When purchasing supplemental insurance, it’s important to shop around. You want to compare premiums, benefits and networks where applicable. Oru agency can do the shopping for you. With us, you can compare all of your Medicare options to make sure you enroll in the most suitable coverage for your needs.

Medicare Supplement Insurance Quotes From Aetna

We have represented Aetna’s Medicare offerings for many years. While they may be more well known for individual and group plans, they are very competitive in the Medicare markets as well.

Those who are eligible can choose from a wide array of policies. Their insurance offerings include:

Medicare Supplement Plans
Medicare Advantage Policies
Prescription Part D Plans
Dental, Vision & Hearing Insurance
Final Expense Life Insurance
Accident & Illness Coverage
Home Health Care & Recovery Plans
Hospital Indemnity & Flex Coverage
Cancer, Heart Attack & Stroke Reimbursement

Now that Aetna has merged with CVS health, they offer more plans in more places. Their Medicare Advantage footprint grew significantly when they acquired Coventry and we continue to see them expand into more counties across the U.S.

Their size and scope allows for many of the ancillary plans listed above. Almost all insurance policies have some kinds of gaps. You can plug those gaps and account for the unknown using any number of the coverage options available.

Those who are eligible for Medicare due to disability will have different options depending on the state in which they reside. Aetna offers some of the most popular Medicare Advantage plans in many areas of the country. They are known for low rates and large networks. One such policy is their $0 Value PPO plan. It’s great for those who want comprehensive coverage, but are on a tight budget.

American Continental, Accendo, & Continental Life

Like most large insurance companies specializing in Medicare, Aetna sells under a few different names. There’s American Continental, Continental Life, Aetna Life & Health, and their newest offering Accendo.

Aetna acquired both American Continental and Continental Life from Genworth Life Insurance Company to expand their Medicare supplement offerings. Both Genworth companies have good reputations and good rates in several states. They also sell policies in many states under the Aetna Health and Life name.

Accendo is a newer Medicare supplement line of business that’s part of their CVS merger. While all of these different lines offer spousal discounts, Accendo has the largest one at 14%. This means spouses who both enroll can each save 14% on their premiums.

Medicare Prescription Part D Drug Coverage

As part of the CVS merger, Aetna was required to sell their Part D drug plans to Wellcare. That’s okay. Wellcare is well known for offering affordable drug plans for those on Medicare. In fact, some of their policies are under $14 a month and have $0 copays on many common prescriptions.

Bu to round out their offerings, Aetna partnered with SilverScript so they could continue to provide robust Part D drug offerings. If you purchase a Medicare supplement from Aetna, you are not required to purchase one of their Part D plans, however. You can enroll in any one offered in you area. We can help you compare SilverScript, Wellcare and all others to make sure you’re getting the most value available.

And if you choose a Medicare Advantage plan, you’ll see that Part D drug coverage is included in most cases. Advantage plans can also include dental, vision and hearing coverage too. We can help you compare these all-in-one plans with those that are purchased separately. Their are pros and cons to each path.

In some cases, it may be more cost efficient to have your supplemental coverage with one company and Part D drug policy with another, but it is nice to know that both plans can be purchased from Aetna in order to keep your insurance simple.

Purchasing Medicare Insurance Plans Direct

It is important to note that Medigap insurance prices are controlled by law. Simply put, it does not matter from where or how you choose to purchase your coverage – the price will be the same.

Agents cannot charge you more or less than the going rate with insurance company itself. Having an agent can be helpful when you are ready to comparison shop or if you need assistance with your current policy.

It is always a good idea to talk with someone who works with Medicare insurance policies on a daily basis before submitting an enrollment on your own. You will want to consider future rate increases, company stability and customer service, and claims experiences.

You will also want to inquire about spousal and household discounts. There is a lot to know. The consumers who we see run into the most problems are typically ones who enrolled in a plan with consulting a knowledgeable professional first.

Contact Us For Assistance, Quotes and Enrollment

Hyers and Associates is a full service, independent insurance agency specializing in Medicare insurance policies. We represent Aetna and many others direct to you.

We can help you find suitable supplemental and Part D policies with the carrier(s) of your choice. Call us or contact us today to learn more about your best options.

Request Aetna Medicare Supplement Quotes Here →

Category: Medicare Advantage, Medicare Supplements

Our independent insurance agency (Hyers and Associates) has offered Medicare supplement insurance from Standard Life and Accident Insurance Company for years. We offer this coverage direct to our clients – at no additional cost.

Our clients appreciate that they can shop for new or replacement coverage with us direct. And we appreciate their loyalty and that’s why we are always on the lookout for new carriers that are competitively priced in certain areas.

Standard Life High Deductible Plan F Supplement

Standard Life and Accident (SLAICO) offers several lines of insurance, but their High Deductible Plan F Medicare supplement insurance is very competitively priced in most states. Rates for applicants will vary depending on a number of factors including age, gender, zip code of residence, and tobacco use.

There are a number of reasons you might be considering HD Plan F for your supplemental insurance coverage, but the one we hear most often is low premiums. It does not make good financial sense to enroll in HD Plan F unless there are significant premium savings – and SLAICO’s rates hit the mark.

In many cases, HD Plan F with Standard Life can be more than $100 less per month than a traditional Plan F. For those who are looking to save premium dollars while still insuring against catastrophic claims, HD F can be a very good financial decision.

About Medicare Supplement High Deductible Plan F

HD Plan F works very much like a traditional Plan F save for the fact that is has a yearly deductible. For 2019, the deductible is $2,300 which is a $60 increase over year 2018. Benefits will not be paid until the policyholder has reached his or her deductible, but Medicare will continue to pay its portion first.

The deductible amount can change every year (as mandated by the government run Centers for Medicare and Medicaid Services) and those changes will affect all plans. This simply means that you cannot lock in your deductible based on the year when it was purchased. Once CMS makes changes, those changes affect all plans – both new and old.

It is also important to note that High Deductible Plan F does not have any network restrictions. One of the biggest issues consumers have with Medicare Advantage and Medicare Select plans is navigating their networks.

In many cases, HD Plan is as, if not more, affordable than many Select and Advantage plans, but without any network restrictions. This is an important issue for many Medicare eligible consumers. They like to know they can use any doctor or hospital that accepts Medicare assignment and HD Plan F allows them that freedom.

About Standard Life & Accident Insurance Company

SLAICO has been offering insurance policies in the senior market for over 50 years. They are highly rated with the AM Best ratings agency.

They offer several lines of insurance for those both over and under the age of 65, but providing affordable insurance to seniors is a priority. Other types of insurance offerings from SLAICO include life insurance, annuity policies, health insurance and various ancillary coverages.

SLAICO works with agencies like ours in order to provide insurance direct to consumer. There are no additional fees or commissions to place your business through us. You also get the benefit of working with someone with knowledge of the insurance industry at large.

Hyers And Associates Medicare Insurance Agency

We are an independent insurance agency specializing in the senior market and offering insurance policies in several states. We work extensively with Medicare supplements, Part D prescription drug policies, long term care plans and annuities.

Compare Medicare Supplement Quotes Now →

Category: Medicare Advantage, Medicare Supplements

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Medicare Part A Ways to Pay Your Premiums

Automatic Methods

Paper Methods

Medicare Part B Ways to Pay Your Premiums

Medicare Part D and Advantage Premium Payments

Medicare Supplement Insurance Billing

If You’re Already Enrolled in Medicare Part A & B

Your Medicare Advantage Program and Part D Prescription

Other Reasons to Make A Change

If You’re Enrolling for the First Time

Contact Us!

Medicare Part A Hospitalization

Medicare Part B Preventive Care

Medicare Part C Medicare Advantage Program

Medicare Part D Prescriptions

Let Us Help You

Changes That Can Be Made During OEP

Part D Prescription Drug Coverage Changes

What About Medicare Supplement Insurance?

Contact Us To Discuss Your Options

1) Medicare Does Not Cover Everything

2) There Are Strict Timelines & Procedures

3) Your Choices Now Affects Your Future Options

4) Medicare Does Not Cost The Same For Everyone

5) There Is A Limited Open Enrollment Each Year

Contact Us For Insurance Quotes And Coverage

Medicare vs. Medicare Advantage

The Medicare Advantage Alternative

Benefits of Medicare Advantage

Concerns With Medicare Advantage

What to Think About

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D

Hospital Indemnity Plans Go Beyond Medicare

Covering Medicare Under Observation Hospital Stays

How Do Indemnity Health Insurance Plans Work?

Do They Offer Any Additional Benefits?

Contact Us For Enrollment Advice & Insurance Rates

1. Understand the Terminology

2. Think About Your Needs

3. Shop Around

4. Don’t Be Hasty

Do You Prefer Medicare Supplements Or Advantage Plans?

Medicare Supplements Are Regulated By The Government

Understanding Your Medigap Coverage Options

Certain Medicare Supplements Offer More Value

Don’t Buy The Least Expensive Plan

Don’t Put Too Much Stock In Any One Rating Class

Use an Agent When Purchasing Supplemental Coverage

Take Advantage Of Spousal & Household Discounts

Choose A Different Part D Prescription Drug Provider

Contact Us To Learn More About Medigap Insurance Plans

Contact Us To Compare Medicare Advantage Plans

Learning About Medicare Supplement Rates & Increases

Changing Medicare Supplement Insurance Carriers

Supplemental Insurance – An Agent’s Perspective

First: A Little About Medicare

Understanding Guaranteed Issue Windows

Understanding Supplemental Medicare Insurance Policies

Medicare Supplement Insurance Quotes From Aetna

American Continental, Accendo, & Continental Life

Medicare Prescription Part D Drug Coverage

Purchasing Medicare Insurance Plans Direct

Contact Us For Assistance, Quotes and Enrollment

Standard Life High Deductible Plan F Supplement

About Medicare Supplement High Deductible Plan F

About Standard Life & Accident Insurance Company

Hyers And Associates Medicare Insurance Agency

Annuities For Passive Income

2024 Medicare Premiums & Deductibles

Options When Inheriting An Annuity Account