Every year The Centers for Medicare and Medicaid Services (CMS) make changes to the Medicare program. CMS has posted the numbers for 2013 and there are no alarming changes, but it is important to know what out of pocket expenses to expect going forward.
Deductible and coinsurance amounts will increase January 1 and that will affect the cost sharing provisions of all Medicare supplement plans. Supplemental insurance plans are not “grandfathered-in.” Changes to Medicare by CMS affect all Medigap plans – both new and old.
2013 Medicare Part A and Part B Changes
| Medicare Feature |
2012 Amount |
2013 Amount |
$$$ Increase |
| Part A Deductible (Inpatient Hospital) |
$1,156 |
$1,184 |
$28 |
| Part B Deductible (Physician’s Services & Supplies) |
$140 |
$147 |
$7 |
| Hospital Coinsurance Days 61-90 |
$289 |
$296 |
$7 |
| Hospital Coinsurance Days 91-150 (lifetime reserve) |
$578 |
$592 |
$14 |
| Skilled Nursing Facility Coinsurance |
$144.50 |
$148 |
$3.50 |
At face value, there are no significant changes to the Medicare cost sharing amounts. As in past years, the limits to what certain Medicare supplement insurance and some Medicare Advantage plans must cover have only increased incrementally. However, these new numbers are something to keep in mind when you experience rates increase on your privately insured Medigap coverage.
The Part B Deductible For 2013 Is $147
The good news for those who purchased or are considering purchase of either Plan G or Plan N is the nominal increase in the Part B deductible. The increase was only $7 – moving to $147 for 2013 – up from the current amount of $140 for 2012.
This means that CMS is working to keep the Part B annual deductible low going forward – at least in the short run. Consumers worried about high out of pocket costs with Medicare supplement plans that do not cover the Part B deductible (like Plans G & N) can rest easy. The cost share is low and will continue to remain that way.
Thus, paying more for traditional Plan F is not necessarily the best option for some seniors. If Plan G is more than $12.25 less per month than Plan F, then Plan G can make good financial sense. There may little reason to pay more for Plan F considering that it only covers an extra $147 for 2013. As always, it’s important to keep in mind that the Part B deductible will likely increase going forward.
What Is the Plan F High Deductible For 2013?
The new deductible for HD Plan F is $2,110 which is a $40 increase from 2012. For comparison sake, the amount was an even $2,000 in year 2010. This is a modest increase by most measures, so High Deductible Plan F will continue to be a popular option for many seniors.
The HD version of Plan F is a good choice for those who want to keep their monthly premiums low while eliminating the worry of a network driven plan. The trade-off is the potential for higher out of pocket expenses however. Those who are in good health and are comfortable with a $2,000+ deductible oftentimes purchase HD Plan F. Premiums in many parts of the country can be near $30 a month for those in their mid to late 60’s.
Out Of Pocket Cost Increases For Plans K and L
By many estimates, supplemental Plans K and L were designed to mimic Medicare Advantage coverage. These two coverage options have more out of pocket and cost sharing amounts than most other Medigap plans. In return, the monthly premiums are lower and can be well under $100 for seniors in their 60’s and 70’s.
The 2013 out-of-pocket maximum for Plans K and L are $4,800 and $2,400 respectively. This is a $140 increase for Plan K and a $70 increase for Plan L. Again, these appear to be reasonable numbers when compared year over year and compare favorably with most Medicare Advantage plans.
Summary
For those who are new to Medicare or who have been enrolled for several years, it is important to note that there are no dramatic changes to the 2013 cost sharing amounts. Medigap Plan, F, G, N, K, L and High Deductible F are and will remain good choices for coverage.
First year premiums and renewal rates will vary depending on several factors. It is always a good idea to speak with an independent agent before purchasing; or while shopping around for new supplemental coverage. This way, you can learn more about the nuances and history of competing insurance carriers that you might be considering.
Contact Our Independent Medicare Supplement Agency
Hyers and Associates, Inc. is an independent insurance brokerage specializing in the senior market. Contact us today to discuss Medicare supplements, Advantage plans, and Part D prescription policies.
Category: Medicare Advantage, Medicare Supplements
If you are in the workforce beyond age 65 and covered by your employer’s group health insurance coverage, it is important to be aware of your Medicare insurance options. There are a few common penalties (both monetary and temporal) that you might face should you miss your enrollment deadlines.
Penalties and Medicare enrollment delays can easily be avoided so long as you are proactive. It is wise to talk with your human resources manager when you turn 65. You will want to ask specifically about your group health insurance eligibility. You can also talk with an insurance agent who is knowledgeable about group plans and Medicare eligibility.
If you are still not satisfied, then you might also reach out to your local social security office. Oftentimes the representative there can provide valuable advice. Additionally, it is a good idea to read about your options online and at Medicare.gov.
Employer Group Size – Twenty Is The Magic Number
As it relates to Medicare decisions, the most important factor is the size of your company in terms of employees when you turn 65. If your group is under twenty employees, then you will need to enroll in Medicare Parts A and B.
You can no longer stay on your group health insurance even if it goes undetected. Once your group insurance carrier figures out that you are Medicare eligible and that your group does not meet the 20 employee requirement, then the insurance company will no longer pay benefits and can recoup costs for benefits already provided.
In a nutshell, if you are within 3 months of your 65th birthday and still plan on working at a company with fewer than 20 employees, then you should enroll in Medicare Parts A and B and you should also consider Medicare supplemental coverages.
Employer Groups With More Than Twenty Employees
If you are soon to be 65 and working for a group with more than 20 employees that provides group health insurance, then you can safely maintain this coverage if you wish.
Some will choose this option in order to avoid paying Medicare Part B premiums. Medicare Part B premiums are means tested, so those in higher income brackets will pay more for this coverage as well as Part D prescription drug plans.
If you are happy with your group health plan, then you can delay enrollment into Medicare Part B and stay on your group health plan while also avoiding the cost of Medicare Part B, supplemental, and Part D premiums.
You may choose to enroll in Medicare Part B at age 65 even if you are still under your large group health plan, but it is important to know that you are not forced into Medicare when you continue working for a large employer group that offers group health insurance.
The COBRA Health Insurance Conundrum
One simple piece of advice is this: Don’t take COBRA health benefits when you retire and are over age 65. COBRA usually lasts 18 months, but by the time these benefits expire, then you will have missed your individual deadline to enroll in Medicare Part B.
If you are over 65, then there are very few reasons, if any, to stay on COBRA for an extended period of time. Your Medicare Part B enrollment window begins when you leave your job, not when your COBRA benefits end.
If you have waited beyond your 6 month Medicare open enrollment window (after separating from employment) to enroll in Part B, then you will be subjected to a 10% Part B late enrollment penalty when you do try to enroll with the government. The 10% penalty will be for your lifetime. And you will have a new waiting period before you can enroll in Part B. It’s a double whammy and it’s not good.
By avoiding COBRA and talking with your local social security office upon separation from employment or turning age 65, you can be sure that you are enrolling in Medicare at the appropriate time. You will also want to use this guaranteed issue period to find the supplemental coverage that you feel best fits your Medicare needs.
What About Medicare Supplemental Coverage?
Medicare covers roughly 80% of most health bills. This is why most seniors purchase a Medicare supplement, Medicare Advantage, and/or Part D plan. These coverages can help pick up some or all of what is not covered by Medicare.
Supplemental plans are sold by insurance agents (like us) and are private policies whereas Medicare Parts A and B are federally sponsored public plans. Supplemental plans can also have late enrollment penalties and delays. And in some cases, you may not be able to purchase any supplement if you have waited beyond your open enrollment or guaranteed issue period of time.
Medicare Parts A and B are only the first half of the Medicare puzzle. Once you have enrolled in Original Medicare with the government, you will want to use your open enrollment window to explore your supplemental plan options. It is wise to speak with an independent agency (like us) to decide which plan(s) best fit your needs and budget.
Medicare Is A Little Complicated
There is no doubt that if you are new to Medicare, the enrollment process can be somewhat intimidating. Above all else, it is most important to enroll at the appropriate time. Missing your open enrollment window will add a premium penalty and delay your eligibility.
If you are unsure, it is wise to lean on the experts who work with senior insurance programs everyday. Talk to a chosen insurance agent, human resources manager and/or a Medicare representative over the phone or in person.
Contact Us
Hyers and Associates, Inc. is a full service independent insurance agency specializing in health coverage for seniors. Contact us today to learn more about your options.
Category: Medicare Advantage, Medicare Supplements, Retirement Planning
What are Medicare Select insurance policies? They are traditional Medicare supplement policies (like Plans F, C and N for instance) that require the use of a preferred network of doctors and hospitals for routine care.
Medicare Select Plans are sometimes popular as they are less expensive than traditional non-network driven supplemental plans. They are appropriate for those who are comfortable using a preferred network of doctors and hospitals for regular care.
Understanding Medicare Supplement Insurance Select Networks
Supplemental select policies work much in the same way as Health Maintenance Organizations (HMOs). The insurance company negotiates service contracts with a network of doctors and hospitals in the area where the supplement is offered – usually larger cities. These negotiations result in lower medical costs.
The cost reductions are then passed on to the consumer in the way of lower monthly premiums on their Medigap select policies. There is no additional cost sharing however. A Plan F is still a Plan F – the insured simply needs to stay in-network for his or her medical services.
How Are Emergency Costs Covered Under Medigap Select Plans?
It is important for the consumer to use the approved network for all routine services. If not, then the select plan may not pay its share of the bill. In some cases, referrals from a primary physician may be needed to see certain practitioners. If you travel extensively or winter in a different location, a Select Plan may not be appropriate.
Emergency services are covered out of network so long as the insurance company agrees that the situations was an emergency. Routine care will not be covered out of the approved network. Regardless of how or where medical care is needed, Medicare Parts A and B will always cover its share of approved expenses first.
Advantages & Disadvantages Of Medicare Select Plans
The primary advantage is simply cost. By agreeing to use the approved network, consumers can save money on their Medicare supplement insurance. In some cases however, traditional supplemental plans may be less expensive than even some select plans. It is wise to shop around.
Much like Medicare Advantage plans, the primary disadvantage is simply the constraints of the network. It is important to be certain of any network limitations by first checking with the insurance company and/or the agent before purchasing a policy. And consumers must be aware that certain doctor groups and facilities may be in the approved network one year and out the next.
Consumers who move out of the approved service area will be afforded a 63 day window to purchase a new supplemental plan without the need for medical underwriting. Not all plan designations will be available during a “guaranteed issue” period such as this one, but the consumer will have certain rights to purchase new coverage.
Comparing Supplemental Select Plan Networks And Quotes
Not all carriers offer select plans as they simply do not have the size or scope to build network driven plans. It is usually the larger companies with existing health insurance and Medicare Advantage networks who offer these types of plans, but they are somewhat rare.
A few companies worth considering if you are in the market for a Select plan will be Anthem Blue Cross and Blue Shield, AARP United Healthcare, Assured Life, Gerber Life, Mutual of Omaha and a handful of others.
By working with an independent Medicare brokerage like ours, you can compare both select and traditional Medicare supplements online. We can help you compare the direct rates for both types with several carriers.
Compare Medicare Supplement Quotes Now →
Category: Medicare Advantage, Medicare Supplements
The 2011 Medicare open enrollment window is almost upon us. Otherwise known as the Annual Election Period or AEP for short, this period of time can be used by Medicare beneficiaries to switch insurance plans.
The dates are a little different this year as the window starts and ends early. AEP will run from October 15, 2011 to December 7, 2011. It is important however to remember what changes can and can’t be made during this window of time.
Disenrolling From Medicare Advantage Insurance
AEP is most commonly used to disenroll from a Medicare Advantage (MA) plan. Unless there are other extenuating circumstances, Advantage plans can only be cancelled during the yearly Annual Election Period. Most MA carriers will require a letter of disenrollment in writing from the insured; a phone call is not always accepted.
Upon disenrollment, a Medicare eligible person can enroll in a new Advantage plan that better suits their needs or return to Original Medicare. If the latter, then a Medicare supplement and/or prescription Part D drug plan might be purchased in order to fill the gaps in Original Medicare Parts A and B.
It is very important to note, that if someone has been in an Advantage plan for longer than one year, they may need to be medically underwritten in order to enroll in a traditional Medicare supplement insurance plan. This means that the applicant could be turned down if they are in poor health.
It is usually a good idea to get an application for traditional supplemental coverage in early to make sure that certain health qualifications can be met. Underwriting requirements will differ between various providers, so working with an independent Medicare supplement agency (like us) can be a wise choice to ensure coverage is obtained. This way Medicare eligible consumers can ensure a seamless transition to new coverage that will become effective January 1, 2012.
Switching Prescription Part D Insurance Plans
The Annual Election Period (open enrollment) also allows consumers to purchase a new Part D drug plan and drop their old coverage. This time period can also be used by consumers who did not purchase Part D coverage during their initial open enrollment window to find a plan.
For those who did not enroll when they were supposed to, there can be late enrollment penalties however. These penalties amount to a 1% per month addition for each month that coverage was not elected. For example, if someone (without credible coverage) waited 16 months to purchase a Part D plan, then their monthly premiums will be 16% higher than someone who enrolled on time.
Open enrollment allows those who have stand alone Part D drug plans to purchase more suitable (or less expensive) coverage if their current plan is no longer meeting their needs. If Medicare Advantage coverage that is coupled with a Part D plan (MAPD) is dropped, then a new Part D plan will likely need to be purchased as well.
Enrolling In Medicare Supplement Coverage
For those who qualify either medically or through their open enrollment window, AEP can be used to purchase Medicare supplement coverage as well. If someone is dropping an Advantage plan, then most supplemental insurance providers will require a letter of disenrollment signed by the applicant. This same letter can then be sent off to the MA provider for processing.
One common misconception about AEP is that this period of time can be used to switch Medicare supplement providers without any medical underwriting. This is not the case. Consumers can switch supplemental insurance coverage any time of the year, but most companies will require some amount of underwriting. If a change is desired, there is no reason to wait until the end of the year to do so.
The only exception to this rule is for those who are dropping a Medicare Advantage plan after one year and re-enrolling back into Original Medicare. The Centers for Medicare and Medicaid Services allow for a one year Medicare Advantage trial period. If after one year the consumer is not satisfied, s/he can purchase most Medicare supplement insurance plans without the need for medical underwriting.
It is important to note that there are a couple of states that offer a yearly open enrollment window for changing Medicare supplement coverage without underwriting (Missouri and California for example), but these states have specific individual anniversary windows that will not necessarily coincide with the yearly Annual Election Period.
Request Quotes And Information
Hyers and Associates, Inc. is a full service, independent insurance agency offering Medicare insurance and Part D prescription drug policies direct to consumer in many states across the country.
Contact us today if you have questions or assistance with your Medicare coverage.
Category: Medicare Advantage, Medicare Supplements
As you approach Medicare eligibility, you’ll be faced with the decision of how to best supplement your government provided Part A and Part B Medicare insurance coverage.
You want to know which options and which plan(s) provide the most benefits at the lowest price. There are Medicare supplements and Medicare Advantage plans to choose from, but you can’t have both simultaneously.
There are only three options to consider when it comes to supplementing your Original Medicare:
- Purchase a Medicare Supplement Plan
- Purchase a Medicare Advantage Plan
- Do nothing and purchase no insurance coverage
The Cost of Medicare Supplement Insurance Plans
Supplemental insurance prices will vary from state to state and zip code to zip code. There are several factors that will determine your monthly premiums. Rates are usually only locked in for one year and can increase as you get older.
However, the underlying question some of our clients ask is, “What is the cost if I don’t purchase coverage?” The short answer is we simply don’t know. Consumers who are already in poor health will almost always purchase a Medicare supplement right away. Missing your personal 6 month Open Enrollment window can make it hard, if not impossible, to purchase a Medigap later.
But Medigap plans are like any other insurance. You purchase comprehensive coverage and hope that you don’t need it. Really, the best insurance is the kind you don’t use. You don’t want to use your home, auto, life, or disability plan because that means something has likely gone wrong. However, you do want to know you don’t have open ended costs if a health issue arises.
So to answer the question – yes, Medicare supplement insurance is usually worth the cost. There are several different plans to choose from and each will fill in most or all of the gaps in Medicare. In this way, you can know exactly what your out-of-pocket exposure is each year. And with almost all supplements, you don’t have to worry about referrals or network restrictions. This means that you can use any doctor or hospital that accepts Medicare patients.
Really, you’re purchasing peace of mind. With most Medigap plans, you know you can go where you want when you want without facing significant out-of-pocket expenses. You have paid into Medicare your entire working life, so it makes sense to close or minimize your gaps with a supplement like F, G, N or High Deductible F.
You Can Purchase a Medicare Advantage Plan
Another option to supplement Medicare is to purchase an Advantage plan. You will still pay your Part B premiums, but Advantage plans will insure you for what Medicare A and B covers as well as some of what they do not. Additionally, many plans will include rx coverage as part of the coverage. Part D drug is not included with a supplement and must be purchased separately.
Medicare advantage plans are popular with some of our clients simply based on price. If you live in Florida for example, Medicare supplement plans can be expensive. Advantage plans are usually less expensive for a couple of reasons.
The primary reason is most Advantage plans have more out-of-pocket exposure. It is important to ask about your maximum out-of-pocket each year both in and out of network. And that brings up another point; Advantage plans rely on participating networks of doctors, hospitals, and medical facilities in order to offer lower monthly premiums.
This can be a problem if you need care outside of the network of if you spend a lot of time in multiple states. As an agent, the issue I see most with consumers is the need to visit a certain specialist (or facility) and that provider does not accept their coverage because they’re out of network.
The Centers for Medicare and Medicaid Services allows a one year free trial period for consumers who choose Advantage plans. After one year, medical underwriting will be necessary with most Medigap providers in order to enroll into a traditional Medicare supplement. Consumers can be denied coverage due to poor health if they wait longer than a year.
In a nutshell, Advantage plans are not perfect and traditional supplements are not always the best option either, but going without coverage can be the most ill-advised choice.
What if You Choose Not to Purchase Insurance?
I don’t recommend it. Why? Well, there are may reasons, but most of all because you cannot time your health. You may need coverage before you have a chance to buy it. If we had the elusive crystal ball, we would buy insurance the day before we needed it.
There are some consumers who will roll the dice and not purchase any insurance, but they need to know that it is very difficult to purchase a Medicare Supplement or Advantage plan if you are already in poor health.
That is to say that if you missed your open enrollment window, then you can be denied coverage. There is this misconception that the time period between October 15th and December 7th each year is Medicare open enrollment for supplemental coverage. This is not correct!
This time of year (referred to as the annual election period or AEP) can be used to change Part D drug plans or to disenroll from an Advantage plan, but not to purchase new supplemental coverage on a guaranteed issue basis. This means you must be in reasonably good health to purchase most supplemental plans unless you are using your one year free trial period provided by CMS.
Timing your insurance purchase can be a foolhardy plan. Most people do not try and time any of their other insurances, so your health coverage should be thought of in the same way. You can avoid the insurance company declining the application, monetary penalties, and mandatory delays simply by purchasing coverage when you were supposed to originally.
Call an agent and talk to them. Call us! The Medicare puzzle can be complex at first glance, but we’ll make it simple. It’s a good idea to speak with our experts, learn from other’s mistakes, and avoid future complications when it comes to Medicare.
Request Assistance
Hyers and Associates is a full service insurance agency working in several states across the country. We specialize in Medicare supplements, Medicare Advantage, and Part D prescription drug plans. We offer all plans direct and at no additional cost.
Category: Medicare Advantage, Medicare Supplements
If you will soon be age 65, you’ll want to know how to sign up for Medicare Parts A and B with the federal government. You may have questions about supplemental insurance as well.
Medicare Parts A & B enrollment is done through the Social Security Administration and can be accomplished in three different ways. See more on that below. Supplemental insurance is obtained through brokers like us.
Most consumers enroll at age 65, but those on disability can enroll earlier. And those who have qualifying group coverage at work can defer Part B enrollment until retirement.
Signing Up For Medicare At Age 65
There are three ways to enroll in Medicare:
An easy and quick way to enroll is online. Because of Covid, many Social Security offices are not allowing face-to-face meetings.
However, the government has improved the functionality of their website and you can now enroll online in Part B only. This would apply to those who were already (and automatically) enrolled in Part A at age 65. You’ve always been able to enroll in Parts A & B together, but this new feature is helpful.
You can save the hassle of visiting your local office which may be far away or temporarily closed. If you’re enrolling in Part B only (because you already have Part A), you may need to provide proof of creditable coverage from work.
Calling the toll-free number (1-800-633-4227) is the next best way to start the process. It may take some time to get someone on the phone, but they’ll mail you your needed forms. It’s wise to start early as it can take a month or more to get everything going. In fact, Medicare allows you to start the process 3 months before your 65th birthday. We recommend doing so.
And where and when available, you can make an appointment at your Social Security office. Again, it may take a couple weeks to get an appointment, so start the process early. Meeting with a representative is helpful if you’re unsure about starting your Social Security payments. Medicare is tied to Social Security so oftentimes you’re working on both at the same time.
Watch Our Video Below On How To Enroll In Medicare & Choose Supplemental Coverage
Medicare Late Enrollment Premium Penalties
No matter how you choose to enroll in Medicare, it’s most important to do it at the right time. If you do not enroll in Parts A and B during your designated open enrollment window, you can be accessed higher premiums for life. And your coverage might be delayed as well.
Both Part B and Part D (drug) components of Medicare have late enrollment penalties for those who miss their personal deadlines. For most consumers, their enrollment window is the 3 months before their 65th birthday, month of, and three months after. For others, it’s when they enroll in Part B which can be early due to disability – or later because of employer coverage at work.
If you’re not sure, talk to an expert. Call us or someone like us. Missing your open enrollment window will cause coverage delays, monetary penalties, and unhappiness.
Understanding Medicare Part A
Open enrollment will differ for everyone, but most consumers enroll in Part A at age 65. Medicare Part A is free to U.S. citizens and permanent residents who are eligible for social security benefits, railroad retirement, and/or those who paid (or were a spouse of someone who paid) Medicare taxes.
This is usually a cost-free benefit. SSA advises consumers to enroll at age 65 even if they are not retired and do not plan on taking social security benefits. If you cannot meet the above mentioned criteria, you can still enroll in Part A by paying monthly premiums.
Most consumers get their Medicare card in the mail as they near age 65. Enrollment happens automatically, costs nothing, and is set going forward.
Understanding Medicare Part B
Medicare Part B is available to those age 65 who are also eligible for Part A. It’s also available to those who have been receiving disability benefits for 24 months.
Medicare Part B is NOT free. Premiums can vary based on your income. Those above certain income thresholds pay higher premiums based on a sliding scale. Those below certain levels pay less than the going rate. In general, Part B premiums are approximately $140 a month for most Medicare recipients.
It’s important to enroll in Part B at the right time for you personally. For some, that’s age 65 and for others it’s earlier due to disability. Still others can defer their Part B enrollment until after age 65 if they have qualifying group health insurance at work.
However, some consumers still have to enroll in Part B even if they have insurance at work. The size of your employer group will determine your best course of action.
It is highly recommended to speak with your human resources manager and a SSA representative to best understand how to proceed with Part B enrollment.
Paying Part B Premiums
Almost all Medicare beneficiaries have to pay Part B premiums. Again, it’s not free. If you’ve started Social Security, the premiums will be deducted automatically. There’s nothing you need to do… unless you want to defer Part B enrollment. If that’s the case, you need to tell SSA or Medicare.
If you are deferring Social Security, but still enrolling in Part B, then you can pay your premiums through an electronic funds transfer or bank draft. You can also mail a check quarterly.
Supplementing Your Medicare Coverage
Medicare does not cover everything. The government sponsored program has many gaps. It’s wise to plug them so you don’t face large bills later. There are two paths here:
- Enroll in a (Part C) Medicare Advantage Plan
- Purchase Medicare Supplement Coverage
One is not necessarily better than the other. Working with a broker, you can decide which type of policy best fits your needs and budget. You can’t have both – it’s one or the other.
Path 1) Medicare Advantage Part C Plans
Medicare Part C plans are private insurance plans referred to as Medicare Advantage plans. By rule, these policies must cover all of the benefits provided by Medicare Parts A & B, but privately so. In other words, you are turning your Medicare admin over to a company like Aetna, Humana, Anthem BCBS, United Healthcare or others. You typically need to stay in their network of doctors and hospitals to receive the best cost for healthcare.
Advantage plans offer benefits above and beyond traditional Medicare Parts A & B. Most include Part D drug benefits, dental, vision, hearing, recovery benefits, meals, transportation and more. But more importantly, they shore up the holes in original Medicare so you have known out of pocket costs for the year.
Medicare Advantage plans come in several shapes and sizes with differing benefit structures and maximum out of pocket costs for the year… both in and out of network. We can help you understand what to expect from these types of policies.
Path 2) Medicare Supplement Insurance
With a Medicare Supplement plan, you keep your Original Medicare Part A and B benefits from the government. You’re simply plugging the holes using a secondary payer. Supplements fill in all or most of the gaps. They start paying once Medicare stops.
There are generally no networks to worry about – you can see whoever you want that accepts Medicare. That’s virtually everyone. These policies are typically more expensive than Medicare Advantage plans, but are also more comprehensive as well. You will usually have less out of pocket exposure with a Supplement.
These policies typically don’t include much in the way of ancillary benefits. You will need to purchase dental, vision and Part D Drug coverage separately. They aren’t able to roll everything into one like their counterparts.
Medicare Part D Prescription Drug Coverage
The final piece of the Medicare puzzle is Part D prescription drug coverage. Part D is usually fairly simple and refers to the prescription drug plans that are offered by private insurance companies.
Some are sold on a stand-alone basis while others are packaged together with Medicare Advantage plans. Medicare supplements and Part D Drug coverage are always sold separately, however. Even if they are from the same insurance company, they must be two separate policies by rule.
It is important you enroll when first eligible to avoid late enrollment penalties and/or delays. Most consumers purchase a Part D plan either separately or as a package when eligible.
Open enrollment for Part D plans occur each year from October 15th to December 7th. If you are unhappy with your prescription drug coverage, then you can purchase a new plan (effective January 1st) without medical underwriting or proof of insurability.
Contact Us for More Information
Hyers and Associates is a full service health insurance brokerage offering Medicare guidance and insurance across the country. We can help you sign up and enroll in Medicare. We can also help with your supplemental coverage as well. Contact us today!
Category: Medicare Advantage, Medicare Supplements
If you are currently enrolled or soon to be enrolled in Medicare, you usually have just two insurance choices to close/minimize the gaps in this government insurance program: Medicare Supplements or Medicare Advantage plans.
It’s a good idea to choose one or the other as Original Medicare has several benefit gaps with open ended expenses. Either of these two choices will close these gaps and reduce your out-of-pocket exposure to a known amount.
Comparing Medicare Part C (Advantage) Insurance
Part C is the generic term that includes all privately sold Medicare Advantage plans available for purchase. Your county of residence will determine which Advantage plans are available for enrollment. These are sometimes referred to as MA or MAPD plans for short. (The P D stands for prescription drug.)
Medicare Advantage plans are private insurance programs offered from providers like Aetna, Anthem BCBS, Cigna, Humana, United Healthcare among many others. These same insurance companies will also offer Medicare supplements as well, but you can’t have both. It’s one or the other.
When you compare Medicare supplements to Medicare Advantage (MA) plans, you are simply trying to determine a suitable and affordable way to cover the insurance gaps not covered by Original Medicare Parts A & B. There are pros and cons to both.
Comparing Medicare Supplements to Advantage Plans
| Benefits |
Medicare Supplements |
Medicare Advantage Plans |
| Monthly Premiums |
Usually higher – Especially for plans C, D, F & G |
Usually lower than most Medicare supplements |
| Potential For Out-Of-Pocket Expenses? |
Less. Plans C, D, F, G, N and others offer more comprehensive coverage with less out of pocket exposure |
Greater. Most Advantage plans will have both in and out of network out of pocket maximums. These can be as high at $10,000. |
| Yearly Deductibles? |
Less. Most plans cover the larger Part A deductible. Some don’t cover the Part B deductible which is small, yearly amount. |
Yes. Varies from plan to plan and whether you are in or out of network. Copays and coinsurance are typically much higher with Advantage plans |
| Choice Of Doctors & Hospitals? |
Yes. Insured can use any doctor or hospital with almost all traditional Medicare supplements no matter the insurance company chosen. |
Depends on the plan. PPO’s have larger networks than HMO’s, but you must stay in network with both to reduce your out of pocket exposure. HMO plans offer no coverage out of network. |
| Includes Part D Rx Coverage? |
No. Part D coverage must be purchased separately on a stand-alone basis. |
Yes. Most Advantage plans bundle Part D coverage into one policy. These are called MAPD plans. |
| Overall Flexibility |
Yes. Allows insured to change plans and disenroll throughout the year. No network limitations and plans will travel out of state. Good for those who spend time in multiple states. |
No. Insured must wait until certain times of the year to disenroll. Medical underwriting may be necessary to later purchase a supplement. Usually only covers emergencies out of network. |
| Offers Ancillary Benefits? |
No. Supplements are not allowed to offer ancillary type insurance options at this time. |
Yes. Many Advantage plans include dental, vision, hearing and other perks. |
Medicare Premiums, Out-Of-Pocket & Plan Flexibility
It is difficult to compare monthly insurance premiums versus potential out-of-pocket costs. If you remain in good health, a low cost Advantage plan will be the least expensive choice overall. However, if you have regular health issues or a significant incident, an Advantage plan can have much higher out-of-pocket expenses when compared to a Medicare supplement like Plan F, G or N.
Furthermore, your one year trial period is up, you may be unable to switch back to a traditional supplement if you have certain preexisting conditions. Most Medicare supplement providers require medical underwriting if you have been enrolled in an Advantage plan for over one year. In other words, you can be declined coverage. Additionally, it can be difficult to disenroll from a MA plan outside of the Oct.15th thru December 7th Open Enrollment window each fall.
In fairness, there are states like Florida where Medigap rates can be higher than most other places. And regardless of out-of-pocket expenses, some consumers simply cannot afford both a Medicare supplement and a stand-alone Part D plan. For these folks, an Advantage plan can be the most suitable option as some are offered at $0 per month.
Medicare Advantage Networks – Doctors and Hospitals
One important difference between supplements and MA coverage are the network options. Unlike almost all supplements, MA plans have a network of doctors, hospitals and medical facilities that the insured is mostly required to use for service. All plans will cover emergencies out of network, but your idea and the insurance company’s idea of an emergency may differ.
The problem arises when a specialist is needed for consult or if the insured is admitted to a rehabilitation or other medical facility that is out of the provider network. It’s not that the insured cannot see these professionals or use the facility, but the Advantage plan may provide little in the way of reimbursement – if any at all. This can lead to significant out-of-pocket expenses.
Prescription Drug Part D Rx Coverage
This is an area where MA plans tend to be more beneficial to the insured. Current laws allow insurance companies to package Advantage plans and Part D coverage together in one package. Not all MA plans combine Parts C and D together, but many do as an incentive to the consumer. And many of these combination MAPD plans can be found for under $75 a month. Some are as little as $0 a month.
Conversely, Medicare supplements and prescription Part D coverage must be sold separately by law. There was a time when the two plans could be purchased in tandem, but past regulations separated the two. Many companies offer both supplemental and Part D, however they cannot be purchased together. And it’s wise to shop them independently on one another.
This means that Part D plans will come at an additional cost for those who want a traditional Medicare supplement. Part D premiums will vary, but plans that fit most consumers cost between $15-$30 a month. The plan that’s most suitable will depend on what prescriptions you take. Even if you don’t take any at all, it’s wise to have a plan in order to avoid the lifetime Late Enrollment Penalty.
What Is The Future For Medicare Advantage Plans?
It’s hard to say. Health care reform is an evolving piece of some of the most significant legislation passed in recent decades. Medicare supplements are here to stay, but Advantage plans seem to fall in and out of the political cross-hairs. For now, MA and MAPD plans are alive and well.
It is important to note that if your MA provider leaves your service area or discontinues coverage, you will receive an open enrollment window when you can purchase some supplements (or new MA plan if one exists) without any required medical underwriting.
Contact Us For Quotes And Coverage
In summary, there is not a one-size-fits-all plan for Medicare beneficiaries. While more of our clients tend to purchase Medicare supplements, many also are very content with Advantage plans. We do both and will help you narrow down your choices to the ones that look most suitable for your needs and budget.
Hyers and Associates is an independent insurance agency serving several states nationwide. We work with the leading Medicare insurance providers to help our clients compare their options and enroll in coverage directly – at no additional cost.
Request Medicare Insurance Consultation →
Category: Medicare Advantage, Medicare Supplements
« Previous Page
