If you are near (or already) eligible for Medicare, you might be wondering about your Medigap options. You should consider Medicare Supplement Plan G straightforward choice for affordable & comprehensive coverage.
It’s one of the most complete plans available. It also offers good value when compared to other plans like F and N. The premium increases tend to be less with Plan G and your yearly out-of-pocket exposure is always known.
Medicare Plan G vs Plan F & N
As an independent broker, I found that many Medicare-eligible consumers leaned toward Plan F before 2020. Now they are deciding between Plans G and N.
Plan F covers all gaps in Medicare Parts A & B. So long as your medical care is a Medicare-approved expense, it will fill in all of the gaps. Plan N has copays and does not cover Part B Excess Charges. Are these two better choices than Plan G?
Here is the review:
Is Plan G a Good Choice for Medigap Coverage?
What are the best arguments for Plan G Medicare supplement insurance? First, it’s important to know Plan G fills in all gaps in Medicare Parts A & B except for one. Plan G does not cover the Part B deductible.
The Medicare Part B deductible is $257 in 2025. It was $240 in 2024 and $226 in 2023. These increases coincide with other increases in Medicare Part B premiums and consumer out-of-pocket exposure.
For reference, the deductible was $233 in 2022, $203 in 2021, $198, in 2020, $185 in 2019, $183 for 2017-18, and $166 in 2016. For the years 2013-15, the amount was $147.
Increases are regulated by the government and have not increased significantly year over year. The deductible changes when officials at CMS (Centers for Medicare & Medicaid Services) announce new cost-sharing amounts.
It’s important to note that Plan F covers the one-time, yearly Part B deductible and Plan G does not. That is the only difference between the two. For reference, Plan N does not cover the Part B deductible either.
What are the Advantages of Plan G?
Medicare-eligible consumers should consider Plan G for a couple of reasons. The first reason is cost. As you price Medicare supplements from the vast number of insurance carriers, you will see Plan G is over $30 less per month than Plan F in many cases. (And it’s not always much more expensive than Plan N.)
When you take $30 and multiply it by the 12 months in a year, you come up with $360. So why spend an extra $360 more per year in Plan F premiums to cover a $257 deductible? The math does not add up. You are saving money with Plan G over Plan F. And it’s one of the most comprehensive medicare supplements available.
Watch Our Video to Learn More about the Advantages of Plan G
What About The Annual Medicare Part B Deductible?
This begs the question: What happens if CMS raises the Part B deductible well above $257? What if they decide to increase it to $500 or even $1000?
First, you should know Part B deductible increases are tied to inflation. So unless the rules change or inflation increases significantly, the deductible would only increase incrementally each year. This has always been the case.
In the event the Part B deductible increases significantly, Plan F premiums will increase as they must account for this gap. Insurance companies will not absorb the increased cost should it occur. They will pass it on to policyholders.
One way or another you’re paying for it – either in the way of higher premiums or by meeting the deductible itself. With Plan G you are in more control and can save money through lower premiums. That’s why it is a good Medicare supplement plan.
Plan G Is Now A Guaranteed Issue Policy
Medicare changed the rules in 2020. Plan F is no longer available for those new to Medicare beginning January 1. See more on that below.
This means that like Plan F before, Plan G is now offered on a guaranteed issue basis for different reasons. This would be one argument against Plan G. Guaranteed Issue plans tend to increase in price more quickly because the insurance companies offering them are forced to accept consumers with poor health. This drives up claims and in turn increases premiums for all who are enrolled.
Plan N (same as it’s always been) is not a guaranteed issue policy. Thus, insurance companies can be more selective in who they accept for this plan. Medical underwriting will determine who qualifies.
With (perhaps) fewer unhealthy enrollees in a plan, there will be fewer claims. Rates will increase more slowly. It was not unusual to see Plan F rates go up more quickly in the past. Now that Plan G is a guaranteed issue policy (when applicable), we expect to see monthly premiums increase more quickly than with a Plan N Medicare supplement.
Some Medicare Supplements Discontinued In 2020
Yes, it’s true. Any plans covering the Part B deductible are no longer offered to those gaining Medicare eligibility starting in January 2020. Those who were eligible for Medicare before 2020 can keep their existing coverage, however. The three policies affected are Plans F, C, and High Deductible F.
What does this mean? In practice, discontinued blocks of business will trend older and perhaps unhealthier. And rates may increase more dramatically because of this. When rates go up, consumers shop. Those who are healthy enough to find new coverage (like Plan G, N, or High Deductible G) will likely enroll in new coverage, further exacerbating the problem. This happened with Plan J when it was completely discontinued in 2010.
That’s why you see a lot of companies introducing Plan G to their portfolio. United Healthcare (AARP branded) and Anthem Blue Cross and Blue Shield now offer Plan G in Ohio and several other states.
High Deductible Plan G Is Now Available
Since the High Deductible Plan F rules have changed, High Deductible Plan G is the new option for those new to Medicare in 2020 and beyond. This policy is available to all Medicare beneficiaries both new and old. The plan is interesting as it has essentially two deductibles. The normal $2,870 High Deductible annual amount as well as the Part B deductible.
Will the Part B deductible also count towards the normal $2,870 plus the high deductible? In most cases, yes it will. So you will likely only have to meet one. If, however, you met the high deductible with only Part A expenses, then you would still be responsible for the Part B amount.
It would be very rare for a situation like this to occur, but it’s something to be aware of. High Deductible Plan G is gaining traction. More companies now offer this choice. Premiums are very low and you can see any doctor or hospital that accepts Medicare.
Contact Us To Compare Plan G Medicare Supplement Quotes
In summary, when shopping forMedicare supplement insurance and comparing benefits, plans, and prices – Medicare Plan G should be on your list. The premium difference usually makes up for the Part B deductible and the smaller rate increases are helpful. Contact us to learn more about Medicare supplement plans!
Many of our clients ask about the free Silver Sneakers gym membership and how to qualify when shopping for supplemental insurance plans. It can save members a lot of money.
Some insurance companies offer this valuable benefit, but many do not. And availability will depend on where you live. We help our clients compare the Medicare insurance policies offering this perk while crunching the numbers to make sure they aren’t overpaying for their coverage.
What Is Silver Sneakers & Why Should I Be Interested?
Silver Sneakers is a gym and fitness membership organization for those age 65 and older. It partners with several health insurance plans in order to offer unlimited gym access to over 13,000 locations across the country. This program also offers free fitness classes (both in and out of the gym) to accommodate all levels of experience.
More than 60 health plans nationwide have partnered with Silver Sneakers to include this valuable benefit. Some of these include AARP Silver Sneakers (also known as United Healthcare), but they have discontinued this relationship in several states.
Many Medicare supplement and Medicare Advantage insurance plans include this benefit at no extra cost.
Medicare Supplements With Silver Sneakers Membership
As a rule of thumb, more Medicare Advantage plans offer Silver Sneakers than doMedicare supplement policies. Membership availability will depend on the State where you live. It’s more common to see larger insurance Medicare supplement providers offering this benefit. Many smaller companies will not.
Popular insurance companies like Anthem Blue Cross and Blue Shield, Humana, United Healthcare (AARP), and Medical Mutual of Ohio offer this program in many states. This benefit does not cost extra. It is included as part of your overall monthly premiums.
Taking it a step further, Silver Sneakers is one of the very few benefits that Medicare supplement insurance companies are allowed to include at no additional cost. Unlike Medicare Advantage plans, supplemental policies cannot (by rule) include many ancillary benefits. Gym memberships are one of the few free service available.
Medicare Advantage Plans Including Silver Sneakers
There are many, manyMedicare Advantage plans affiliated with Silver Sneakers. Your options will depend on where you purchase your insurance. If you would like to see which insurance companies in your state include this plan, view theparticipating health plans here.
It’s not uncommon to see both large and small insurance companies include this popular benefit. Large carriers like Aetna, Anthem Blue Cross & Blue Shield, Coventry, Gateway, Humana, United Healthcare and WellCare (to name a few) participate in most states.
Which is Better – Medicare Advantage or Supplements?
It’s important to know that Medicare Advantage plans are much different than Medicare supplement plans and you cannot have both at the same time. While Silver Sneakers is a nice perk, it may not be reason enough to choose one policy over the other. It’s a good idea to discuss the differences with an independent agent before enrolling.
Getting The Most Out Of Your Medicare Insurance
Too often Medicare insurance policies are purchased and stashed away. Whether you purchase a Supplement or Advantage plan, it’s important to know about extra benefits. Medicare Advantage plans are allowed to offer ancillary benefits like dental, vision and hearing. Conversely, Supplements, by rule, cannot usually offer as many added benefits.
How do I Get Silver Sneakers?
If you aren’t sure, just ask your agent while considering your options. Sometimes we cannot disclose all perks offered by an insurance company so as not to inadvertently steer clients one way or the other.
Of course, Silver Sneakers is one of the biggest perks and some of our clients will choose a carrier based on this benefit alone. It’s important to crunch the numbers, however. If you frequently use the gym and a membership will save you $60 a month, then it might be an easy decision. But if you don’t use the gym often you might benefit from a lower cost Medicare plan that does not offer this benefit. We can help compare your best options.
Here are a few FAQ’s that will help you:
What Insurance Plans Include Silver Sneakers?
The best way to find the participating plans is to check out theSilver Sneakers eligibility page and look there. The website will tell you exactly which health insurance plans cover it.
What’s the Silver Sneakers Minimum Age?
In order to qualify for this program, you have to be at least 65. Generally it is given in conjunction with the age for Medicare.
How do I Get My Membership Card?
You’ll receive a 16 digit code or card from your health insurance company. Once you have that, you can access any participating gym or center. You will also receive a card you can use at any participating gym or fitness location.
What Does it Include?
You get access to over 15,000 gyms across the nation. Not only can you get into the gym, you are able to take classes that promote a healthy lifestyle. Also, many gyms offer programs and social opportunities for their members. As a note that you don’t have to got a gym to take the classes. Many community centers and other places are available to you. And there are additional programs that allow you to save toward a family member’s college scholarship!
Contact Us For Quotes, Coverage & Enrollment
Hyers and Associates is an independent insurance agency specializing in Supplements, Advantage plans and Part D coverage. We help our clients compare and contrast all of their options. We’ll tell you which plans offer Silver Sneakers and discuss whether or not this value-added benefit puts one plan on top of another. Contact us today!
Today we are going to look at the differences between the most commonly used Medicare Supplemental Insurance Plans F, G and N.
There is a lot of confusion about Medicare Supplemental Insurance F, G and N options, also called Medigap Insurance. The Hyers and Associates team members work with these plans every day. Some policies provide better value over the long run – so it’s crucial to understand the nuances of each.
Understanding the Basics of Medicare Plans F, G and N
Medicare Supplemental Insurance, also called Medigap insurance, will pay out of pocket expenses remaining after Original Medicare (Parts A & B) have paid their portion of your healthcare claim. If you are a Medicare Advantage member you do not need, nor can you have, a supplemental plan.
When initially signing up for Original Medicare, insurance companies must accept your request for insurance, regardless of pre-existing conditions. If you do not obtain a Medigap policy when you are signing up initially for Original Medicare you can later be denied. After your initial sign-up, insurance companies may require medical underwriting for pre-existing conditions. This means you can be turned down.
Medigap plans that are sold under the same letter designation are required to provide the exact same specific and identical benefits. The policies are sold by various private insurance companies that may charge different rates, but the coverage is identical. Let’s take a look at what’s similar and different between these three most commonly purchased plans.
Medicare Supplement Plan F
Medigap Plan F provides more comprehensive coverage than any other Medicare Supplemental Plan. This tends to make it more expensive than other plans, however, check with various insurance companies before assuming that. There is also a high deductible Plan F that has a higher out of pocket amount before coverage kicks in.
With high deductible Plan F you’ll pay all out of pocket Original Medicare costs until you reach a designated amount ($2300 in 2019) before your policy coverage kicks in. The advantage of choosing a high deductible plan is lower monthly premiums than the regular Plan F.
Plan F benefits include the following:
Medicare Part A deductible
Medicare Part B deductible
Medicare Part A coinsurance and hospital costs
Medicare Part B coinsurance or copayment
Medicare Part B excess charges
Medicare Part A hospice care coinsurance or copayment
First three pints of blood
Foreign travel emergency coverage (per the plan limits)
Plan F usually provides the most help with Original Medicare costs, especially if you see a doctor frequently.
Medicare Supplement Plan G
Medigap Plans G and F cover all the same benefits with the exception of Medicare Part B deductible ($185 out of pocket in 2019). Medigap Plan G and F are the only plans to cover Medicare Part B excess charges caused by non-participating Medicare providers. Non-participating providers are allowed to charge up to 15% more than what Medicare normally permits, which you are responsible for paying.
Medicare Supplement Plan N
Medigap Plan N is identical to Plan F, with the exception of for paying these out of pocket expenses:
Medicare Part B deductible (just like Plan G)
Medicare Part B excess charges (different than G & F)
The other difference with Plan N is copayments. Routine office visits (up to $20 copay), and emergency room visits (up to $50) if you’re not admitted as an inpatient to the hospital are required.
Give Us a Call For More Information
If you have any questions regarding Medigap F, G and N policies the team at Hyers and Associates is here to help. We work with a wide range of insurance companies and can help you sort through various options available.
We can also help you find a Medicare Part D prescription provider. Insurance is what we do every day, so let us help you find the best decision that fits you. Contact us today with your questions.
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.
Here at Hyers and Associates, we are offering a guaranteed issue Medicare supplement insurance policy for our Ohio clients in 2019. So long as you have an existing supplemental policy, you can apply for this one with no medical underwriting.
This is a limited time offer, so contact us today. There is only one insurance company doing this and their rates are very competitive. There are no health questions and their rates are very competitive.
Guaranteed Acceptance – No Medical Underwriting
If you have health issues, you know how hard it can be to switch from one Medicare supplement policy in Ohio to another. Insurance companies are allowed to ask questions, review your health history and turn you down for coverage.
This can be very frustrating – especially if you have been in a plan for several years and your rates have increased dramatically. With this new program, we are seeing rate decreases for our clients anywhere from $10-$50 a month. And that’s without changing their plan. Those who move from Plan F, to Plans G or N are seeing their rates go down even further.
Silver Sneakers Benefit In Ohio
There is one very large insurance company in Ohio that’s dropping their Silver Sneakers gym membership benefit. If you have them, then you know who they are. That only leaves three other companies offering Medicare supplement coverage with Silver Sneakers in Ohio.
Well, we have more good news. This guaranteed issue provider also offers Silver Sneakers. That’s right: No medical underwriting and you get the same free gym membership so you can stay active and healthy.
This insurance offer helps so many of our clients. Not only are we reducing their rates by offering supplemental insurance with no medical underwriting, but they can keep the gym membership they count on as well.
Medicare Supplement Plans F, G and N
Our company also offers the three most popular Medigap policies – Plans F, G and N. Their Plan G and Plan N rates are very competitively priced. Their F rates are in line with most other companies. (They also offer High Deductible Plan F.)
If you’ve done your homework, you know that Plan F will no longer be for sale for new Medicare recipients in 2020. That’s why a lot of our clients are moving to Plan G supplements (and Plan N) so they don’t stay in a discontinued plan.
Typically when Medicare officials stop offering a plan, the rates go up more quickly. (This happened with Plan J in 2010.) Plan G and N will stay on the market, however, and most likely have more rate stability. And when you do the math, you can see that Plans G and N oftentimes offer better value as well.
Check Your Medigap Insurance During Open Enrollment
Now is the time of year to check your in Ohio surance coverage and make sure you have the most suitable plan. If your rates are too high or your losing your free gym membership, then contact us. We should be able to help you on both fronts.
This no underwriting Medicare supplement plan will only be available with effective dates of January 1, 2019 to June 1, 2019. Now is a great time to take advantage of this opportunity.
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.
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.
It’s that time of the year again. The holidays will be here soon, and with that time period also comes your annual open enrollment period for Medicare.
So many decisions, so little time. Let’s take a quick look at this opportunity and why you should take advantage of it.
Here are 5 Tips For Medicare Open Enrollment:
1. Don’t Miss Your Annual Open Enrollment
Don’t miss this opportunity to take advantage to evaluate your current position against other possible choices. Open Enrollment for your 2019 coverage is Oct 15 through Dec 7, 2018. Your choices will go into effect Jan 1, 2019. The Annual Enrollment Period (AEP) is your once a year opportunity to make changes to your plan.
This is the one time each year when you can switch from Medicare Advantage to Original Medicare or vice versa. You can switch from one Medicare Advantage to a different Medicare Advantage, or change your Medicare Part D prescription coverage to a different Medicare Part D plan.
If you do not have a Medicare Part D plan for prescriptions, this is your opportunity to find one. This is usually your only opportunity each year to improve your coverage, save money, or possibly both.
2. Don’t Wait Until the Last Minute
Don’t you hate the stress you experience when you wait until the last minute to get things done? Don’t let your Medicare decisions become a part of your last minute holiday rush. Start looking at choices early in the season to you give yourself adequate time to make your best decision possible.
Decisions made under duress are usually not the best decisions you’ll make, so start evaluating at your options early in the season. And also realize that insurance brokers are under significant stress this time of year as well. If you start early, you are more likely to get the time and attention you need from your agent. Most of us are stretched pretty thin toward to later part of Medicare AEP.
3. Understand Automatic Renewal
If you do nothing your policy will usually automatically renew with the same coverage you currently have. However, you really should check to see if changes have occurred that you are not aware of. Sometimes your providers Medicare Part D coverage will change the drugs they cover, cost of said drugs, premiums, deductibles, copays, etc.
Medicare Advantage plans update each year as well. You need to be aware of any network, out of pocket, prescription changes and so forth.
Make sure they are still covering the prescriptions you are using. It is also possible for them to change the coverage that is available. If your Medicare plan is no longer being offered or if you are ineligible you will receive a non-renewal notice in the mail.
4. Check Your Providers are Accepting Your Coverage Choice
Not all doctors and healthcare providers accept Medicare, and not all doctors accept all plans, so check with your preferred providers to make sure the plan you choose is accepted. Also, make sure your Prescription D coverage will cover any medicines you currently take on a regular basis.
There are several tiers available for prescription coverage and they can vary in what they will cover so you’ll want to be sure your meds are covered at a rate you can afford. If you have limited providers for your medications you’ll want to be sure your store has not changed the plans that you are currently using or wanting to change to.
And the pharmacy you use can make a big difference. Many Part D plans offer lower costs at their network of preferred pharmacies. Make sure to check the pharmacy you prefer is the best one for the plan you choose. It can save you hundreds of dollars.
5. Do I need Medicare Supplement Insurance?
You may have heard about Medicare Supplement Insurance – also called a ‘Medigap’ policy. These are separate insurance policies that cover out-of-pocket costs Medicare does not cover. This could include things such as deductibles, copayments and coinsurance.
In most states, a Medicare Supplemental Insurance policy can be purchased anytime. However, if you are considering dropping or changing your Medicare or Medicare Advantage you will want to make sure you qualify for a Medicare Supplement Insurance policy before making that change. In many cases, you’ll have to pass medical underwriting so you’ll want to start early to see if you qualify.
Let Us Help You Sort Through Your Options
There are so many choices available, so be sure to make the most of this opportunity. Give one of our friendly and skilled brokers a call as we can help you sort through the many choices and help you make the best choice.
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
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!
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.
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.
For many Americans, Medicare is their primary insurance coverage provider. Most of these people are retired, and some are disabled. And when they need health care services, they just pull out their familiar Medicare card.
Now the face of Medicare is changing. And soon a new Medicare card will be issued to those who are covered by this plan. In case you haven’t heard, new ID cards will be issued for all eligible members beginning in April 2018. This will be a slow rollout over twelve months.
Basic Facts About the New Medicare Cards
Most people carry a driver’s license or state identification card. Besides valid ID, a Medicare card is one of the most frequently used cards in your wallet. New Medicare cards will be sent out between April 2018 and April 2019 depending on where you live.
The new Medicare card will have a randomly generated number that is unique to each cardholder. Once this card is in your hands, you will no longer use your Social Security number as your plan identification number. Many cardholders will be pleased this sensitive number will no longer be the basis for proving eligibility. Using a specific, random number for each policyholder is a format that resembles other insurance providers. And this model offers a higher level of security to Medicare cardholders.
New cards will also be made of paper. The idea is they’ll be easier to use and copy while saving taxpayers money. Additionally, you will be able print off a new one by logging in to your account at Medicare.gov. You might print off more than one and keep one laminated for longevity purposes.
New ID Cards Protect Your Identity
Identity theft is a worrisome problem. And nobody wants to try to prove they were a victim of this type of fraud. The new Medicare card number will help protect your identity. And Medicare will never ask cardholders for personal or private information. Be aware that Medicare will never call or ask about your new ID. If you are contacted, its likely a fraudulent scam.
There will be no fees for new ID cards. They will look just like they have in the past with the familiar red, white and blue template. No longer will there be the insured’s Social Security number, however. The Medicare Chip Reauthorization Act of 2015 (MACRA) requires SSNs to be replaced with new beneficiary identifiers or MBIs. This should help to cut down on Medicare fraud and identity theft.
New Cards Will Arrive – Nothing To Do
No action needs to be taken to get your new Medicare card. One important step you can take now it to verify your mailing address is updated and accurate. And if your address needs to be corrected, contact Social Security at socialsecurity.gov/myaccount or call 1-800-772-1213. If you’re unsure, reach out to Social Security to verify the address on file. The right address ensures your new Medicare card arrive safely at the right place. And then you just watch your mailbox to get your new card.
Don’t expect new cards right away. Some won’t arrive until 2019. In fact, Medicare beneficiaries in Ohio and Kentucky will be some of the last people to receive new cards . For some, the new IDs may not arrive until April 2019. In other words, don’t be alarmed if your friends in other states have theirs, but your Medicare card has not arrived yet.
Out With the Old and In With the New
Immediately destroy the old card when your new Medicare card arrives in the mail. You do not want it to be misplaced or improperly used. In addition, if you are concerned about security issues, use scissors to cut the card up into tiny pieces.
Start using your new card right away to get the same benefits you are accustomed to receiving with your old one. And your new card with its new number provides better protection than the old system. Doctors and hospitals know that these new IDs are on the way. It should in no way surprise them when you present them with this new information. And the same applies to your supplemental information as well.
What About Medicare Supplemental Insurance?
Different carriers provide Medicare Supplemental Insurance. Those cards will remain the same unless you receive separate notification directly from your provider. Continue to use your old Medicare Supplemental insurance card as well as your Medicare Advantage cards. The same is true of Part D dug plans. There should be no changes to any of your IDs with these three programs.
If you have questions about your supplemental insurance coverage, contact us or your local insurance agency to find out more. Any reputable agent can help you get the Medigap coverage you need. Also, this added coverage pays for a full range of healthcare services.
If you want more information about this important change, contact us, your trusted insurance agent, or go to Medicare.gov to get additional details. Otherwise, you just need to wait for your new card to land in your mailbox!
Thank you for reading our blog! How can we help you? Contact us today.
This year marks an increase in the cost of medical care. As such, it is wise to understand what you are paying for when you have Medicare.
More importantly, there is a need to know why getting supplemental coverage is a necessity when you consider the costs of Medicare and what will be covered.
Government provided Parts A and B (commonly referred to as Original Medicare) have several gaps. Filling those gaps with a Medigap or Advantage plan can save you thousands.
Understanding the Medicare Premiums
First, let us discuss what the costs are regarding premiums. There are four basic types of premiums stipulated in Medicare, albeit the last two are like extensions of the first two major premiums.
Part A Premium – this is also called premium-free Part A. Many people do not pay this because of the cost. This has the best coverage, but it is also not pragmatic to a lot of people. If you get this type of Medicare, you will pay $422 each month. But this only applies if you paid less than seven years’ worth of Medicare taxes. But if you paid the taxes, the standard cost is $232.
Part A – for this premium, you will get the following for each period:
$1,340 deductible
the coinsurance for the first 60 days that is worth $0
coinsurance per day per period on the 61st to the 90th day worth $335
and coinsurance for the 91st day onwards worth $670
Part B Premium – the standard cost of this is $134. Those who have Social Security benefits can pay less, and they pay, on average, $130. You can increase your premium if you can afford it but you will not anything closer to Premium A.
Part B – this covers deductibles and the costs of coinsurance. You will be paying $183 per year, and you will typically pay 20% of the amount for doctor services. This applies to most in-patient services and outpatient therapy plus medical equipment.
Part C Premium – this is a little tricky because it varies from one plan to another. However, Part C is not a separate benefit. It is still part of the policy, but it allows private firms to provide Medicare benefits. Examples of these are HMOs and PPOs. They are also known as Medicare Advantage Plans
Part D Premium – this refers to outpatient prescription drug insurance. This is a part of the Medicare policy that allows a patient to be covered on the costs of prescription drugs. However, this insurance is only covered by private companies and not directly by the government.
The Importance of Supplemental Coverage
Also called Medigap, Medicare Supplement Insurance is sold by private companies that allow you to cover expenses that the government does not insure. Examples of these are deductibles, copay, and coinsurance.
With Medicare, you have to be on US soil to get your benefits. But with Medigap, many providers offer health insurance for you even if you are outside the United States, something that the typical Medicare insurance will not cover.
Another benefit of Medigap is that it may allow you to get 50% to 100% coverage for blood transfusions for the first three pints. With Medicare, the government will only pay on the third pint. Medigap also covers some skilled nursing facilities should you need one. Most Medigap plans can shoulder up to 100% of the coinsurance for this need.
All in all, there is no single insurance plan that will cover everything. The best thing to do is to understand your financial capacity and determine which medical expenses are beyond your financial means. Once determined, you can then select the best insurance policy for you. Keep in mind, however, that the original Medicare does not cover many medical services that you might need in the future. In this case, it is always best to opt in for a Medigap coverage.
Thank you for reading our blog! How can we help you? Contact us today.
Understanding the world of health insurance can definitely become challenging. If you feel overwhelmed by the policies offered to you and the coverage you need, you are not alone. Medicare and supplemental insurance policies are filled with jargon and fine print that make many of our heads spin.
We would like to help clear up the confusion. Keep reading for an overview on what Medicare covers and the gaps which supplemental insurance helps fill.
Medicare coverage is based on three factors. Federal and state laws, national coverage decisions and local or state coverage decisions come into play. While coverage is not black and white, knowing what Medicare generally covers keeps you in the know. And, it helps determine your need for supplemental insurance.
Medical Expenses Medicare Covers
While educating yourself on Medicare coverage, keep in mind that limits apply. For instance, Part A states that it covers skilled nursing home care. On a more in-depth look, this coverage does not include long-term or custodial uses of nursing home facilities. Caution is required when interpreting the wording of any policy.
To start building your understanding, check out the information below. Medicare takes care of you in regard to:
— Hospital care, including acute, critical, rehabilitation and long-term care service
— Hospice care related to palliative care, therapies, social services and counseling
To determine if a service, test or item is covered by Medicare, talk with your healthcare provider. Often these professionals have a working knowledge of coverage and provide wise counsel. You may also visit medicare.gov and use the coverage search feature located there. Simply type in the item you question coverage for, and you are directed to an answer.
You may also contact a licensed insurance agent to understand your health insurance options. The business of these professionals is knowing what policies cover and which fit your medical and financial situation best. In any case, do your research to prevent unexpected, costly gaps in coverage. Unfortunately, the weight of understanding falls on you.
Reasons You Need Supplemental Insurance
Gaps in Medicare coverage do exist. Knowing your current medical requirements and planning for future ones gives you a picture of your need for supplemental insurance. These plans pick up the Medicare slack by providing coverage when your primary plan fails to do so. However, be aware that supplemental policies vary and may leave gaps as well.
In our example above, Medicare denies claims for custodial or long-term nursing facility care. The aging population proves the reality that you may need these services at some point. The Motley Fool reports that an average nursing home tab runs $225 per day, which averages out to $82,125 per year. The cost rises with a private room. Insured by Medicare alone, you pay these expenses out of your bank account.
Medigap or Medicare Supplemental Insurance covers some conditions and situations Medicare denies. However, some expenses remain uncovered. In the nursing home example, you are left to foot the bill even with Medigap insurance. Looking into other policies still may be needed to address your future health needs and prevent unexpected financial hits.
You may consider supplemental insurance for coverage of:
These medical services tend to be denied by Medicare. If you want to avoid paying out of pocket, investing in a supplemental insurance plan may be the answer. But, as with all plans, read thoroughly or seek professional expertise on what policies cover. Each plan differs in its scope of coverage.
Medicare Alone or Partnering With Supplemental Insurance?
Determining the best insurance option for you requires research and consideration. After all, you do not want to pay for services you will never use. Plus, supplemental insurance is expensive, and the cost rises as you continue to age. Is it worth the investment?
Weighing the costs of supplemental plans and potential out-of-pocket expenses helps determine the wisdom of purchasing these additional policies. Your personal health history and family medical history come into play as well. And, buying sooner rather than later also saves you money. Again, talking with a licensed insurance agent educates you as to what options exist and gives you answers as to which investment proves worth the return on your unique situation.
Thank you for reading! How can we help you with your supplemental coverage? Contact us today.
Navigating the Medicare insurance game proves tricky and complex. With so many options and varying deadlines for each policy, confusion often sets in and overwhelms the average applicant. And with changing regulations, you need quality medical coverage more than ever. What are your options when you miss the Medicare supplemental insurance deadline?
Medigap helps. This supplemental insurance catches some of the medical expenses left to come out of your pocket by original Medicare policies. If you missed your initial enrollment deadline, you may be wondering if you can still take advantage of this supplemental insurance. Fortunately, you have options. Let’s take a look at what Medigap is and what to do if you missed the deadline.
What is Medigap
Medigap offers additional coverage to your original Medicare policy. In short, you must be Medicare eligible and a recipient of it. The supplemental insurance, Medigap, brings peace of mind by helping pay deductibles, copayments and coinsurance, not covered by your original policy.
Keep in mind: Medigap fails as a cure-all. This insurance does not cover vision care or eyeglasses, dental care, hearing aids, prescriptions, long-term care or private nursing. Also, some insurance plans, such as the Medicare Advantage Plan, do not partner with Medigap.
However, Medigap policies provide extra coverage for hospital and doctor services which otherwise drain finances. You get a choice in the level of coverage you want and pay a monthly premium based on the plan chosen. Purchased through private insurance companies, the premiums vary.
What If the Medigap Deadline Is Missed?
Initial open enrollment for Medigap runs for six months from the first day of your birth month, in the year you turn 65. For instance, if you turn 65 years old on October 20, 2018, your enrollment period runs from October 1, 2018 through April 1, 2019. But, what if you realize this period has passed?
All is not lost if you missed the deadline. Check out the following circumstances when you might apply for Medigap after the initial open enrollment deadline.
Medigap Guaranteed Issuance
Some applicants are guaranteed Medigap coverage. If you fall into one of the following categories, you need not wait for an enrollment period to apply:
– Your employer-sponsored supplement to Medicare ends.
– You lose eligibility for an employer’s plan due to divorce or death of the member or the company reduces benefits for any reason.
– Your Medicare Advantage Plan raises premiums or copayments by 15 percent, reduces benefits or the plan ends.
Pre-existing Conditions
When Medigap applications follow continuous creditable coverage, you cannot be denied based on a pre-existing condition. In the case of pre-existing conditions, Medigap becomes more difficult to approve outside the initial enrollment period. Your application can be denied.
However, knowledgeable insurance agents help you choose and obtain the Medigap plan which fits your needs, even if you miss the enrollment period. Medigap policies may accept your application but refuse to cover pre-existing conditions for up to six months. After that period, they must cover the condition.
Switching to Medigap
If your enrollment with Medicare Advantage made you ineligible for a Medigap policy, switching to Medigap opens a door after the enrollment period. The best times to make the change are:
– Special enrollment periods
– The Annual Election period (from October 7 through December 15)
– And, the Medicare Advantage Disenrollment period (January 1 through February 14)
Eligibility requirements must be met. And, keeping your Medicare Advantage until approved for Medigap proves wise. Again, an expert helps identify the ideal times to apply and the best companies to work with while navigating deadlines and details.
Changing Medigap Plans
Several Medigap plans exist. Several insurance companies offer the policies. Should you need to change plans or insurance companies to one which better meets your financial and health needs, you may do so outside the open enrollment period.
Most states require a new application and a set of medical questions. This raises the chance of being denied on pre-existing conditions. Several states allow switching with no medical review. A financial penalty may also be involved. Seeking knowledgeable council helps you understand where your state falls on these issues.
What is Best for YOU?
Determining the best plan with the least amount of red tape, deadlines, and fees may overwhelm you. Furthermore, private insurance companies set prices and determine rules for eligibility which complicates the shopping process.
You are not alone. Seeking the help of knowledgeable insurance agents ensures that you do not miss deadlines or open enrollment periods. It also sets you on a path to finding the best Medigap option for you both medically and financially, even outside the enrollment period.
So, can you still qualify for Medicare Supplemental Insurance? The answer: Likely, yes.
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