Medicare open enrollment is currently underway from Oct. 15 to Dec. 7 of this year. This means that if you want to change your coverage or add a supplemental insurance plan, this is the time to do it. All new insurance policies take effect on Jan. 1, 2018. But, before they do, you have some time to learn about the different options and pick the one that works best for you.
During open enrollment, you can either join a new Medicare Advantage Plan or add on a stand-alone prescription drug plan (Medicare Part D). If you are enrolled in a Medicare Advantage Plan already, you have the option of switching to Original Medicare if you no longer need everything that plan offers. Wondering what exactly you should do when open enrollment for Medicare begins? Here are some essential steps to take:
If you’re confused about the different terms being tossed around during this period or are unsure about what something means, this is the time for you to do some research and learn more about the different plans and terms used to describe Medicare options.
Medicare Advantage Plans are health insurance plans that are required by law to cover the benefits of Original Medicare Parts A and B. They also often offer extra coverage, such as prescription drug plans and dental, vision or hearing benefits. Medicare Advantage is administered privately. Although you will still get all of the coverage that Medicare Parts A and B offer, it will go through a private insurance company instead of the government. Medicare Part B premiums will still be paid to the state. Also, hospice care will be administered by the federal government if it is included in the policy.
Medicare Part D is a Medicare policy that subsidizes the cost of prescription drugs, which may be necessary if you have a condition that requires you to buy expensive prescriptions often. It can be purchased as a stand-alone policy, combined with Original Medicare or included in your Medicare Advantage plan. Most of the time, you can mix and match depending on what your other medical insurance needs are.
Original Medicare encompasses two policies: Medicare Part A and Medicare Part B. These offer different benefits with different deductibles, premiums, and copayments. For each plan, you will have to pay a deductible for your health care costs. This deductible is a minimum amount that you need to pay before the government covers the rest. For Medicare Part B, you also need to pay monthly premiums. For both kinds of plans, it’s common for you to have a copayment for health treatment once your deductible is paid.
Supplemental plans (also known as Medigap) cover the out-of-pocket costs that you may have to pay if you have Original Medicare. Some examples include cosmetic surgery, foreign health care, hearing aids and exams, long-term care, most eyeglasses, dental care, and dentures. You can buy these plans from private insurance companies. Any costs incurred that aren’t covered by Medicare are automatically forwarded to your Medigap policy.
Which plan you choose, and thus how much you pay, will depend on your individual medical needs. For example, if you expect that you will be spending a lot out of pocket for prescription drugs in the upcoming year, you should consider enrolling in a Medicare Part D or Medicare Advantage plan that covers prescription drugs. If you plan to travel a lot and want an insurance plan that includes health care you receive abroad, Medicare Advantage might be the best choice for you.
There are many different policies offered that all cover various types of benefits at varying costs. As such, make sure to consider the overall price of each and which services you need the most. Because there are so many options, compare each carefully. In other words, shop around. Don’t just find the first policy you think looks right for you and stick with it — think critically, and look for something better and cheaper.
You have all the way until Dec. 7 to make a decision, so take your time. Start doing research now, and don’t leave the application until the last minute. This way you can be sure that you’re making the choice that’s right for you (and not just made under pressure).
However, if you do make a decision that you’re unhappy with later, you do have a chance to change it. From Jan. 1 to Feb. 15, you can switch out of a Medicare Advantage plan and back to an Original Medicare plan if you regret signing up with the former during open enrollment.
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Category: Medicare Advantage, Medicare Supplements
If you’re currently on Medicare, you are probably keenly aware of everything that it covers. From surgery to physical therapy, this government entitlement benefit provides health insurance for Americans 65 and older who have worked into the system and are now retired. But although Medicare is relatively comprehensive, it doesn’t cover everything — which is why some people choose to purchase affordable Medicare Supplement Insurance plans to help fill in the gaps.
Also known as Medigap, Medicare Supplement Insurance is sold by private companies to cover the costs that Medicare doesn’t — like copayments, coinsurance, and deductibles. If you have significant healthcare needs, Medicare Supplement Insurance can be more economically viable than paying for each non-Medicare item separately. And because law regulates prices, you don’t need to spend too long deciding which company you’re buying your policy from — instead, you should consider what type of Medigap plan you need.
The different plans, which range from A to N, vary in the gaps they cover and the cost of the policy. Supplements include lifetime reserve, long-term hospital stays, hospice coverage, skilled nursing, preventative care, foreign travel emergencies, deductibles, and coinsurance. Plan F is the most comprehensive, covering all possible supplements; however, it is also the most expensive. Plan F has a high-deductible (HD) version, which has a $2,200 deductible for 2017 and has lower rates in most states than a traditional Plan F policy.
Plans G and N also cover a significant number of supplements and may grow in popularity due to new legislation which bans the sale of supplements that cover the Part B deductible, starting in 2020. Plan G fills all the gaps in Original Medicare except for the Part B deductible, which is fairly small — only $183 in 2017. In comparison, Plan G premiums can cost up to $20 less per month than Plan F. Plan N also does not cover the Plan B deductible as well as Part B Excess Charges, but it covers office copays instead — providing a maximum of $20 for doctors and $50 for ER visits.
Unfortunately, the one thing Medicare Supplement Insurance doesn’t cover is prescription drug plans. These plans still have to be purchased separately under Medicare Part D. Another consideration is that depending on your income, you may be charged more for Part D (as well as Part B), which may affect your decision of which Medigap policy to purchase. Something else to keep in mind is that Medigap only covers insurance for one person, so if you want to get supplemental insurance with your spouse, you will need to purchase two policies.
Medicare Supplement Insurance is popular because it helps insure medical expenses that Original Medicare doesn’t cover — so if you expect to need any of services that happen to be Medicare gaps, like hospice care or foreign travel emergency care, it makes sense to buy Medigap so that these gaps are filled. On your own, you can rack up a bill worth tens of thousands of dollars, which is why many people choose to purchase an insurance policy instead. Medigap is also helpful if you expect to have a high deductible or high copayments, which specific policies can cover for you.
Medicare Supplement Insurance is also becoming more critical as more and more people are eligible for Medicare. In the United States, nearly 11,000 people will turn 65 each day for the next 13 years, and almost 20 percent of the population will be 65 or older by 2030. The addition of so many Medicare-eligible Americans means that the system will be stretched to its limit — which makes it even more crucial to have insurance that can help fill in the gaps in Medicare coverage. Medigap policies are automatically renewable, which means that even if you develop health issues that start costing the insurance company a lot of money, they are not legally allowed to prevent you from continuing to pay your premiums.
Finally, it makes sense to pick the insurance company that provides the better discount, customer service, and rate stability for Medigap insurance. However, the list of companies offering Medicare Supplement Insurance is long, and you don’t want to spend time calling each one to determine their policies and offers. That’s why it makes sense to go through a reputable brokerage that provides you with each company’s rates at no additional cost and advise you as to the best place to purchase your insurance.
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Category: Medicare Supplements
If you’re nearing age 65 (or retiring and losing group insurance) you may need help with Medicare planning. It’s always best to get started early so that you fully understand all of your options. Choices you make now will affect your options in the future.
We help our clients through this progression. There is a natural order to Medicare enrollment and in this article, we will walk you through it step by step. We’ll help eliminate the confusion so you’re Medicare ready day one.
The first step in Medicare planning is enrolling in Medicare Parts A & B. Most people are entitled to Part A automatically when turning age 65 because of work credits. Nothing usually needs to be done here. Medicare will mail out your red, white and blue card showing your Part A effective date as the first of the month when you turn age 65.
Medicare Part B is the gatekeeper, however. This is the one that requires your careful attention. Not everyone is automatically enrolled (or entitled to Part B) at age 65. In fact, some people defer Part B enrollment until they retire some months or years after turning 65. But it’s the part of the puzzle that allows you to move to the next step, so you’ll want to make sure you’re on top of it.
Failing to enroll in Medicare Part B when you are required can lead to enrollment delays and/or late enrollment penalties. These penalties can increase your Part B premiums (what you pay to the government) for your lifetime. It’s very important to get this enrollment timed correctly.
You’ll only want to defer Part B enrollment if you have creditable coverage elsewhere; maybe through your employer. If this is not the case and you’re turning 65, you need to start the enrollment process. There are several ways to enroll in Medicare Part B:
There are thousands of people turning 65 every day. The representatives at Medicare are usually pretty good at telling you how & when to enroll. Whether you defer Social Security beyond age 65 will also determine your path forward. If you are electing SS payments, then you may want to make an appointment at your local SSA office. Your Part B premiums will be deducted from your SS check when you begin payments.
If you are deferring Social Security beyond age 65, then you can try options 1 or 2 as they are more convenient. In this case, Medicare will bill you quarterly for your Part B amounts. Make sure you keep track of and pay those bills. We’ve seen cases where some people missed their Part B payments and that led to a coverage gap and a lifetime penalty.
Okay, so your Medicare Parts A and B are in the works – or finalized. What now? The next step in Medicare planning is deciding how best to supplement your coverage. You are now in your Open Enrollment window. This period of time lasts approximately 7 months. It includes the 3 months prior to your Part B effective date, the month of, and the three months following. The world is your oyster.
During your specific, one-time Open Enrollment window, you can purchase any Medicare Supplement, Part D or Advantage plan you want. It’s wise to explore all of your options. What you choose now can limit your choices down the road. Again, you usually only get one shot at this – and if your window expires and you’ve done nothing – you can face medical underwriting, insurance declines, late enrollment penalties and coverage delays.
There are several gaps in Medicare and to go it alone with only A & B will expose you to significant out of pocket costs. So you’re next decision is deciding whether you are a Medicare supplement or Medicare Advantage person. You cannot have both. Each has their own pros and cons. We compare Supplements to Advantage plans here if you would like some background.
This is a good time to speak with an independent agent, your friends & family, and also gather information online. There is not necessarily a right or wrong way to fill the gaps in your Medicare coverage. Once you’ve done your research and talked with those who understand both Supplements and Advantage plans well, your decision won’t be too difficult. Just remember, you cannot have both. It’s one or the other. And make sure to ask you agent about how your choice now will affect your options later.
If you’ve chosen a Medicare supplement plan over an Advantage plan, it’s wise to purchase a stand-alone Part D drug plan as well. (Most, but not all, Medicare Advantage plans include Part D drug coverage – so you don’t need to buy one separately. Advantage plans that do not include Part D coverage usually won’t allow you to buy a stand-alone drug plan without cancelling-out your Advantage coverage. Advantage plans without a Part D element are usually appropriate for veterans and those who have creditable drug coverage elsewhere. This is another good time to talk with your agent so that you don’t accidentally cancel any coverage you want.)
Failing to purchase a Part D drug plan during your Open Enrollment window will likely lead to delays and penalties when you do want to enroll. Medicare assesses a 1% penalty for each month that you were required to own a drug plan and did not. This Late Enrollment Penalty (LEP) accumulates over time and results in increased premiums for life. Even if you don’t have need for a Part D rx plan, it can be wise to buy the cheapest placeholder available simply yo avoid the penalty.
In a nutshell: If you choose a Medicare supplement, you may also want to purchase a stand-alone Part D drug plan as the two (by rule) are sold separately. If you purchase a Medicare Advantage plan, then chances are it already includes a drug plan and nothing more needs to be done. Any knowledgeable agent can walk you through this process quickly and easily so that you are compliant.
We get these questions a lot. The answer is government run Medicare does not cover much in the way of dental, vision or long term care. If you want this insurance, then you will need to pay separately in most cases. Medicare only goes so far.
It’s important to note that some Medicare Advantage plans include basic dental, vision and hearing. Others offer more robust coverage at an additional cost. Conversely, Medicare supplement plans do not offer any ancillary coverage – basic or otherwise. It will need to be purchased separately if you choose a Medigap plan like F, G, or N.
And no combination of Medicare, Supplement and/or Advantage plan covers much in the way of long term care. The most you can hope for is 100 days of skilled care coverage. If you need the more common types of care (custodial and intermediate) then you won’t even be afforded 100 days.
Our clients who are concerned about estate protection will usually turn to a long term care insurance policy. Fortunately, there are several options to address these costs. There are traditional LTCi policies, hybrid LTC annuities and life insurance, short term care plans, hospital indemnity insurance as well as cancer, stroke and heart attack policies. One size does not fit all in such a broad category – so we help our clients find the options that suit them best.
When you are Medicare planning and enrolling, you’re just marching down the cafeteria line. You get your meat and potatoes (Medicare A & B) from the government and then your vegetables and dessert (supplemental & Part D insurance) from a broker. We’re happy to guide you through all phases so you find the insurance plans that best meet your needs and budget.
Ready to get started? Contact us today!
Category: Medicare Supplements, Retirement Planning
If you own a Health Savings Account and you’re approaching Medicare eligibility, you likely want to know what you can and can’t do with your unused funds.
The good news is you can keep your HSA once on Medicare. This is helpful for those who have accumulated significant assets in their accounts. Furthermore, there are several Medicare specific expenses you for pay for tax-free using your HSA balance.
Not everyone begins Medicare at age 65. If you have qualified group health insurance (over 20 members), you can defer Medicare enrollment. In this case, you can keep your HSA qualified health plan and contribute up to the allowable maximums each year.
But once you elect Medicare Part B and leave your group health plan, you can no longer contribute to your HSA. Those are the rules. You must have a HSA qualified, high deductible health insurance plan in order to make contributions each year. And if you leave your qualified group plan in the middle of the year? You will need to have already contributed the allowable amount before making Medicare your primary insurance.
Your HSA funds always belong to you – not the insurance company. You can move your account to any custodian that accepts HSA’s. Most owners use a savings account, but some with larger balances invest in mutual funds or other market sensitive instruments. It’s up to you where you’d like to keep your deposits once on Medicare.
HSA funds can only be put toward qualified medical expenses in order to be withdrawn income tax-free. As was before, you can continue to use your HSA to pay for expenses like dental work, eye exams, chiropractic and acupuncture visits, but Medicare eligibility opens up a few more doors.
The I.R.S. allows you to use your Health Savings Account to pay for:
If your income is above certain thresholds, you will be charged more for your Medicare Part B and Part D premiums. You can use your HSA balance to pay these increased premiums as well. This can help to alleviate some of this financial burden until your income potentially decrease in retirement.
You can also pay for Medicare related deductibles, copays and coinsurance with your HSA. Even with a comprehensive Medicare Supplement plan, you may still have out of pocket costs. HSA plans can cover those – like your Part B deductible for insurance. You can also cover the cost sharing expenses associated with Medicare Advantage plans like deductibles and copays.
If you wish, you can use your Health Savings Account to pay for the care of a family member. The I.R.S allows for tax-free distributions from HSAs to cover health expenses for a spouse or a dependent. This is true even if you’re on Medicare and they are not.
You cannot, however, pay for a Medicare supplement (Medigap) policy using your HSA funds. That is one rule we’d like to see changed. Most Medicare supplement insurance plans are usually over a $100 a month. Allowing consumers to cover those regular expenses with an HSA would be helpful. Maybe we should petition Congress for this change…
However, if your supplement has deductibles, coinsurance or copays, then you can cover those amounts income tax-free with your HSA dollars. Some of our clients choose Medigap plans with larger out-of-pocket costs so as to maximize their HSA spending. This can be even more beneficial as some of the lower tier plans offer great value. There are some very compelling arguments to purchase Plans G or N (over C or F) regardless of your HSA status.
It’s important to understand that if you withdraw HSA funds for anything other than a qualified medical expense, a taxable event will likely be created. And if you’re under age 65, the government can levy a 20% penalty on top of any income taxes you may owe.
Yes, assuming you are purchasing a tax-qualified long term care insurance plan. (The government deems which types of LTC plans are tax qualified and which are not.) The good news is almost all LTC plans sold today are tax-qualified. Plans that don’t meet this standard are easily identified. They usually involve increased income (from an annuity) or an accelerated death benefit (from life insurance). Ask your agent or the underwriting insurance company when in doubt.
Your age will determine how much you can withdraw from your HSA to pay from long term care insurance tax-free. Those age 65 and above can spend approximately $4,000 each year while those above age 70 are allowed to spend closer to $5,000. Using HSA dollars is a great way to fund some or all of a long term care insurance policy costs.
Hyers and Associates is an independent agency. We specialize in Ohio Medicare supplement plans as well as Advantage, Part D, life and long term care. We work in several states across the country and can help you learn more about your best insurance options and strategies. Contact us today!
Category: Medicare Supplements, Retirement Planning
We see quite a few mistakes people make with their Medicare insurance plans. Many of these are avoidable by knowing the most important rules, regulations and timelines while having a good team around you.
If you’re researching your options as you near Medicare eligibility, you know there is a lot of information to sort through. We’ll discuss the most common issues we see and how to avoid them.
Medicare is a maze, but it’s not always easy to backtrack if you reach a dead-end. A wrong turn can result in enrollment delays and lifetime penalties. The most common mistake we see is people missing their personal enrollment deadlines. Everyone’s Medicare enrollment timeline is a little different and it does not always correlate with turning age 65.
Some people defer Medicare Part B because they have group health insurance available through a large employer (more than 20 employees). Others think they can defer Medicare and take COBRA instead. The first option is usually okay, the second is not. This is just one example of a so-called Medicare trap that awaits those who are eligible. In other cases, we see people enroll in and pay for Medicare Part B when they may not need to.
Part B is the gatekeeper and there is almost always a right and a wrong time to enroll. And if you do nothing, the government can automatically enroll you at age 65 if you’re already taking Social Security payments. That might be a mistake if you have creditable large group health insurance available that you plan on keeping. It’s important to know when to start your Part B with the government.
Assuming you have navigated the above satisfactorily, then it’s time to think about your supplemental insurance. Once Part B starts, then you have a six month window to buy any Medicare supplement without medical underwriting and a three month window to buy a Part D drug plan. We see a lot of mistakes here.
Many people let these windows pass thinking they can buy a supplement any time they want – or later during the yearly Open Enrollment. That’s not the case. The so-called Open Enrollment in the fall each year does not apply to Medicare supplements. Enrolling late in a Part D plan incurs lifetime penalties.
Missing your window to purchase a Medicare supplement, Advantage or Part D drug plan can cause future ineligibility (due to medical underwriting) and late enrollment penalties from the government. Everyone’s timeline will be a little different, but in almost all cases, once Medicare Part B begins the clock is ticking to purchase supplemental insurance. There are usually no free passes once your personal enrollment window has expired.
Once you’ve enrolled in Medicare and any other supplemental/replacement type plans of your choosing, your coverage cannot be cancelled… unless you don’t pay your premiums. It might seem silly to even bring this up, but it’s one of the most common issues we see. People miss their premium payments – and if the policy lapses, it can be difficult to reinstate.
Most Medicare beneficiaries have their Part B premiums taken directly from their Social Security checks. That’s easy enough. But if you’ve delayed SS, then your premiums will be billed to you quarterly. You must keep track of your Medicare premiums and pay them on time. One of our clients did not. She had to then wait for the Medicare General Enrollment Period (January 1 – March 31), reinstate her Part B for a July 1 effective date, and pay a 10% lifetime penalty on top of her normal premiums. It was not a good situation for her and there was nothing we could do to help.
Another gaffe we see all too often is the failure to pay Medicare supplement and Part D premiums on time. Most of our clients set up their policies on bank draft and have no problems. Others wish to be billed and it’s not uncommon for a payment to be missed when someone is traveling, sick or otherwise preoccupied.
The issue is once a Medicare supplement, Part D or Advantage plan lapses due to non-payment, the insured is at the discretion of the insurance company for reinstatement. If denied, then medical underwriting may be required. If the insured is unwell, then it can be very difficult to find a new policy. On top of that, late enrollment penalties can be assessed on your Part D drug insurance coverage.
No matter how you choose to pay your bills, you must keep your payments up to date. Setting things up on a bank draft is more foolproof in our opinion. Just remember to take inventory and contact the insurance company(s) if you change banks.
When you’re aging into Medicare, retiring or losing creditable group coverage, it’s time to build a team. You’ll want to consult with your human resources manager, check with state and local resources, lean on friends and family, and most importantly contact a knowledgeable insurance agent.
We see too many people try to be their own insurance agents. Most of the time, they have bad information or an incomplete picture of Medicare. Don’t try to be your own insurance agent! Just trust us on this one. It saves you no money whatsoever and will likely lead to heartburn down the road. As agents, we are not allowed to charge you any more or less than the going rate for any plans you are considering. And we know a lot more than what you might find out by reading a few articles like this one.
Those of use that have been doing this a while are extremely knowledgeable; we’re as close to experts as you’ll find. Think of us as field-guides who can show you what to do and when to do it while explaining the repercussions of a particular decision. Medicare is full of “if this, then that’s” and we can tell you how one decision will affect another.
We live in a “do it yourself” world, but there are some things that are best left to the experts. It can be difficult to learn all there is to know about Medicare on your own. Build a good team around you, find an independent agent you trust and put them in your bullpen. You can rely on their knowledge now and in the future. It doesn’t cost you a thing and you’ll be much less likely to run into problems going forward.
Medicare only goes so far. We get a lot of questions from our clients about foreign travel and long term care. We’ll discuss both, but of the two, long term care is more important. It poses the single biggest risk to any portfolio, family, estate, inheritance and so forth. In a few words, Medicare does not cover much in the way of long term care expenses.
Medicare, when coupled with most Medicare supplements, covers only the first 100 days of skilled care in a hospital, rehab or nursing home. That’s it. Medicaid only picks up the tab once you’ve depleted your assets. It’s unwise to count on either of these two programs to pay for routine long term care expenses. Skilled care is administered by a doctor, but most people need custodial care which is help with the activities of daily living. Medicare does not cover custodial care at all – or skilled care for more than 100 days. If you want this type of coverage, you’ll need to purchase a long term care insurance policy.
When it comes to foreign travel emergency Medicare, if combined with supplemental plans C, D, F, G, M or N, only pays a maximum of $50,000 lifetime after a $250 deductible has been met. This should be okay for most short trips abroad, but if you’re someone who travels abroad for long periods of time, you may want a health policy tailored to your trip. We help our clients with those as well.
Once you’ve decided whether a Medicare supplement or Medicare Advantage plan is most suitable (you can’t have both), you’ll want to explore all of your options. Too many times I see consumers gravitate toward the insurance company they had before becoming Medicare eligible. This can be a mistake.
There are several options in the Medicare markets and many policies are identical. In almost all cases, Medicare supplements offer the same coverage with the exact same access to doctors and hospitals. In other words, a Plan G is a Plan G. It doesn’t matter whether you buy from one of the big guys or a lesser known name. Many of the smaller supplement providers offer lower rates and smaller increases, however. Don’t rule out the smaller carriers just because they are new to you. You might be spending more than you need to and you can be missing out on extras like Silver Sneakers.
You should also ask your independent agent about any Medicare supplement discounts available. Let us know if you have a spouse who will soon be eligible for Medicare or if you share a household with someone. In some states this will qualify you for a 5%-12% discount even if the other person does not apply.
And you need to review your insurance on a regular basis. It may be okay to stick with your Medicare supplement for a few years, but Medicare Advantage and Part D plans usually change their coverage yearly. What works well now may not be your best option next year. If you don’t shop, then you can be in for a rude awakening when filling prescriptions or visiting doctors.
This is another good reason to have a relationship with an agent. We’ll have your information on file and also be aware of the ever-changing Medicare landscape. We can quickly see if any changes are needed or if there are policies that will save you significant dollars. We have saved some of our clients well over $100 a month without decreasing their benefits simply by replacing their older, more expensive plans. Shop once in a while, it can do your pocketbook a world of good.
Hyers and Associates is an independent Medicare supplement insurance agency. We specialize in Medigap, Advantage and Part D plans. We’ll make sure you understand all of your options while also helping you to avoid the many Medicare mistakes laying in wait. Contact us today to discuss your options, compare plans and enroll direct in the insurance that best fits your needs and budget.
Category: Medicare Supplements
We get the question from our clients all the time, “Do Medicare supplement insurance plans have networks?” A rare few do, but most don’t. If you are asking this question, then it’s important to better understand how these insurance policies work.
In this post we will discuss in detail what you can expect from your Medicare supplemental insurance plan. This will make it easier for you compare and buy a plan so you don’t encounter any unexpected bills or network restrictions in the future.
The first and most important thing to know is that Medicare is usually your primary insurance once you enroll in Parts A & B. This means that your Medicare supplement insurance is secondary. You are simply pairing a supplement to your government-run Medicare insurance. Put another way, almost all supplements just piggy-back off of the network of doctors and hospitals that accept Medicare A & B. Most everyone accepts Medicare, so they will also except the supplement you choose.
These Medigap policies (like Plan G, F and N) have no networks at all. Supplements start paying once Medicare stops – no matter the insurance company, Medicare is your network and almost all supplements just compliment Original Medicare. They do not create a secondary network of providers for you to worry about. In other words, your supplement does not determine who you can see – Medicare does. You get to see the same doctors and use the same hospitals with Humana, Aetna, United Healthcare or any of the smaller insurance companies you may not have heard of yet.
(The above assumes you don’t also have group employer coverage and you’re not enrolling in a Medicare Advantage plan. In the case of group coverage and Medicare Advantage plans, you can still have network restrictions. It depends on which insurance is primary, but there are not these same concerns with a supplement.)
The short answer is, YES! Because Medicare is primary and your supplement is secondary, networks will not differ in any way between insurance companies. You have the same access to providers with almost all plans.
When you got to see your doctor, you just present your Medicare and supplemental ID cards and they take care of the rest. In fact, most Medicare supplements coordinate through Medicare which means you don’t have to worry about the billing process whatsoever.
It does not matter which Medicare supplement insurance company you choose. It can be a very large well-known company like United Healthcare – or it can be any number of smaller insurance companies you may not be familiar with. The networks are the same. If they accept Medicare, then they’ll accept your supplement. The billing will be the same and hassle-free.
Our advice: Don’t narrow your Medicare supplement insurance options to only a few large companies. There are several smaller companies with very good reputations and below average rate increases. The smaller players are very much worth a look in our opinion!
Many of the larger companies have thousands of policyholders. This usually results in several claims. Higher claims means larger premium increases. Smaller companies that are a little further from the main stream don’t usually have these same issues can can usually hold rates lower for a longer period of time.
Yes, there is one type of Medicare supplement that has network restrictions. These are called “Select Plans” and they are not very common. Select Plans are usually offered from larger providers like Anthem, United Healthcare and Mutual of Omaha to name a few. (These same larger carriers offer traditional plans with no networks too, of course.)
Select Plans will require you to stay in-network for routine care usually administered by your primary care physician. Emergencies will always be covered, however, and are not subject to any network restrictions. The advantage of Select Plans are the lower premiums they offer.
If you find a traditional plan with no network restrictions at the same price as a Select Medicare supplement, the traditional plan might be a smarter purchase. There’s no point in narrowing your options unless it saves you significantly on your premiums.
The final word on the matter: Almost all Medicare supplement plans have no network restrictions.
Hyers and Associates is an independent Medicare supplement agency. We specialize in Medigap and Part D plans and work hard to make sure our clients understand the insurance they are purchasing. Contact us today to discuss your options, compare plans and enroll direct in the supplement that best fits your needs and budget.
Category: Medicare Supplements
Reviewing and understanding your supplemental insurance options can be overwhelming when you are new to Medicare. There are several options to choose from and it’s hard to know which plans with which provider will be most suitable for the long haul.
In the following article, we provide tips and advice to help you navigate this somewhat complicated product category. With this knowledge, and our experience, you can form an educated plan of attack in order to find the supplemental plan that best fits your needs. (Note: Medicare supplements are sometimes referred to as Medigap plans and we will use these two terms interchangeably.)
For the purposes of this post, we’ll assume you have decided to enroll in a Medicare supplement over an Advantage plan. By rule you can’t have both – so you’ll want to decide which policy fits you best. Most of our clients prefer that Medicare supplements have no network restrictions and little out-of-pocket exposure, but one size does not fit all.
That’s not to say one is better than the other, they are just different. Advantage plans can be less expensive and usually include Part D drug coverage rolled into one bundle. We offer both types of policies and can help you compare and contrast them if you’re unsure which you prefer.
When starting this process, you first want to know that Medicare supplements are very much a cookie-cutter type of product. Plan F from company A has to cover the exact same benefits as a Plan F from company B – while also providing the exact same network.
Insurance providers cannot monkey around with the benefit design. These policies simply piggyback off of Original Medicare and help fill in the leftover gaps depending on the level of coverage you choose. There’s no wiggle room for the insurance companies to deny claims. If you encounter a Medicare approved expense, your supplement will cover its designated gaps.
And with almost all Medicare supplements (the rarely purchased Select Plans being the only exception) there are no networks to worry about. You will have the same network of hospitals and doctors with Aetna as you would with Anthem BCBS, United Healthcare, Mutual of Omaha or any other provider you may or may not have heard of.
Medicare is your primary insurance and your permanent network. If your doctor or hospital accepts Medicare, then they will accept any traditional supplement you present them. You are never shopping networks with a supplement like you would with an Advantage plan.
At present, there are ten different Medigap plans sold today – Plans A-N.
| Medicare Supplement Plan: | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A Hospital Coinsurance | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Lifetime Reserve Days | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| 365 More Hospital Days | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Parts A and B Blood | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Part B Coinsurance | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔* |
| Part A Hospice Coinsurance | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ |
| Skilled Nursing Coinsurance | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ | ||
| Part A Deductible ($1,288) |
✔ | ✔ | ✔ | ✔ | ✔ | 50% | 75% | 50% | ✔ | |
| Part B Deductible ($166) |
✔ | ✔ | ||||||||
| Part B Excess Charges | ✔ | ✔ | ||||||||
| Foreign Travel Emergency | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
Key: A ✔ means the benefit on the left is covered. For example, Plan F checks all boxes and fills in all gaps in Medicare Parts A & B. The * denotes that Plan N has office copays.
You can see from the above that some plans are very similar. Plans F and C are very similar as are Plans G and D. In our experience, Plans F, G and N are the most commonly purchased policies. We see very little demand for Plans A, B, K, L and M as they are not as comprehensive.
It’s important to note that Plans C, F and N also come in “Select” versions which require network use for routine care. We don’t see much demand for Select plans either. Finally, there is also a High Deductible Plan F option that requires the insured to cover a $2,180 deductible before the supplement will pay its share.
Plan F is the most popular Medigap plan at present capturing an estimated 4 out of every 10 buyers. The reason: It’s the most comprehensive plan available. However, new legislation passed in 2015 states that beginning in 2020, no Medicare supplement plans can cover the Part B deductible. This means Plans F and C will no longer be for sale, but if you’ve enrolled previously, then you can keep your existing plan.
In our opinion, it’s important to consider policies other than Plan F. We’ve written extensively about the value Plan G provides in terms of cost, benefits and renewal history. In many cases, the lower monthly premiums Plan G provides more than make up for the small Part B deductible it does not cover.
And Plan G (as well as Plan N) are not Guaranteed Issue plans. This simply means they are more exclusive in their enrollment and do not have to accept as many applicants as Plan F. Therefore Plan G tends to have a healthier pool of applicants causing the premiums to rise more slowly. Our agency is regularly updated with rate increases and we see Plan F increasing more quickly than Plan G in many instances.
The temptation is to buy the cheapest Medicare supplement in the letter you prefer most. It pays to take it a step further. You’ll want to know how long said insurance company has been offering that line of supplements and their renewal history.
Many providers release new lines of supplements under a slightly different name every few years so as to offer lower premiums. This sometimes causes above-average rate increases for those stuck in the old, no-longer-for-sale line of business. You should ask your agent about the age of the supplement as well as the yearly renewal history.
In most cases, agents have access to about 4-5 year of rate increases. We can tell you which plans with which companies have been most stable. These Medigap plans may not be the least expensive, but they can save you money going forward if their rates are more stable. In other words, pay a little more now so you pay less later.
We see a lot of demand for Issue Age Medicare supplement insurance plans over Attained Age coverage. Most of the time, it’s because these policies are misunderstood. Issue Age plans will usually increase in price each year just like Attained age plans, but not because you are a year older.
And most of the time, Issue Age plans are more expensive to begin with. Well, if the more expensive Issue Age plan passes along an 8% annual increase compared to, say a 4% increase with the Attained Age plan – it’s pretty clear which one is better.
Community rated plans offer the same rates to everyone no matter their gender or location. If I’m a female living in Pittsburg, why would I want to pay the same rate as a male in Philadelphia? The answer is you wouldn’t. Again, talk to your agent about rate increases before settling on a rating class.
You sometimes hear the saying, that if you are your own lawyer, doctor, accountant, etc – then you have a fool for a client. The same could be said for insurance broker. You don’t know what you don’t know and that lack of information can lead to poor decisions. Many of our clients have first spoken to friends, family and neighbors and come to us with a lot of conflicting and wildly inaccurate information.
Don’t miss out on important information, use an independent agent. Know that it does not, by law, cost you any additional money to place your business with us. By rule, we offer the same rates as if you called the insurance company yourself. But those of us who are independent can quote you the direct rates with several carriers at one time.
We can also talk about the experiences of our clients with various carriers, their rate increases and reputations, as well as other nuanced items like premium discounts and the like. Don’t go it alone. You are not saving any money and likely missing out on valuable information an agent can provide now – and in the future. Medicare changes yearly and sometimes significantly. It’s nice to have an unbiased agent in your back-pocket when you have questions.
Many carriers offer spousal and/or household discounts on their supplemental plans. In some cases, you don’t have to be married (just living with someone) to qualify for a premium reduction. Savings will vary between companies and by state regulations, but can be as much as 12% in some areas.
It’s important to bring your household makeup to the attention of your agent. Maybe you have a spouse who will be Medicare eligible in a few months, or maybe you live with an adult child, sibling or significant other. These factors will help agents make recommendations so you can maximize your savings.
In most cases, the least expensive way to pay is monthly (via automatic bank draft) or annually by check. If you choose to pay quarterly or semi-annually, your rates can be higher. And many companies will not bill you monthly – they’ll want to draft automatically in order to avoid higher administrative costs. We recommend that our clients consider bank draft – it’s safe, secure and reliable. It will also help to prevent policy cancellations if you are travelling or your invoice is lost in the mail. Most insurance companies offer several payment options, however.
Sometime our clients choose the same Part D prescription drug provider as the one offering their Medigap plan. Don’t do this without first comparing all drug plans for the prescriptions you take. There is no bundled savings by using the same provider and in many cases you’ll be paying more than you need to.
We help our clients compare their Part D plans at Medicare.gov. It’s a good website to see who offers you the most savings at the pharmacy (or mail order option) of your choice. Part D Rx plans can differ by wide margins, so it’s important to shop these plan independently of your Medicare supplement.
We are an independent Medicare supplement brokerage and have been working in this market for several years. Using our knowledge and experience, you can find the supplemental coverage that best suits your needs and budget. You will also have us as a resource in the future when you want to discuss changes to your insurance plans.
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Category: Medicare Advantage, Medicare Supplements
When shopping for Medicare supplement plans, it’s important to know many providers offer spousal and/or household discounts for married applicants – or those who share a residence.
These discounts usually range from 5-12% depending on the insurance company guidelines.
There are several providers offering supplemental premium discounts to those who qualify. AARP United Healthcare, Aetna, Anthem Blue Cross & Blue Shield, Bankers Fidelity, Cigna, Heartland National, Humana, IAC, Manhattan Life, Medico, Mutual of Omaha and Sentinel Life are just a few that do. (There are some carriers that do not offer any discounts no matter your circumstances.)
The most common type of discount for Medicare supplement insurance requires both spouses make application and be accepted. Couples don’t have to choose the same plan, but both parties must enroll with same company.
For instance, one spouse may apply for Plan F and the other Plan G or Plan N. So long as both are accepted to the plan of their choice, a spousal discount will apply to each policy. The discount percentage will not differ depending on the chosen plan. If the selected insurance company offers a 5% discount, then both policies will be reduced by that amount.
A new trend with Medicare supplements is to offer a household discount to applicants who are living with someone else. The other household member does not need to apply (or own a policy) for the applicant to enjoy the same discount offered to couples.
In this case, living with a spouse, sibling, adult child, roommate or significant other may qualify the applicant for a premium discount. In most cases, the household member not applying must be above age 50 (sometimes 60) for the applicant to qualify. Additionally, most insurance companies will require that the two household members have lived together for at least the last 12 months.
Some states allow for a Medicare supplement household discount while others do not. It’s important to inform your agent about your living situation to see if you might qualify. Undoubtedly, there are those who are missing out on available discounts because they did not work with a knowledgeable broker.
Medicare supplement discounts are not usually lifetime programs. With most, you must meet the ongoing requirements of either being married and both insured – or living with someone of the proper age and for the required length of time.
In the event of divorce, death or permanent move – the applicant(s) can lose their premium reductions. Insurance companies do not necessarily audit their members, but they will be aware when another applicant is no longer on the plan for any reason.
Another easy way to save on your supplemental insurance costs is by choosing the payment method(s) most preferred by the provider. In most cases, paying by monthly bank draft or one annual lump sum is least expensive option. If you prefer to be billed monthly, quarterly or semi-annually, then you will almost always pay more overall.
And we are often asked about premium discounts with Medicare Advantage and Part D drug coverage. Unfortunately, there are no marital or household discounts of any kind for these policies. You must pay full price even if someone you live with chooses the same plan with the same company.
It’s also important to know that some states (Florida is a good example) do not allow for spousal discounts on any of their Medicare supplement plans. It’s hard to say why, but Insurance Departments across the country all have different rules.
There are several ways you can qualify for discounts on your Medicare supplement insurance plans and you don’t necessarily need to be married to do so. Each carrier (and state) will have their own rules and guidelines, so it’s a good idea to speak with an informed broker who represents several insurance companies to find your best deal.
It does not cost a penny extra to place your business with an agent or broker and you can end up saving money simply by being aware of the savings options available in your home state.
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Category: Articles, Medicare Supplements
As part of the Medicare Access and CHIP Reauthorization Act of 2016, supplemental plans that cover the Part B deductible will no longer be for sale in 2020. This legislation means that Plan F, Plan C and High Deductible Plan F will no longer be fore offered to those who are new to Medicare in 2020.
If you have purchased one of these three plans before 2020, you can keep your coverage. You’ll also be able to shop for a new Plan F, C or HD Plan F. These changes only affect those who are new to Medicare in 2020 or after. It does not change anything for those who were already eligible.
Your existing Plan F, C and HD F policies will no be cancelled by your insurance company. You can keep them for as long as you wish.
Yes and no. It will only be available to those who were Medicare eligible before January 1, 2020. This applies to those who were on Medicare due to age, retirement and/or disability. If your Medicare Part B begins after 2020, you will have to choose another policy like Plan G or Plan N.
This is not the first time Medicare had discontinued supplemental plans. In 2010, Plans H, I and J were taken off the market for everyone. Of the three, Plan J was most popular because, like Plan F, it was most comprehensive. Those who owned it could keep it, but no other plans were available for purchase under any circumstances.
In our experience, reducing availability of any supplement can have adverse consequences for current owners. With no new members coming in, there are fewer younger and healthy people to offset claims from the group. This usually drives rates up more quickly.
Consequently, those who are in good health may enroll in less expensive coverage due to above-average rate increases. This can leave a remaining pool of unhealthy members who may have more trouble qualifying for a new policy due to health issues. Those left behind may experience higher rate increases than those who are in a policy that is still available for sale and accepting new members.
When Medicare officials modernized supplemental plans in 2010, a very strong argument for Plan G could be made over Plans F and C. Plan G covers everything these plans do except for the small Part B deductible ($185 in 2019).
When you compare costs, the lower premiums with Plan G almost always make up for the Part B deductible – and then some. In other words, why pay an extra $25 a month for Plan F to cover a $185 one-time yearly deductible. It doesn’t make good financial sense.
And Plan G and Plan N are not Guaranteed Issue policies. The only time you can purchase Plan G without the need for medical underwriting is when you’re within 6 months of your Part B effective date. There are a lot of other circumstances where you can purchase Plan F well after your Part B effective date and not be turned down.
This simply means Plan F has to accept many members who might be in poor health. This difference translates to higher rate increase with Plan F when compared to Plan G. As an agent, I see rate increases cross my desk often. It’s not unusual to see insurance companies raise their Plan F rates by a couple of percentage points more than their Plan G and N rates. Again, this makes Plan G more attractive for the long haul due to smaller premium increases.
It’s worth noting that Plans D and G will replace Plans F and C as Guaranteed Issue policies in 2020. Like Plan F before them, these two coverages will now have to accept members in certains situations when they did not before. All of these changes now make Plan N look like the best policy in for lower rate increases over the long run.
If Plan F follows the trend of Plan J upon phaseout, there will be some policyholders who experience unpleasant, above-average rate increases. The questions is: How far ahead should we start to plan? There’s no time like the present to discuss your options. If you’re in good health, it may be wise to explore changes now.
Certainly Plans D, G, and N are good choices. Their out-of-pocket exposure is low and their premiums are affordable. If you are in good health and able to switch coverage before 2020, it might be a good idea to consider a new policy that will remain on the market for everyone.
And there will also be the addition of High Deductible Plan G to replace High Deductible Plan F. Both of these policies will offer low premiums (under $50 a month in most states), but High Deductible G will cost less and most likely have lower premiums increases year over year.
There’s a lot to think about when purchasing a supplement for the long run. We help take the mystery out of Medicare insurance shopping for our clients.
We are an independent Medicare supplement brokerage with over 20 years of experience. Don’t just place your coverage with anyone. Talk an agency that specialize in these policies and does so everyday. We can help you find the insurance plan that’s reliable now and in the future.
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Category: Medicare Supplements
If you are over 65 and leaving your group health insurance, you’ll need to plan carefully when considering COBRA as your semi-permanent insurance. If you do not enroll in Medicare Part B upon separation from employment, you can face late enrollment penalties including fines and delays.
Unfortunately, the transition from group health insurance to Medicare – and the role that COBRA may play – is poorly understood by many who advise on the subject. You may receive bad information by speaking with the consultants at Medicare.gov., your HR person at work, and those who work in the insurance industry. It’s wise to talk with several people before making a decision.
The mistake most often made is when you’re over age 65, do not enroll in Medicare Part B and choose to make COBRA your primary insurance. While the COBRA plan may satisfy your medical needs, delaying enrollment into Medicare Part B can create delays and fines down the road.
Enrollment into Medicare Part A is automatic and usually without cost at age 65, but Medicare Part B enrollment is not always automatic and monthly premiums must be paid. The important catch here is the expiration of your COBRA insurance does not allow for the automatic enrollment into Medicare Part B, but your original loss of group health insurance does.
In other words, you can enroll in Medicare Part B when losing your group insurance, but if you wait to do so until after your COBRA policy has expired you will face delays and permanent fines. You will have to wait until the General Enrollment Period (GEP) that occurs from January 1 to March 31 – and your Part B won’t take effect until July 1. When it does take effect, you will have an additional, permanent charge (late enrollment penalty) attached to your monthly premiums.
You will also need to be enrolled in Part B if you wish to purchase a Medicare supplement insurance plan, like Plans F, G, N, etc. You can always supplement your Medicare Parts A & B with your COBRA coverage, however.
It’s important to compare the cost of your COBRA plan with that of supplement and Part D rx coverages to see which option offers more value. Usually, the supplement and Part D combination are more affordable with less out of pocket than COBRA insurance, but every situation is different. (You may also want to investigate a Medicare Advantage plan as another alternative.)
If you do decide to supplement Medicare Parts A & B with COBRA, most insurance companies will allow you to enroll in a “Guaranteed Issue” Medicare supplement (Plan F, C, etc.) after your COBRA expired. You will have missed your chance to purchase non-guaranteed issue supplemental policies like Plan G and Plan N, however. Medical underwriting will be required to enroll in non-guaranteed issue plans, so there is a trade-off.
It’s important to note that in some cases enrolling in Medicare Part B once COBRA has already been selected may give your employer the right to cancel your COBRA policy whereas the opposite is not true. It depends on the order of enrollment. Enrolling in Medicare first (before selecting COBRA) gives you more options.
If you choose to supplement your Medicare A & B with COBRA, then you must make sure that the drug coverage associated with your COBRA policy is deemed “creditable.” In other words, it must be as good or better than what is offered by stand-alone Medicare Part D prescription drug policies.
If your COBRA drug coverage is creditable (your HR or insurance rep will know) then nothing more needs to be done until your COBRA policy expires. At that time, you can enroll in a Part D drug policy no questions asked. There will be no late enrollment penalties or fines to worry about.
If your drug coverage is not creditable, then you will likely want to enroll in a Part D policy – even if you choose COBRA over a Medicare supplement or Advantage plan. By waiting until after your non-creditable COBRA policy expires, you will face a permanent Part D premium penalty and likely have an enrollment delay as well. It’s a double whammy – just like the Part B enrollment penalties.
When it comes to Medicare enrollment, there’s a lot to know. And there are traps that can cause difficulties – even when you try and do everything right. Permanent fines, delays and penalties can cause financial hardship and overall aggravation when mistakes are made.
At Hyers and Associates, we help our clients avoid such pitfalls while operating within the Medicare guidelines and timelines. Contact us today to talk more about your insurance options.
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Category: Medicare Supplements, Retirement Planning
If you’ve ever been declined a Medicare supplement insurance plan due to medical underwriting, then you know the frustration. Some carriers are more stringent than others and the slightest health issue can be grounds for denial.
And in most states, you have only one or two chances to choose a supplement without the need for medical underwriting. Those times are during your 6 month Open Enrollment window – or if you qualify because of a Guarantee Issue event.
The good news is that a couple of Medicare supplement providers are now offering insurance policies without significant medical underwriting requirements. This can be beneficial if you have been stuck in a high-cost Medigap plan and been denied coverage elsewhere due to health history. You can apply for these plans any time during the year.
If you have been turned down in the past while trying to switch coverage, you may qualify for insurance with two of our carriers. While it is not guaranteed that you will be eligible for either, the underwriting standards are far less strenuous than with most other insurance companies. And a switch may help to lower your monthly premiums.
There are several health conditions that are almost always automatic declines for a Medicare supplement when outside of an open enrollment window. And sometimes, it’s a culmination of factors and not one on its own. The good news is that there are a couple of insurance companies that will consider applicants with the health issues listed below.
Some of these conditions include, but are not limited to: Alzheimer’s disease, Angina, Angioplasty, Atrial fibrillation, Atherosclerosis or arteriosclerosis, Cardiac pacemaker, Cardiomyopathy, Carotid artery disease, Cerebral palsy, Chronic bronchitis, Chronic lung or respiratory disorders requiring the use of oxygen, Chronic COPD or COLD, Liver Cirrhosis, Coronary artery disease (CAD), Dementia or Senility, Diabetes with neuropathy, retinopathy or vascular disease, Emphysema, Heart valve surgery, Hepatitis (other than hepatitis A), Implantable or subcutaneous defibrillator, Irregular heartbeat, Myasthenia gravis, Other liver disease, Parkinson’s, Peripheral vascular disease, PSA levels greater than 6.0, Stent placement, Systemic lupus, Transient ischemic attack (TIA).
Height and weight (build) can also be an issue when trying to switch to a new Medicare supplement plan – especially when other chronic conditions are present. Fortunately, height and weight will no longer be used to decline coverage when determining eligibility outside of the 6 month Open Enrollment window with this new rating class.
Now it’s important to note that these new Medicare supplement underwriting classes are not guaranteed issue. And depending on your rating class, the premiums may not be lower than what you have now. This is a step in the right direction, however. If more carriers follow suit, then this additional competition will provide more choices and flexibility while driving down rates for everyone.
We are independent Medicare supplement brokers and can help you shop for the best rates on the plans that best suits your needs. If you have been declined in the past and your current rates are becoming unaffordable, then we may be able to help. Contact us today for more information.
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Category: Medicare Supplements
Mutual of Omaha has many offerings, but they may be best known for their Medicare supplement insurance plans. Their policies are competitively priced across the U.S. and rate increases with their Medigap coverage has been trending lower the last few years.
A.M. Best rates them A+ due to their large base of policy holders, cash reserves and strong balance sheet. More recently, they began offering Prescription Part D, Medicare Advantage as well as dental and vision insurance in the senior markets.
Like all supplemental carriers, Mutual of Omaha does not offer each of the ten plans available. Depending on your state of residence, Plans A, B, C, D, G, N and F and High Deductible F will be available in most cases. They also offer High Deductible Plan G as of January of 2020.
In some zip codes, Select Plans C, F and G will be available for purchase as well. Select Plans are network-driven policies that require the insured to use an in-network doctor or hospital for non-emergency care. Monthly premiums will be lower for Select Plans when compared to traditional non-network coverage.
There are several factors that will influence your Medicare supplement rates and some of these variables only apply during certain time periods. Our agency can help you determine your rating class whether you’re in your 6 month open enrollment window, a guaranteed issue time period, or if you’re simply shopping for lower Medigap rates.
Tobacco use, height and weight, gender, age, household discount availability, plan preference and zip code can all affect your final rates. During your Open Enrollment window (when you are age 65 or new to Medicare Part B) some of these factors cannot be used to determine your monthly premiums. If you are guaranteed issue (already enrolled in Medicare Part B, but losing creditable coverage elsewhere) then some factors can raise your overall premiums – and some plans will require medical underwriting.
The household premium discount will vary in amount (7%-12%) and availability from state to state as well. In some areas, a member of your household must also be applying with you (or already own a policy) in order to qualify for the discount. In others states you must only reside with a spouse, sibling or domestic partner to qualify for the discount.
Plan G is quickly becoming a popular Medicare supplement and for good reason. The rates are low, the annual premium increases can be smaller and the overall savings can more than make up for the small Part B deductible. In many states, Mutual of Omaha offers some of the lowest Plan G rates available. This is especially true when the household discount applies.
When shopping for supplemental insurance, one of the most important variables can be future rates increases. You want to purchase a plan that can provide stable future rates as switching supplements in the future can be difficult. Plan G tends to be more stable as it’s not a guaranteed issue plan unless your new to Medicare Part B. As Plan G requires medical underwriting in more instances than Plan F, it tends to have fewer enrollees. This can translate to smaller rate increases over time.
Many Medicare Supplement providers are now offer both free and at-cost ancillary benefits and/or discounts as part of their coverage. Gym memberships are important to many of our clients. Mutual of Omaha offers either a discounted membership (up to 30%) or a full membership at only $25 a month at several participating locations nationwide. This benefit can save members hundreds of dollars.
There are also discounts on hearing aids, eye exams, lenses and frames, and several other value added benefits. Should you want full dental and vision coverage as part of your Medicare Supplement plan, then that can be added at a reasonable monthly cost. This is beneficial for those who might need more than just routine cleanings.
Our independent insurance agency offers Medigap coverage direct from every carrier we work with. We are licensed with dozens upon dozens and can help you compare quotes all across the country. If you are interested in Mutual of Omaha’s Medicare supplement insurance coverage or if you would like to see how they stack-up against the competition, contact us today.
Category: Medicare Supplements
Welcome to Part II of our two-part series regarding the most frequently asked questions our agency encounters about Medicare Supplement insurance policies. In this installment, we discuss the nuances of these plans including: rates, underwriting, making changes and the agent’s role.
Click Here To Read Part I Med Supp FAQs →
Can My Rates Go Up Each Year? Why Do They Increase?
Yes, rates with most plans and most carriers increase each year. It does not matter which type of plan you choose (Attained Age, Issue Age or Community Rated) as rates usually increase on your yearly anniversary.
There are several reasons for increases including: changes to Medicare, overall claims experience, policyholder birthday, etc. It’s important to understand that each year CMS shifts more costs to Medicare supplement policies and that affects rates for all plans – both new and old.
With most supplements, your rates are locked in for 12 months. After your 12 month rate lock is over, then rates can increase at irregular times. Insurance companies are not obligated to stay on a 12 month cycle, but many do.
Can I Be Singled Out For A Rate Increase?
Insurance companies cannot single you out for a rate increase. Rates will increase equally for everyone in your block of business which could include several thousand people.
When rates increase, they are adjusted for all policyholders in your block. For instance, United Healthcare might announce a 4% increase on all plans next year for the state of Ohio and that would be that. Another carrier, Stonebridge Life, might announce an increase in that state of New Jersey of 6% on all plans except Plans G & N – which will increase by 4%. Insurance companies are not obligated to raise rates on all plans equally.
Are Some Carrier’s Rate Increases More Friendly Than Others?
Without a doubt, some carriers have a much better track record with rate increase history than others. In our experience, this is one of the most important aspects of Medicare supplement insurance – renewal rates.
You don’t want to shop on first year rates alone. You want to ask about renewal history with the carriers you are interested in. All plans experience rate increases – even Issue Age Medicare supplements. As it can be difficult to switch carriers in the future, buying a plan with stable rates is of utmost importance.
Is It Possible To Know What My Rates Are Going To Be In The Future?
No. If you’re age 65, you can ask about rates for an 80 year old, but that number would be for an 80 year old applying today. As agents, we only know new business rates and in some cases renewal history. We have no way of knowing what your rates will be in the future – no on does.
Can I Get Rated-Up Based On My Health?
There are a lot of factors that can affect your rates including: your state and zip code of residence, gender, age, tobacco use, height/weight, marital status, etc. These are all items you want to disclose to your broker when discussing rates.
If you’re in your open enrollment window, then some of these factors won’t matter. Very few carriers underwrite to your overall health. You are either accepted or declined if applying outside of open enrollment or guaranteed issue periods.
Are Issue Age Plans Better Than Attained Age? What About Community Rated Plans?
In our experience, you are simply shopping for a Medicare supplement carrier with a history of reasonable rate increases. It’s important to know that there really is no silver bullet here – all carriers raise rates to some extent.
Even though an Issue Age plan might not raise your rates because you are older, that does you no good if there normal rate increases are 5% above the next best Attained Age plan. In many cases, Issue Age plans increase rates just as quickly (if not more so) than Attained Age supplements.
On the other hand, Community Rated plans charge the same rate for everyone (male or female) who is the same age and living in the same state. That can be beneficial to males living in the most expensive zip codes, but detrimental to a female living in a less expensive zip code. In other words, Community Rates plans may only benefit a select few.
Thus, you may not want to put too much emphasis on how a plan is rated. It’s better to focus on an insurance company’s historical performance of rate increases.
What About Preexisting Conditions? Are They Covered?
If you are in an Open Enrollment or Guaranteed Issue window, then Medicare supplement carriers cannot ask about the status of your current health. They must accept you (not necessarily for all plans) and cover any conditions you have right away.
If you are outside of one of these windows, then you must go through medical underwriting by answering several yes/no health related questions. A phone interview may be required as well.
Typically one of two things will happen if medical underwriting is required: You will either be accepted or turned down for coverage. If you are accepted, then most carriers will cover any preexisting conditions assuming you have been truthful during the application process.
There is at least one insurance company that can adjust their rates based on medical underwriting. This is not the norm, but it means a healthier person will pay less than someone who has one of the conditions listed on the application. Again, this is a moot point during Open Enrollment & Guaranteed Issue windows of time.
Can I Be Turned Down If I Want To Switch Plans Or Carriers?
Yes. In most cases, medical underwriting will be required if you want to switch from one insurance company to another – or if you want to upgrade or downgrade your supplement (like moving from a Plan N to a Plan F, for instance.)
A few states have a few exceptions to these rules, but most don’t. There is no annual Open Enrollment for Medicare supplement insurance, so you want to choose a strong plan with a reputable carrier the first time. The Annual Election Period (AEP) that runs from October 15th through December 7th each year does not allow you to switch Medicare supplements no questions asked. Medical underwriting is still required at this time in almost all cases.
Are Discounts Offered If I’m Married Or I Pay A Certain Way?
Yes, several carriers offer marital discounts. These can range from 5% -12% for the policyholder. Some insurance companies require that both spouses apply while others do not. And in other cases, a discount will be made available so long as someone age 50 or older is living in the same household.
Usually the least expensive way to pay your premiums is monthly or annually. If you pay monthly, most carriers will require an automatic bank draft or credit card debit. Very few carriers will send a paper bill each month.
Other companies will bill you quarterly or semi-annually, but a a check for the first installment will be required with the application. In our experience, a monthly bank draft is the least expensive and most reliable way to pay for and keep your insurance in force.
Do I Need A Medicare Supplement?
I can’t answer that. It’s insurance like any other – your home, your car, etc. Some insureds may access their policy infrequently, but that’s okay. We have a saying in this industry: The best kind of insurance is the kind you don’t use.
However most people buy a supplement for the proverbial rainy day. Anecdotally, I worked with a person recently who did not own a supplement. She had to pay a $3,000 bill after an emergency room visit and overnight hospital stay for what turned out to be a caffeine attack. The out of pocket costs she paid (after Medicare covered its portion) were a rude awakening. (She’s a client now.)
What Are The Most Popular Medicare Supplement Plans?
The policies purchased most often from our agency are Plans F, G, N and High Deductible F. We see some interest in the others, but these four are the most popular by far.
Plans F & C are very much alike, but more carriers offer F, it can be less expensive than C, and it covers Part B Excess Charges – so it might be a better choice. Plans G and D are also a lot alike, but Plan G is offered by more companies, has only one gap (the $183 Part B deductible), and can be less expensive than D.
Plan N is just a step below Plan G. It is the only plan that requires a copay at the doctor’s office ($20 maximum) and emergency room ($50), but it is very reasonably priced. Part B Excess Charges are very rare and disallowed in some states (Ohio for instance) and that can make Plan N a good choice.
High Deductible F is the least expensive Medicare supplement of them all. In many areas it can be around $30 a month for a 65 year old. It does have a $2,240 deductible (for 2018), but many of our healthier clients like the premium savings it offers. Additionally, it does not have network limitations like $0 Medicare Advantage plans sometimes do.
Which Medicare Supplement Insurance Plans Offer the Most Value?
In our opinion, the Medicare supplements that offer the most value are Plan G on the higher end and High Deductible Plan F on the lower end. Plan N is probably in that discussion as well.
In many cases, the difference in premium between Plan F and Plan G more than makes up for the one-time $183 Part B deductible that G does not cover. And Plan G is not a guaranteed issue plan. That can translate to smaller rate increases with Plan G – and stable rates are the holy grail of Medicare supplement insurance
As mentioned in the previous question, High Deductible F is very inexpensive. In fact, it has the lowest rates available in many areas of the country. And your premium savings can help to cover the deductible if it’s ever encountered. If there is one knock against HD Plan F, it’s that you may have trouble upgrading your coverage in the future if you have health issues.
Do I Pay An Agent To Help Me Enroll? Does It Add To The Cost?
No, you never pay an agent and it never adds to the cost. If you are a 65 year old female in Pennsylvania and you want a Plan G from Mutual of Omaha, then the cost will be the exact same no matter your source of purchase – even if you call Mutual of Omaha directly.
Prices are controlled by law and agents cannot mark-up or mark-down the rates – no matter how much we like you. We earn a commission on the sale if you buy from us – or someone at the insurance company gets compensated for the sale. Either way, someone wins.
In our opinion, you are much better off with a knowledgeable independent brokerage (like ours, of course) who can shop rates from several carriers. It’s much easier to learn the good, bad and the ugly from someone who has long term experience with several different insurance companies – and it does not cost you one penny extra!
Do I Really Need An Insurance Agent’s Help?
Here’s the primary issue: You don’t know what you don’t know. Working with Medicare beneficiaries daily, it’s amazing the amount of misinformation and misunderstanding that we encounter. We talk to people who have made decisions (sometimes bad ones) on something their doctor or their neighbor told them.
Trust us, it’s wise to consult a professional – someone who works in this industry daily and has years of experience. Almost every single prospective client we talk to says, “Oh, I didn’t know that” at least once during our educational conversations.
Again, it doesn’t cost you a thing and the vast majority of us are very helpful and easy to work with. Plus it’s always a good idea to have an agent at the ready when you have questions or need help with your policy(s) in the future.
Category: Medicare Advantage, Medicare Supplements
If you’re shopping for coverage, you probably have several questions about Medicare supplement insurance plans.
We have been working with these policies for many years and answer the most common questions below. This way, you can make decisions that best fit your needs.
What And When Is Open Enrollment For Medicare?
For most, open enrollment occurs when they turn age 65. For others, it’s when they first enroll in Medicare Part B. Not everyone enrolls in Part B at age 65. Some enroll early due to disability and other will defer if they have creditable group health insurance at work. The size of your employer group (20 employees or more) will determine whether you can wait to enroll in Part B.
When first enrolling in Medicare Part B, you’re in your personal Open Enrollment window. You have approximately 7 months to purchase a Medicare supplement plan. Some people enroll in Part B, but still keep their group insurance at work, but that’s not always the best move. Make sure you talk with a knowledgeable insurance broker when you’re making these decisions.
Most everyone has only one Open Enrollment window – either at age 65 – or when they enroll in Medicare Part B for the first time. This is the time to act. If you miss your open enrollment window, then medical underwriting may be required to purchase a Supplement.
No matter the supplemental insurance you choose, you will still need to pay your Medicare Part B premiums. Medicare supplement and Part B premiums are two separate expenses.
(Note: Open enrollment does not occur every year in the Fall. That window of time is called the Annual Election Period (AEP) and does not give you a free pass to purchase supplemental insurance without medical underwriting. More on this later.)
I Received A Letter About My Guaranteed Medicare Rights. What Does It Mean?
You may receive a letter from your employer group coverage – or from an existing Medicare Advantage plan – that it’s terminating. Guaranteed issue windows are different than the Open Enrollment time period discussed above. They are shorter in duration and don’t always allow for the purchase of every Supplement available. (Plan N is not a guaranteed issue plan, for example.)
Only someone who is already eligible for Medicare and enrolled in both Medicare Parts A and B will receive (or can request) a letter of guaranteed Medicare rights. Your options will vary depending on your situation, but you can purchase most Medicare supplements. And you can usually enroll in any Part D drug plan during this window of time.
No matter your window, you need to be entitled to Part A (usually through work credits) and enrolled in Part B before you can purchase a Medicare supplement plan.
What Are Medicare Supplements Insurance Plans?
Medicare supplements are private insurance plan that fill in some (or all) of the gaps in Original Medicare Parts A & B. Supplements and Original Medicare work in tandem. Medicare pays its share and then your supplement pays its portion. You present both your red, white and blue government issued Medicare card and your chosen Medicare supplement ID to your healthcare provider when receiving care.
There are ten standardized Medicare supplement plans A-N. There are some variations of certain plans as well. Some policies offer a High Deductible version while others come in a Select variety. View our chart here to better understand the benefits of each policy.
Who Offers Medicare Supplement Insurance?
There are several insurance companies offering Medicare supplement insurance policies – some you have heard of and others you have not. These are private insurance companies like Aetna, Anthem Blue Cross and Blue Shield, Humana, Mutual of Omaha, National General, United Healthcare and many, many others.
You do not purchase these plans from the government. You buy them direct through brokers and agents. You can also buy them from the insurance company. Your cost will be the same no matter your source of purchase. No agent or company can offer a sweetheart deal of any kind.
Why Haven’t I Heard Of Some Of These Insurance Companies?
The first thing to remember is that Medicare supplements work in tandem with Original Medicare Parts A & B. Insurance companies (both large and small) do not have to build any networks of doctors and hospitals. They simply have to pay their share after Medicare.
There are few barriers to entry into this market. It’s very competitive and full of several insurance companies. If your doctors accept Medicare, they will accept most any Medicare supplement you present to them.
This is not like traditional health insurance where certain doctors only accept certain plans. In other words, a United Healthcare Plan F gives you no more choice of healthcare providers than does a Plan F from Tumbleweed Life of New Mexico. (Please don’t go looking for Tumbleweed Life. That’s a joke, but you get the point.)
Are Their Network Limitations At All With Medicare Supplements?
With almost all plans, the answer is NO. The only two plans sold using networks are “Select Plans”. In our experience, Select Plans are not popular. They are easy to recognize and only offered by a few large insurance companies.
Most of our clients purchase traditional policies – not the Select version. Again, the vast majority of supplements have no network restrictions. A Plan G is a Plan G is a Plan G. If you’re unsure, ask if it’s a Select Plan.
I Called My Doc’s Office – They Don’t Take The Insurance Company I Like. No What?
We run into this more frequently than we should. The folks running the billing departments at some medical offices don’t always understand Medicare. Or they assume you’re asking about Medicare Advantage plans. Most Advantage plans do have network limitations and some doctors will be out of network with these plans.
Don’t worry – Medicare supplements don’t work that way. Explain to them you’re talking about a traditional Medicare supplement – not a Select Plan and not a Medicare Advantage plan. Trust us, they take it. They will bill your insurance company like all others. Sometimes, they just don’t always understand the process or your question.
Do Medicare Supplements Cover Prescription Drug Coverage?
No they don’t. There are no Medicare supplement plans sold today that cover prescription drugs. Some Medicare Advantage plans include Part D drug coverage, but by rule supplements cannot provide this benefit. Part D prescription drug plans are sold separately from a wide range of private insurance carriers.
We’ll help you for find the right Part D drug plan. We have software that allows us to compare all of your best options based on what you take. Your Part D drug coverage can be just as important as your supplemental insurance.
What Are Medicare Advantage Plans? Do I Need One Of Those Too?
You can learn more about Medicare Advantage (MA) plans here. They are network driven insurance plans that privately cover the benefits of Medicare Parts A & B and also some of the gaps left behind. MAPD plans usually include Part D drug coverage and oftentimes require the use of in-network facilities and a primary care physician.
MA plans are offered from carriers like Aetna, Anthem Blue Cross and Blue Shield, Humana, United Healthcare and others. Original Medicare (Parts A & B) is a public insurance program. Advantage plans are private and while highly regulated, they operate differently than what’s offered from the government.
By rule, you should not own both a Medicare supplement and a Medicare Advantage plan. It’s one or the other. We can help you understand which type of insurance might work best for you.
Does Original Medicare Only Cover 80%? Will A Supplement Pay The Rest?
Our clients ask about the 80% number often. It’s a bit of a misnomer. Your remaining bill after Medicare can be more, less or equal to 80% depending on what you’ve encountered. Part A (hospital inpatient services) is much different than Part B (doctor’s office) costs.
If you study a Medicare benefit grid, you’ll notice there are different deductibles, copays, coinsurance and cost sharing that will add up to more or less than 80% of a medical bill. So don’t make any decisions based on the 80% number you hear about so often.
How Does Billing Work? Do I Have To File Claims? What If It’s Not A Medicare Approved Expense?
Roughly 95% of doctor’s offices and hospitals handle the billing for you. You give them your ID card and they will bill your insurance company. Medicare coordinates with most Supplements directly. Insurance companies are very good about paying claims quickly. Medicare is very regimented; there is no wiggle room. Insurance co’s know their exact finacial responsibility and pay it accordingly.
If you seek medical care for something that is not a Medicare approved expense (homeopathic medicine, for example) then your supplement will not cover it. Medicare supplements only cover their portion after Medicare… and only for approved expenses. That’s all, nothing else.
Am I Covered When I Travel Domestically? How About Abroad?
Almost all Medicare supplement policies cover you domestically. The only ones that may not (other than for emergencies) are called Select Plans and as mentioned above. If you summer in Ohio and winter in Florida, these policies will travel with you. You purchase your supplement based on your state of residence, but you don’t need to notify your insurance company when travelling.
Plans C, D, F, G, M and N are the six plans sold today that cover Foreign Travel Emergency. There is a $250 deductible and $50,000 lifetime limit on this coverage gap. If you travel abroad frequently or for extended periods of time, then there are other affordable health insurance policies better designed to cover you during such trips.
What Happens If I Move To A New State?
Typically your Medicare supplement will travel with you when you move to a new state. You only need to call your insurance carrier (or contact your broker) so that your carrier is aware of your new address. Your rates might be adjusted based on your change of residence, but that’s all.
(It’s important to note here that prescription Part D drug plans do not typically travel from state to state. When you move, you may need to inform your insurance company and sign up for a new plan even though it’s the same plan as you had in your former state of residence.)
Do Some States Have Different Medicare Supplement Rules? What If I’m Under Age 65?
Yes, some states have different rules, but the plans themselves rarely differ. In other words, a Plan F is a Plan F in most places. What can differ is how the plans are rated, access to plans and rules about changing plans.
Some states only offer Issue Age rated plans. This does not mean your rates will never go up, but they won’t go up because you’re a year older in these states.
And some states allow those under age 65 to purchase a Medicare supplement if they are eligible for Medicare due to disability. Tennessee and Illinois are two examples. This rule is very much state specific. A Medicare Advantage plan may be the only option for those who reside in states where supplements are not for sale under age 65 – like Ohio and Indiana for instance.
And a couple of states – like Missouri and California for example – offer periods where the insured can switch plans (no questions asked) during an anniversary or birthday window of time. Consumers in these states can save money by switching to “like or lesser coverage” each year during their individual anniversary window.
When shopping for coverage it is smart to inquire about, and familiarize yourself with, any rules that are unique to your state or residence.
Do Medicare (and/or Supplements) Cover Long Term Care Expenses?
Not really and not for very long. Medicare pays the full cost for the first 20 days – and part of the cost of the next 80 days – for skilled care only. Most Medicare supplements fill in the skilled nursing facility coinsurance gap for those same 80 days . After day 100, neither Medicare or any Medicare supplement will pay for your long term care costs – period.
And it’s important to note that Medicare, when combined with supplemental insurance, only pays for the first 100 days of skilled care. That’s care administered by a doctor. Most people need intermediate or custodial care. That’s help with the activities of daily living.
The only policies that pay for skilled, intermediate and/or custodial care for significant periods of time are long term care insurance policies. In other words, you don’t want to rely on Medicare (or your supplement) to pay long term care expenses in the short or long run.
Can You Explain The So-Called “Open Enrollment” Window Each Fall? What Is It?
This is the yearly window of time that runs from October 15th through December 7th. People will refer to it as “Open Enrollment” but it’s actually called the Annual Election Period – or AEP for short.
During AEP, you can switch prescription Part D plans, change or move in and out of Medicare Advantage plans, but it has little bearing on Medicare supplement insurance. In other words, AEP gives you no free pass to purchase a Medicare supplement policy or change to a new one.
While a lot of consumers switch Medicare supplements during the AEP window, it’s not because there is no medical underwriting. It’s just a time of the year when people are actively thinking about their insurance plans and rates.
Category: Medicare Advantage, Medicare Supplements
Our independent agency represents several companies, but we are seeing a lot of interest lately in the Transamerica Life Medicare supplement insurance plans. In our view, there are several reasons for this including: cost, ratings, renewals and name recognition.
First, a little about the company: Transamerica (that big pyramid building in San Francisco) is a subsidiary of Aegon. They have an A+ rating due to their size and financial strength. They began offering Medicare supplements approximately two years ago and market supplements in several states.
In our opinion, renewal history is one of the most important factors when shopping for supplemental insurance. Carriers with a bad reputation don’t tend to last long in this business as agents and policyholders keep a watchful eye on this variable.
Fortunately, Transamerica Life has a good reputation with their renewal rates thus far. In many areas we are seeing rate increases in the range of 2-5%. That’s very competitive (2% seems to be the norm in most places.) And in some states (Pennsylvania for instance) their Plan F, G and N rates increased by 0%. That’s great news for policyholders.
Policyholders and agents alike are both happy when rates hold steady or increase slowly. Most agents aren’t interested in moving their book of business each year and their clients would prefer to avoid the hassle of going through medical underwriting.
We offer Medicare supplement insurance from Transamerica Life in several states. Currently, we have seen them popup near the top of our quoting engines in places like California, Florida, Missouri and Ohio among other areas of the country.
Over the years, several new carriers have entered the supplemental marketplace and competition for policyholders is increasing. That is great for the consumer. Lately it seems this competition has forced carriers to price their policies more favorably for the short and long run. Stonebridge Life has followed suit in several states and thus far our clients have been happy with their rates and rate increases.
The nice thing about Medicare in general is that it’s very regimented. Medicare supplements are designed to do one thing: Fill in the gaps left behind by Medicare.
This simply means there are very few issues when it’s time to pay claims. If you have a Medicare approved expense, your supplement will pay most if not all of the balance depending on the plan you have chosen. It’s a very cut and dried system and leaves no wiggle room for Medigap insurers.
Transamerica Life is no different when it comes to claims and customer service. Our clients have been happy on both fronts, but at the end of the day – A Plan F is a Plan F. It does not matter which carrier your choose – TA Life has to pay the same claims as AARP (UHC), Aetna, Anthem BCBS, Humana and all of the other big names.
Like all Medicare supplements, there are no networks to worry about either. You are in the Medicare network and if your doctor accepts Medicare, then s/he will accept whichever supplement you walk in the door with – no matter the carrier.
In other words, you are shopping for more than just a name. Aetna has the same network as Transamerica Life as does United Healthcare and so on. Most people are familiar with Transamerica and their A+ rating goes a long way to comfort potential policy owners.
We are one of the many Medicare supplement brokerages offering Transamerica Life Medicare supplement insurance direct across the country. (This line of business used to be sold under the Stonebridge Life name, but is now offered by the parent company.)
Contact us and we can help you compare the direct rates with several Medigap providers side by side. We can also help with Part D drug insurance as well. We are a one-stop shop for all types of Medicare insurance.
Category: Medicare Supplements