You may have questions about Medicare supplement insurance plans. We have been working with these policies for several years and answer the most common questions below to further your understanding of this insurance.
First: A Little About Medicare
What And When Is Open Enrollment For Medicare?
For most, open enrollment occurs when they turn age 65. For others, it’s when they first enroll in Medicare Part B at a later date. (Not everyone enrolls in Part B at age 65 – some may wait if they have credible group health insurance at work. The size of your employer group will determine whether you can or want to wait to enroll in Part B.)
When you’re first enrolling in Medicare Part B and in your open enrollment window, you will have six months to purchase a Medicare supplement plan – unless you choose to stay on an employer large group plan. (If you enroll in Part B, but keep your employer sponsored group insurance, then you will in a Guarantee Issue window for Medicare supplement insurance when you terminate/leave your group coverage.)
Most everyone has only one Open Enrollment window – either at age 65 or when they enroll in Medicare Part B for the first time. You want to be aware of this period of time and take advantage of what it offers. If you miss your open enrollment window, then medical underwriting may be required to purchase a supplement.
No matter the supplemental insurance you choose, you will still need to pay your Medicare Part B premiums. Medicare supplement and Part B premiums are two separate expenses.
(Note: Open enrollment does not occur every year in the Fall. That window of time is called the Annual Election Period (AEP) and does not give you a free pass to purchase supplemental insurance without medical underwriting. More on this later.)
Understanding Guaranteed Issue Periods Of Time
I Received A Letter About My Guaranteed Medicare Rights. What Does It Mean?
You may receive a letter like this from your employer group coverage – or from an existing Medicare Advantage plan that is terminating. Guaranteed issue windows of time are different than Open Enrollment. They are shorter in duration and don’t always allow for the purchase of every supplement available. (Plans G & N, for instance are not a guaranteed issue plans.)
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 usually enroll in any Part D drug plan during this window of time.
You need to be entitled to Part A (usually through work credits)and enrolled in Part B before you can purchase a Medicare supplement plan.
Understanding Supplemental Medicare Insurance Policies
What Are Medicare Supplements Insurance Plans?
Medicare supplements are private insurance plan that fill in some (or all) of the gaps left behind by original Medicare Parts A & B. Supplements and Original Medicare work in tandem. Medicare pays its share and then your supplement pays its portion next. You will give both your Medicare supplement ID and Medicare cards to your healthcare provider when receiving care.
There are ten standardized Medicare supplement plans A-N. There is one variation of Plan C and two variations of Plan F. View our chart here to better understand what each plan covers.
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, Central States Indemnity, Medico, Mutual of Omaha, Stonebridge Life, United Healthcare and many, many others.
You do not purchase these plans from or through the government. You buy them through agents (or an agency) like ours. You can also buy them direct from the insurance carrier. Your cost will be the same no matter your source of purchase. No agent or carrier can discount a plan to beat the competition.
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 almost 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 today that use networks are Select Plans F & C. In our experience, Select Plans F & C are not very popular. They are easy to recognize and only offered by a few insurance companies.
Most of our clients purchase traditional Plan F or Plan C – not the Select version. Again, the vast majority of supplements have no network restrictions. A Plan F is a Plan F is a Plan F. If you’re unsure, ask us if you think you’re looking at a Select Plan.
I Called My Doc’s Office – They Don’t Take The Insurance Company I Like. What Now?
We run into this non-issue 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. There are no Medicare supplement plans sold today that cover prescription drugs. Some Medicare Advantage plans include Part D drug coverage, but by rule no supplements will provide these benefits. Part D prescription drug plans are sold separately from a wide range of private insurance carriers.
The Plan Finder software at Medicare.gov can be a valuable resource for finding the right Part D drug plan. We can help you sift through and better understand your results. In some cases, 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. MA 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 – MA plans are considered private and while highly regulated, not offered by the government.
By rule, you cannot 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 you might be most comfortable with after a conversation or two.
Does Original Medicare Only Cover 80%? Will A Supplement Pay The Rest?
People ask about the 80% metric often. It’s a misnomer. Your bill after Medicare can be more, less or equal to 80% depending on what you’ve encountered. Part A (hospital inpatient services) are much different than Part B (doctor’s office) costs.
If you study a Medicare grid, you’ll notice that are different deductibles, copays, coinsurance and general cost sharing that will add up to more or less than 80% of a medical bill. So don’t make any decisions based on that magical 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 85% of doctor’s offices and hospitals handle the billing for you. You just give them your ID card and they will bill your insurance company. It’s usually very painless. Insurance companies are very good about paying claims quickly. Because Medicare is so regimented, there is no wiggle room. Insurance co’s know exactly what their responsibility is and then they pay their share.
If you seek medical care for something that is not a Medicare approved expense (homeopathic medicine, for example) then your supplement will not cover any costs. 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 in all 50 states. The only ones that may not (other than for emergencies) are called Select Plans and as mentioned are infrequently purchased. If you summer in Indiana and winter in Florida, these policies will travel with you just fine. You just want to buy your supplement based on your state of residence, but you don’t need to notify your insurance company when travelling or if you’re wintering out of state.
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 very affordable health insurance policies better designed to cover you for 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.