The most popular Medicare Supplements(Medigap Plans) are Plans F, G and N. Since the standardization of Medicare Supplements(Medigap Plans), all letter plans have the exact same benefits…Plan F is Plan F, no matter which company. The only difference is the price, as some companies charge more than others for the same plan. It’s a good idea to shop and compare prices. All companies underwrite various health conditions differently, so even if you’ve wanted to change companies and have been declined in the past, chances are excellent that I can find a company for you. Being an Independent Agent, I represent dozens of companies so that I can get you the most coverage at the best price.
Medicare Part A Coinsurance and Hospital Costs: For most hospital stays, Medicare pays all of the first 60 days except for a deductible, all but $335 per day of the 61st through the 90th day, all but $670 per day of the 91st through the 151st day (one time), and nothing after the 151st day. All plans pay for these copays as well as 100% of an additional 365 days.
Medicare Part B Coinsurance or Copayment: Generally, Medicare pays 80% of these costs. All plans pay for some or all of the remaining 20% as indicated on the comparison chart.
Blood, First Three Pints: All plans pay for some or all of the fist three pints as indicated on the Comparison Chart. Medicare pays 100% of any additional blood needed.
Part A Hospice Care Coinsurance or Copayments: All plans pay for some or all of the Medicare copayment or coinsurance. Medicare pays for all remaining approved hospice care costs.
Skilled Nursing Facility Care Coinsurance: This is a facility that handles the required daily involvement of skilled nursing or rehabilitation staff. Examples of skilled nursing facility care include intravenous injections and physical therapy. Medicare pays all of the first 20 days, all but $167.50 per day of the 21st through the 100th day of approved costs. Medicare pays nothing after the 100th day. The plans pay all, some or none of the first 100 days deductibles or copays as indicated on the Comparison Chart.
Part A Deductible: This is a hospital stay deductible. The amount in 2018 is $1,340 per stay. The plans pay for all, some, or none of the deductible as shown on the Comparison Chart.
Part B Deductible: This is a yearly deductible you must pay before receiving any covered Part B benefits like doctor visits and most other outpatient services. For 2018 this deductible is $183. Only Plans C and F pay for this deductible as indicated on the Comparison Chart.
Part B Excess Charges: This is an amount that a health care provider is allowed to charge above the Medicare approved amount. Only Plans F and G pay this benefit as shown on the Comparison Chart.
Foreign Travel Emergency: This is medically necessary emergency care not covered by Medicare. The benefit is generally 80% to a lifetime maximum of $50,000 with a $250 deductible. Most Plans pay this benefi
The Basics Of Medicare
Medicare is a complex and often confusing subject. If you are turning 65 or older you have, no doubt seen many TV ads, read lots of brochures and flyers mailed to you, and even attended some informational meetings about Medicare and all the additional programs in which you can enroll.
Many seniors tell us that all this information can make the subject even more confusing, and that making choices is almost an uninformed gamble.
Below are the details of all the parts of Medicare, who is eligible, what it covers, what it costs and details of the supplements and programs that help with your out-of-pocket costs.The goal here is to lay out all the facts you need, so that you can make good, informed decisions about your care and any extra insurance you may need.
Medicare is a national social insurance program, administered by the U.S. federal government since 1966, that guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system. It also covers younger people with certain disabilities, as well as people of any age with end stage renal disease and ALS(Lou Gehrig”s Disease). it was designed to cover most but not all of your mefdically necessary costs.
It is referred to as Original Medicare (Medicare Parts A and B). There are other parts of Medicare (Parts C and D) that are also reviewed.
Medicare is a federal health insurance program for U.S. citizens and legal residents. In addition, you must be:
Age 65 or older.
Younger than 65 with a qualifying disability.
Any age and have End Stage Renal Disease(permanent kidney failure requiring dialysis or a kidney transplant. It’s also called ESRD) or ALS(Lou Gehrig”s Disease).
You can join Medicare during designated enrollment periods. Each has a specific purpose.
Initial Enrollment Period (IEP) This is when you are first eligible to enroll in Medicare. The timing of your personal IEP is based on the date of your 65th birthday. You can sign up during the 7 month period that begins 3 months before the month you turn 65 and ends 3 months after the month you turn 65. If you become eligible due to disability, then the timing is based on your disability date.
Annual Enrollment Period (AEP) You can sign up for Part C (Medicare Advantage Plans) and Part D (Medicare prescription drug plans) between October 15th and December 7th. You can also switch or drop a Part D plan at this time if you wish. The change will take effect on January 1st.
General Enrollment Period (GEP) This is a set period of time for people who did not enroll during their IEP. You can sign up between January 1st and March 31st each year. Coverage will begin July 1st. You may have to pay a higher premium for late enrollment.
Special Enrollment Period (SEP) If you didn’t sign up for Part A and/or Part B when you were first eligible because you were covered under a group health plan based on current employment (or a spouse’s) you can sign up for Part A and/or Part B anytime you’re still covered by the group health plan or during the 8-month period that begins the month after employment ends or the coverage ends, whichever happens first.
Annual Disenrollment Period (ADP) Between January 1st and February 14th, if you are in a Medicare Advantage Plan, they can leave their plan and switch to Original Medicare. If you switch to Original Medicare during this period, you have until February 14th to also join a Medicare Part D Prescription Drug Plan. Your coverage will begin on the 1st day of the month after the plan gets your enrollment form.
What does Medicare Part A cover?
In general Part A Covers:
A Semi Private Room and meals
Lab Tests, X-Rays, and Radiation Treatment as an Inpatient
Operating Room and Recovery Room Services
Drugs, Medical Supplies and Equipment as an Inpatient
Care in Special Units Like Intensive Care
Skilled Nursing Facility Care
Nursing Home Care (as long as custodial care isn’t the only care you need)
Home Health Services
What does Medicare part B cover?
In general, Part B covers:
Outpatient Medical Services
Clinical Laboratory Services
Durable medical equipment
Some Preventive Care
Mental Care as an Outpatient
Limited Skilled Nursing Care
Getting a second opinion before surgery
Limited outpatient prescription drugs
Limited Home Care
Limited physical and occupational therapy
What does Medicare part A cost?
Most people don’t have to pay a monthly payment, called a premium for Part A. This is because they or a spouse paid Medicare taxes while working. Most people turning 65 are automatically enrolled in Part A if they have worked a total of 40 quarters in total.
If a beneficiary (a person eligible for Medicare) doesn’t get premium-free Part A, they may be able to buy it if they or their spouse aren’t entitled to Social Security, because they didn’t work or didn’t pay enough Medicare taxes while working, are age 65 or older, or are disabled but no longer get free Part A because they returned to work.
What does Medicare Part B cost?
The standard Part B premium amount in 2018 will be $134 per month (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount ($130 on average). You’ll pay the standard premium amount (or higher) if:
*You enroll in Part B for the first time in 2018.
*You don’t get Social Security benefits.
*You’re directly billed for your Part B premiums (meaning they aren’t taken out of your Social Security benefits).
*You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $134.)
*Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. If so, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
If your modified adjusted gross income as reported on your IRS tax return is above a certain amount ($85,000 filing individually or $170,000 filing jointly) you may pay more than the standard premium. The standard premium may be higher if you didn’t sign up for Part B when you first became eligible. The cost of Part B will go up 10% for each full 12-month period that you could have had Part B but didn’t sign up for it. You will have to pay this penalty as long as you have Part B.
What’s not covered by Parts A and B ?
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or a Medicare Health Plan.
Some of the items and services that Original Medicare doesn’t cover include:
Long-term care (also called custodial care)
Routine dental or eye care
Hearing aids and exams for fitting them
Routine foot care
Care Received Outside the United States Except in Very Limited Situations
Medicare Deductibles, Copayments and Coinsurance
Even if Medicare covers a service or item, you will still be responsible for deductibles, coinsurance, and copayments.
You will pay a deductible of $1,340 for each benefit period for Part A benefits (usually a hospital stay) as well as significant copays for a skilled nursing facility stay of more than 21 days. After an annual Part B deductible of $183 (your responsibility), Medicare will generally pay for 80% of Part B approved benefits. You will be responsible for paying the remaining 20%.
Most people who are enrolled in Medicare decide to get extra coverage to pay for their out-of-pocket health care expenses.
In most parts of the United States, there are two options that are available to you as a Medicare beneficiary (eligible for, or currently enrolled in, Medicare) to reduce or eliminate the out-of-pocket expenses not covered by Medicare Part A & B.
The options are shown below, and the option details follow.
Medigap Plan(Medicare Supplement) and Prescription Drug Plan (Option 1)If you were to choose option 1, you would purchase a “Medigap” or Medicare Supplement Policy from a private insurance company to cover the gaps in your Medicare Parts A and Part B coverage. In most states there are 10 standardized plans available. The richest of the plans Plan F covers 100% of your out-of-pocket expenses resulting for any Medicare approved benefits. You would most likely enroll in a Medicare Part D plan as well, also through a private insurance company.
Medicare Part D/Medicare Part C (Medicare Advantage)
Prescription Drug Plans (Medicare Part D)
Since January 1, 2006, Prescription Drug Plans (Medicare Part D) have been available to everyone with Medicare.
Prescription Drug Plans:
Can substantially reduce your drug costs
Can vary in cost and drugs covered
Require you to use the pharmacy network of the plan
Require you to live in the service area of the plan
Are administered by private companies.
Medicare Advantage Plans (Option 2)
In Option 2, you would enroll in Medicare Part C, also known as a Medicare Advantage plan, or simply a Medicare Plan. It will help pay for your out-of -pocket costs associated with your Medicare approved benefits, and most plans include a Prescription Drug Plan.
It is important to know that:
You will actually ”leave” Original Medicare (Medicare Parts A and B) and enroll in Medicare Part C
You Your Medicare Parts A ,B and D benefits are combined into Medicare Part C.
Advantage plans are a government program administered by private Companies
You must use doctors and other health care providers in the company’s network
You must live in the service area of the plan
Specific enrollment periods apply
Many plans offer extra benefits not covered by Original Medicare
What Should You Do Now
Should you choose Option 1 or Option 2?
This is a very individual decision, but there are certain questions you should ask yourself to help you make your decision:
Is it important to me to have the freedom to choose any doctor that accepts Medicare?
Am I healthy and don’t mind seeing a doctor in a network?
Am I healthy and on a tight budget?
Can I afford the premiums and don’t want to be bothered with deductibles, co pays, etc.?
What You Should Do Now
If you are turning 65, you should start your research and develop your action plan at least three months before your 65th birthday.
If you are older than 65 and want to make changes to your current coverage, it is a good idea to start your research and have an action plan now. You may be restricted by certain enrollment periods or medical history concerns.
Whether you decide on Option 1 or Option 2, you will be dealing with an insurance company. Not all companies operate the same way. Some companies have a history of keeping premium increases to a minimum. Also, premiums vary, sometimes greatly, and sometimes the lowest premium is not always the best choice. There are other variables among companies that you need to be aware of. You will need time to research and compare.
Having your plan in place is the best way to avoid any unintended coverage gaps or needless overlaps in coverage. This is especially true if you plan to be employed after age 65. The transition from your employer sponsored medical plan to Medicare at age 65 is not as straightforward as you might think. Your HR department, the broker that handles your company plan, and even the insurance carrier themselves sometimes do not have the right answers for you, simply because it is not an area they have to deal with routinely. This is why it’s a good idea to have an experienced Independent Agent to help guide you through the process.