What Do I Need to Know About my Medicare Options?
Medicare is a sophisticated system – maneuvering your way through the intricacies is the tricky part. Licensed Medicare Consultants can help you obtain the best coverage based on your specific situation.
Part A
Hospital Insurance
Part B
Physician & Out-Patient Services
Part C
Medicare Advantage Plan
Part D
Prescription Drug Coverage
Because Medicare only covers 80% of Part A and Part B expenses, most individuals will need to enroll in supplemental coverage to cover the remaining 20% that Medicare does not cover..
At age 65, most people enroll in Medicare Part A & Medicare Part B, and they are responsible for the other 20%.
When you opt to enroll in Medicare Part C (Medicare Advantage Plan), it combines Part A, Part B, and sometimes Part D coverage. These are PPO & HMO plans, which have copays and/or deductibles, instead of the 20% balance that Medicare does not cover. The benefits depend upon the policy you select.
Annual Enrollment Period (AEP)
It is essential to review your benefits each year between October 15th and Dec 7th. Unless there is a special exception, this is the time you can enroll, disenroll, or change your plan. This timeframe is referred to as the Annual Enrollment Period (AEP).
Special Enrollment Period (SEP)
Whether you’re moving out of state or making a town move, there are opportunities to change your plan or to enroll in a new plan if necessary. Special Enrollment Period allows you to change your policy outside of the Open Enrollment Period. Typically, you have 60 days to change your plan if you move. This will enable you to either keep your existing plan or enroll in new coverage.
Having an experienced agency guide you through this intricate process is ideal so that you and your family are certain not to be left without coverage.
During the AEP (between October 15th and Dec 7th) it’s critical to review your plan and to seek help if you’re considering making changes to an existing plan.
Regardless of Annual Enrollment and age restrictions, those that already carry a supplement plan can choose to change their plan at any time, and there are options to try and save money on those plans.
What’s the Difference Between Medicare Advantage and Medicare Supplement Insurance Plans?
There are different ways that you can receive your Medicare coverage, or add onto that coverage. Medicare Advantage and Medicare Supplement Insurance are options that may sound familiar, but they’re quite different. They do have one main thing in common: they’re both offered by private insurance companies.
There are two options commonly used to replace or supplement Original Medicare. One option, called Medicare Advantage plans, is an alternative way to get Original Medicare. The other option, Medicare Supplement (or Medigap) insurance plans work alongside your Original Medicare coverage. These plans have significant differences when it comes to costs, benefits, and how they work. It’s important to understand these differences as you review your Medicare coverage options.
Medicare Supplements vs. Most Medicare Advantage Plans
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Concerns of Seniors | Medicare Supplement | Medicare Advantage |
|---|---|---|
| Restrictive Network of doctors and hospitals | ✅ NO | ❌ YES |
| Co-Payments to Providers | ✅ NO on Plan F or G. Up to $20 on Plan N at Doctor | ❌ YES – Varying |
| Up to $7,550 yearly Out of Pocket Costs | ✅ NO | ❌ YES |
| Health Plan Decides What Test and Procedures Are Approved For You | ✅ NO | ❌ YES |
| Can Your Plan Be Cancelled? | ✅ NO Cannot be cancelled as long as premiums are paid | ❌ YES Plans are approved yearly and can be dropped. |
| Ability to Travel the Country and Use Any Doctor or Hospital | ✅ YES | ❌ NO |
| Is Pre-Certification Required for some Treatments? | ✅ NO | ❌ YES Penalties apply if pre-cert not done. |
| MD Anderson Cancer Treatment Center Included? MAYO Clinic Included? | ✅ YES | ❌ NO |
Medicare Supplement Insurance Plans
Medicare Supplement insurance, also known as Medigap or MedSup, is also sold through private insurance companies, but it is not comprehensive medical coverage. Instead, Medigap functions as supplemental coverage to Original Medicare. Current Medigap plans don’t include prescription coverage.
Medigap plans may cover costs like Medicare coinsurance and copayment, deductibles, and emergency medical care while traveling outside the United States. There are 10 standardized plan types in 47 states, each given a lettered designation (Plan G for example) Plans of the same letter offer the same benefits regardless of where you purchase your plan.
You will want to compare the Medigap policies carefully, because while benefits are standardized, the costs are not, meaning they could fluctuate widely depending on the insurance company offering the plan and location.
When is too late?
If you decide to sign up for a Medigap policy, the best time to enroll is actually 6 months prior to turning 65, as this is when the plans will be their cheapest. If you wait until 3 months or less before turning 65 to sign up for coverage, you will pay on average 10% more. This period of time up until 6 months after you turn 65 is called , Initial Open Enrollment period. If you enroll in a Medigap plan during this period, you can’t be turned down or charged more because of any health conditions. But if you apply for a Medigap plan after age 65, you may be subject to medical underwriting; and your acceptance into a plan isn’t guaranteed.
Medicare Advantage Plans
Medicare Advantage plans offer an alternative plan; you’re still enrolled in the Medicare program; in fact, you must sign up for Medicare Part A and Part B to be eligible for a Medicare Advantage plan.
The Medicare Advantage plan administers your benefits to you. Depending on the plan, Medicare Advantage can offer additional benefits beyond your Part A and Part B benefits, such as routine dental, vision, and hearing services, and even prescription drug coverage. If you decide to sign up for a Medicare Advantage plan, call our agency so we can help you shop around because costs and coverage details are likely to vary significantly.