Medicare Plan F Going Away (and Plan C) | ENROLL NOW!

What’s all this talk about “Medicare Plan F?” Is Plan F going away?

It’s true – Medicare Supplement Plan F is GOING AWAY in 2020! If you still want Plan F, you only have until December 31, 2019, to get locked in.

What are Medicare Supplements, anyway?

When you enroll in Original Medicare (Part A and Part B), you have the option of increasing coverage by purchasing a Medicare Supplement plan (also called Medigap). These plans work alongside Original Medicare and add financial benefits (like help paying for your copayments, coinsurance, and yearly deductibles).

Every state (except Massachusetts, Minnesota, and Wisconsin) has ten different types of plans. Each plan is represented by a different letter (A, B, C, D, F, G, K, L, M, and N). Plan F and Plan C are the most inclusive, and in turn, are the most popular. But did you know both plans are going away in 2020? 

Medicare Supplement Comparison Chart
Medigap Comparison Chart

Read more about each type:

  1. Medigap Plan A
  2. Medigap Plan B
  3. Medigap Plan D
  4. Medigap Plan G
  5. Medigap Plan K
  6. Medigap Plan L
  7. Medigap Plan M
  8. Medigap Plan N

Make sure you do not confuse Medigap Plan A with Medicare Part A – they are two very different things! 

Medicare Plan Finder

Medicare Plan F Benefits

Plan F has been a top-seller in many states for years and is the most comprehensive Medigap plan. Medicare Plan F covers: 

  • Blood work copays up to three pints (100%)
  • Foreign travel emergency (80%)
  • Hospice coinsurance and copayments (100%)
  • Part A coinsurance and hospital costs (100%)
  • Part A deductible (100%)
  • Part B coinsurance and copayments (100%)
  • Part B deductible (100%)
  • Part B excess charges (100%)
  • Skilled nursing facility coinsurance (100%)

Medicare Plan C Benefits

Medicare Plan C covers all of the gaps from Original Medicare except for Part B excess charges. More specifically, Plan C includes the following:

  • Blood work copays up to three pints (100%)
  • Foreign travel emergency (80%)
  • Hospice coinsurance and copayments (100%)
  • Part A coinsurance and hospital costs (100%)
  • Part A deductible (100%)
  • Part B coinsurance and copayments (100%)
  • Part B deductible (100%)
  • Skilled nursing facility coinsurance (100%)
medicare-plan-f-going-away-medicare-plan-finder

Plan F vs Plan C

Plan F is very similar to Plan C. The only difference is that Plan C does not cover Medicare excess charges. If a doctor does not accept Medicare assignment rates, you will be responsible for excess charges, but it can not exceed 15% of what Medicare pays. Some states do not allow doctors to issue excess charges. If this is the case, Plan C will operate identically to Plan F.

States that don’t allow excess charges are:

  • Connecticut
  • New York
  • Ohio
  • Massachusetts
  • Minnesota
  • Pennsylvania
  • Rhode Island
  • Vermont

Why is Medicare Plan F Going Away?

Back in 2015, Congress passed the Medicare Access and CHIP Reauthorization Act. According to the act, starting on January 1, 2020, Medicare Supplement plans can no longer cover the Part B deductible, something that only Medigap Plans F and C currently cover. 

When people don’t have to pay a deductible for services, they can end up overusing the doctor. For example, the might schedule an appointment with their doctor for a flu shot instead of using the free clinic inside their local grocery store. By visiting the doctor unnecessarily (and not paying for it), doctor’s offices are getting crowded and doctors aren’t being fully compensated for their time.

Eliminating Part B deductible coverage through Medigap works better financially for the Medicare program and for the doctors who accept it.

Thankfully, that Part B deductible is a small price to pay at less than $200 per year.

Turning 65 Checklist

When will Medicare Plan F be discontinued? What about Plan C?

If you currently have Medicare Supplement Plan F or Plan C, don’t fret! This policy change only affects new beneficiaries. While your rates may increase (as they technically do every year), you will not lose your current coverage. However, if you leave your Medigap Plan F or Plan C for whatever reason, you will not be able to go back to it after 2020. If you do not have Plan F or Plan C, but you would like to, you can lock yourself in by enrolling NOW. You must enroll before January 1, 2020, to receive Plan F or Plan C coverage. 

Due to this change, Plan F and Plan C beneficiaries will be given a chance to compare rates and switch to a new policy. If you decide you may want to switch, you can start by using our Medicare Plan Finder tool to decide what plan option (other than F) is best for you. If you still need help, click here to request a call from a local and licensed agent!

Will Plan F Costs Go Up in 2020?

It is certainly possible that Plan F costs will go up as it is phased out, though it hasn’t been confirmed yet.

Uniquely, the state of Idaho released a memo stating that the Idaho Department of Insurance “is NOT anticipating abnormally large premium increases on Plan F after 2020” in response to questions about Plan F leaving the market. Even people who already have Plan F in Idaho and want to switch to a different Plan F after this year should not face large rate increases.

Can I Get Plan F in 2020?

Medicare Plan F is discontinued in 2020. If you missed the deadline of December 31, 2019, you won’t be able to enroll in Plan F for the first time. If you already have Plan F, don’t worry – you can keep your coverage.

To see what Medicare Supplement options are available for you, go to https://www.medicareplanfindertool.com/.

Medicare Plan Finder Tool
Medicare Plan Finder Tool

You’ll be asked to enter your zip code to get started. Then, you’ll have to answer a few questions: your gender, your date of birth, whether or not you smoke, and what kind of premium you want. After submitting some basic information, you’ll see a list of the plans that the tool recommends for you.

The system may or may not recommend Plan F based on the way you answered the questions.

Medicare Plan Finder Tool Results

When to Enroll in Plan F

If you still want Medigap Plan F, you have just a little bit of time left to enroll. The deadline is December 31, 2019. After then, Plan F will be discontinued for new members.

What is a good alternative to Plan F?

Many seniors and Medicare eligibles who already have Plan F are deciding to drop Plan F altogether and switch to Plan G. Plan G covers everything that Plan F does minus the Part B deductible, and it typically has a lower monthly premium.

Another popular plan is Plan N. The only benefit that is included in Plan G and not Plan N is the coverage for Part B excess charges. However, the thing to remember about excess charges is they are relatively rare. You will only be charged an excess charge if your provider does not accept Medicare.

medicare-plan-f-going-away-medicare-plan-finder

Medicare Plan F vs Plan G

Great news! Plan G is almost identical to Plan F! The only difference is that Plan G does not cover the Part B deductible. Plan F may technically cover more, but many people consider Plan G to be a better value. Yes, you will need to pay your Part B deductible upon your first outpatient visit, but after you pay the deductible, you won’t need to pull your wallet out for the remainder of the year. Since you have to pay the Part B deductible yourself, Plan G has lower monthly premiums, and you could save more than $400 a year!

The standard Part B deductible for 2020 is $198, so the savings from choosing G over F significantly outweighs the cost of the deductible.

Is Medicare going away or just certain plans?

No, Medicare is not going away! Don’t panic!

Both Medicare Plan F and Medicare Plan C will be discontinued on January 1, 2020, but other options may be available in your area. We get it, Medicare coverage and plan options can be confusing and stressful. Policies are constantly changing, and healthcare will continue to evolve.

At Medicare Plan Finder, our agents are kept up to date on all the plans in your area and can help you find a plan that suits your needs and budget. If you’re interested in arranging a no-cost, no-obligation appointment, click here or give us a call at 833-431-1832.

This blog was originally published on October 23, 2018, by Kelsey Davis. The latest update was updated on December 5, 2019, by Troy Frink.

2020 Medicare Plan Finder: How to Find the Best Medicare Plan in 2020

It’s time to start thinking about what you want your Medicare coverage to look like next year. Did your current plan change? Did you develop a new health condition and need more coverage? Are you enrolling in Medicare for the first time? 

No matter your situation, the Annual Enrollment Period (AEP) runs from October 15 through December 7. If you used AEP to enroll, your plan became effective on January 1, 2020.

By now, you may have realized that there are hundreds of Medicare plans out there, all offering slightly different benefits at different costs. So how do you choose?

Contents:

Which Medicare Plan is Best for me?

The best Medicare plan for 2020 is the one that fulfills your needs. To figure out which Medicare plan is best for you, ask yourself the following questions: 

  1. What specific medical services do I need coverage for (ex: lab tests, blood work, surgery, chemotherapy, dental, etc.)
  2. How much room do I have in my budget? Am I able to pay a little more to have more benefits?
  3. Do I qualify for savings (apply for Medicaid, Medicare Savings Programs, and LIS)?
  4. Would I rather pay more on a monthly basis and pay very little when I visit the doctor, or is it better to pay a small amount every month but risk having higher copayments?
  5. Who are the doctors and other providers who I want to be covered in my plan?
  6. What prescriptions do I need coverage for?

Start by Choosing a Type of Plan

There are four main types of Medicare plans to consider when you begin your Medicare plan search. Start by comparing Original Medicare, Medicare Advantage, Prescription Drug Plans, and Medicare Supplements. 

Keep in mind that you cannot have Medicare Advantage and a Prescription Drug Plan at the same time. You also cannot have Medicare Advantage and a Medicare Supplement plan at the same time.

Which plan or combination of plans works best for you?

  • Original Medicare: The original Medicare program. Comprises of Part A (hospital coverage) and Part B (medical coverage)
  • Medicare Advantage: A private plan that you can purchase once you have Original Medicare. Can add additional benefits such as hearing, vision, dental, fitness, etc. Can include a prescription benefit.
  • Prescription Drug Plans: Another type of private plan that you can purchase once you have Original Medicare. Usually only includes a prescription benefit.
  • Medicare Supplements (Medigap): Another type of private plan that you can have in addition to Original Medicare. Adds more financial coverage, like for copayments and deductibles.

You can choose from the following combinations: 

  • Original Medicare only
  • Original Medicare and a Prescription Drug Plan
  • Medicare Advantage
  • Medicare Advantage with Prescription Drug Coverage
  • Medicare Supplement
  • Medicare Supplement AND standalone Prescription Drug Plan
Different Types of Medicare Plans
Types of Medicare Plans

Original Medicare Only

Having Original Medicare only means you’ve enrolled in the government program, Medicare Part A and Part B, but you have not enrolled in an additional (private) plan. Parts A and B can cover some of your hospital and medical costs, but they do not cover prescription drugs and other additional benefits such as dental and vision. 

Original Medicare and a Prescription Drug Plan

If you don’t think you need any other medical benefits aside from what parts A and B cover, but you do need prescription drug coverage, you can enroll in a standalone prescription drug plan in addition to your Original Medicare.

Medicare Advantage

With a Medicare Advantage (MA) plan, you’ll still have to pay your Part B premium, but you can get other benefits. MA plans can include additional health benefits such as fitness program memberships, dental care, vision, and more. 

Choosing a Medicare Advantage Plan

So, did you decide to go with Medicare Advantage? Great! Now, there are a few types of Medicare Advantage plans that may be available for you. First, ask yourself whether or not you need a large network and whether the freedom to see any doctor is important to you. Then, read through these important differences:

  • HMO Plans (Health Maintenance Organization) – You’ll select one primary physician. In some cases, you may only receive coverage for that one doctor (unless he or she refers you to a specialist). Requirements may vary based on your plan.
  • HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
  • PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will usually be lower if you choose one that is in your network.
  • PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
  • SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
  • MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.

Medicare Advantage with Prescription Drug Coverage

Some select Medicare Advantage plans come with a prescription drug benefit. This is important because you can’t have BOTH a Medicare Advantage plan and a standalone prescription drug plan. If you like the idea of Medicare Advantage but need prescription coverage, a “MAPD” or Medicare Advantage Prescription Drug Plan may be right for you. 

Medicare Supplement

Sometimes called “Medigap,” Medicare Supplement plans bridge the gap between your Part A and B costs and your out of pocket costs. For example, Medigap Plan A covers Part A* coinsurance and hospital costs, Part B coinsurance and copayments, up to three pints of blood, and hospice coinsurance and copayments. It does not offer additional health benefits, but it eliminates many of the costs that come with Part A and B. 

The best Medicare Supplement plan is the one that fits your needs at the time. For example, you might not need skilled nursing care when you first sign up for Medicare, so Plan A might work best for you. Eventually, your health condition may require more inpatient services and skilled nursing services, so Plan D may be a better fit.

*Be careful not to confuse Part A with Plan A

2020 Medicare Supplement Comparison Chart
2020 Medicare Supplement Comparison Chart

Medicare Supplement AND a Prescription Drug Plan

Medicare supplements do not offer any prescription coverage, but you are able to enroll in both a Medicare Supplement plan and a standalone Prescription Drug Plan at the same time. 

What is the Best Medicare Plan in 2020?

Everyone wants to know what the “best” Medicare plan is, but just like shopping for anything else, “best” can be subjective. If you were shopping for a vacuum cleaner, you’d probably search “best vacuum cleaners,” too, but what would you find?

We did that part for you, and we got about 228,000,000 results. You’re never going to sort through all those options, right?

Medicare search
Google search results for “Best Vacuum Cleaners”

When you really want to narrow down the best vacuum for your needs, you’re probably going to filter your search by price, capabilities, maybe even the size of the vacuum…any number of things that are going to narrow down your choices to what you really want to purchase.

While there probably aren’t 228,000,000 Medicare plans available to you, there are far too many for this to be a quick Google search! Like choosing the “best” vacuum, choosing the “best” Medicare plan for you requires some research.

Medicare Plan Finder Tool

Our Medicare Plan Finder tool compares plans from carriers in your area. You’ll have to tell us your birthdate and a few other things so that we can determine what you’re eligible for.

Medicare Plan Finder Tool
Medicare Plan Finder Tool

Once you’ve entered your information, you’ll see a graph showing you the names of the plans and the potential premiums you might owe for those plans. This is a great place to start your research.

We ran a sample search for a 76-year-old non-smoking woman in Nashville who wanted a low premium to show you what the results look like. Your online Medicare Plan Finder results may not look the same.

2020 Medicare Plan Finder Tool Search Results
Medicare Plan Finder Tool (These search results may not be an accurate representation of your search results)

New Medicare.gov Tool

You may have heard the buzz about Medicare.gov’s new plan finder tool. They’re offering a “new and improved” experience after getting complaints about their old tool. 

To use Medicare.gov’s tool, you’ll need to enter your Medicare number and some other information. Then, you’ll see a graph of the plans available in your area.

Scour the Internet

We don’t recommend this option, but you could start your Medicare plan shopping experience with a quick Google search. However, watch what happened when we Googled “best medicare plan.” The first four search results are ads.

Best Medicare Plan Google Search
Google search results for “Best Medicare Plan”

The other thing you can try is going directly to the carrier websites, if you already know the name of a company you’d like to purchase from. However, keep in mind that those websites are only going to show you a select group of plans that they alone offer. You could be missing out on better plans from different carriers.

Meet With a Licensed Agent

Another option for Medicare plan research is to let a licensed agent do the work for you. 

Let’s go back to our vacuum cleaner example. Imagine if you had someone do all the vacuum research for you and then present you with only one or two options that meet your needs. Imagine if that service was free, and all you had to do was talk to the agent for a few minutes to hear about all the benefits. What if the vacuum didn’t cost anything different just because you bought it from the agent instead of Amazon. Wouldn’t you take that deal?

At MedicarePlanFinder.com, we have agents across 38 states that can help you sort through your Medicare options and narrow it down for you. The appointments are free and easy, and you won’t pay any more for your Medicare plan whether you buy it from a licensed agent or online by yourself.

The difference is that our agents are experienced and can tell you all the ins and outs of your plan options (maybe even more than what is advertised online)! 

Ready to get started? Give us a call at 844-431-1832 or click here to have an agent call you.

When Can You Enroll in Medicare in 2020?

Your enrollment periods will depend on a few factors, such as:

  • What type of coverage are you hoping to enroll in?
  • Are you over the age of 65?
  • Do you have a chronic condition or low income that qualifies you for a Special Enrollment Period?
  • Do you have a qualifying life event such as moving to a new state where different plans are available?
Medicare Enrollment Periods

Initial Enrollment Period

Your Initial Enrollment Period is the time you get started with Medicare coverage.

If you are eligible for Medicare due to age (you are over 65 or about to turn 65), your Initial Enrollment Period will last from three months before your 65th birthday through three months after.

Initial Enrollment Period Medicare
Initial Enrollment Period Medicare

If you qualify for Medicare for another reason, such as having a disability or chronic illness, your Initial Enrollment Period will be the month of your diagnosis.

Annual Enrollment Period

Once you’ve enrolled in Original Medicare (Parts A and B), you’re eligible for the Annual Enrollment Period. The AEP runs from October 15 through December 7 of each year. During this time, you can enroll in Medicare Advantage or Part D (prescription drug coverage).

Special Enrollment Period

There are two types of Special Enrollment Periods: Immediate/consequential and “long-term”. If you qualify for an immediate Special Enrollment Period, you typically have 90 days to make a change following a major life event. If you qualify for a “long-term” special enrollment period, you are able to change plans once per quarter for the first three quarters of the year (and during AEP, which falls during the fourth quarter of the year). Keep in mind that a SEP is never truly permanent, as you could lose your eligibility at any time due to a major life change.

To qualify for an “immediate” SEP, you must incur a major life change such as moving to a new service area that has different plans available (a different zip code), moving into or out of a medical facility, gaining or losing Medicaid eligibility, etc. You can also gain a SEP if your plan decides to leave the Medicare program

To qualify for a “long-term” SEP, you must be:

  • Eligible for Medicaid,
  • Eligible for a Medicare Savings Program,
  • Eligible for a Special Needs Plan, or
  • Eligible for LIS (Extra Help)

Other Enrollment Periods

Technically, there are two other Medicare enrollment periods as well.

The General Enrollment Period runs from January 1 through March 31 and is a time when people who missed their Initial Enrollment Period can sign up for Medicare parts A and B. The Open Enrollment Period also runs from January 1 through March 31 and is for those who selected a Medicare Advantage plan during AEP and changed their mind.

It’s important to make note of all the Medicare enrollment periods and which ones you are eligible for so that you don’t miss your chance to enroll!

Ready to get started? Give us a call at 844-431-1832 or click here to have an agent call you during your enrollment period.


This post was originally published on October 16, 2019 and was last updated on November 1, 2019.

How to Choose the Best Medicare Plan for You

When it’s time to choose a Medicare plan, it’s easy to get overwhelmed. There are quite a few different types of Medicare plans to choose from. Once you choose what type you want – you still have to choose a plan! Making the right choice is important because it may not be easy to change plans if you change your mind. 

The Annual Enrollment Period (October 15 through December 7) is when anyone can make changes, and for some people, it’s the only time. If you make the wrong choice, you might have to wait a whole year before you can change again (unless you qualify for the OEP or have a SEP).

Which Medicare Plan is Best for Me?

To figure out which Medicare plan is best for you, ask yourself the following questions: 

  1. What specific medical services do I need coverage for (ex: lab tests, blood work, surgery, chemotherapy, dental, etc.)
  2. How much room do I have in my budget? Am I able to pay a little more to have more benefits?
  3. Do I qualify for savings (apply for Medicaid, Medicare Savings Programs, and LIS)?
  4. Would I rather pay more on a monthly basis and pay very little when I visit the doctor, or is it better to pay a small amount every month but risk having higher copayments?
  5. Who are the doctors and other providers who I want to be covered in my plan?
  6. What prescriptions do I need coverage for?
Medicare Plan Finder Tool
Click to start searching for Medicare Plans

Types of Medicare Plans

There are four main types of Medicare plans to consider when you begin your Medicare plan search. Start by comparing Original Medicare, Medicare Advantage, Prescription Drug Plans, and Medicare Supplements. 

Keep in mind that you cannot have Medicare Advantage and a Prescription Drug Plan at the same time. You also cannot have Medicare Advantage and a Medicare Supplement plan at the same time.

Which plan or combination of plans works best for you?

  • Original Medicare: The original Medicare program. Comprises of Part A (hospital coverage) and Part B (medical coverage)
  • Medicare Advantage: A private plan that you can purchase once you have Original Medicare. Can add additional benefits such as hearing, vision, dental, fitness, etc. Can include a prescription benefit.
  • Prescription Drug Plans: Another type of private plan that you can purchase once you have Original Medicare. Usually only includes a prescription benefit.
  • Medicare Supplements (Medigap): Another type of private plan that you can have in addition to Original Medicare. Adds more financial coverage, like for copayments and deductibles.
Different Types of Medicare Plans
Different Types of Medicare Plans

Choosing a Medicare Advantage Plan

So, did you decide to go with Medicare Advantage? Great! Now, there are a few types of Medicare Advantage plans that may be available for you. First, ask yourself whether or not you need a large network and whether the freedom to see any doctor is important to you. Then, read through these important differences:

  • HMO Plans (Health Maintenance Organization) – You’ll select one primary physician. In some cases, you may only receive coverage for that one doctor (unless he or she refers you to a specialist). Requirements may vary based on your plan.
  • HMO-POS Plans (Point-Of-Service) – You’ll select one primary physician, but you’ll have the freedom to visit any specialist in your network for your other needs. You will be charged a fee for visiting specialists.
  • PPO Plans (Preferred Provider Organization) – You can see any doctor, but your costs will usually be lower if you choose one that is in your network.
  • PFFS Plans (Private Fee-For-Service) – You will not need referrals or a primary physician, but you’ll have to pick a doctor that accepts your PFFS plan.
  • SNP (Special Needs Plans) – Designed for those who are eligible for both Medicare and Medicaid, live in a nursing home, or have a chronic illness or disability.
  • MSA (Medical Savings Account) – Works like a tax-free savings account for your medical bills. Medicare will deposit money into your HSA. You can use that account to pay for medical expenses.

How do I Pick a Medicare Supplement Plan?

If you’ve decided that you want a Medicare Supplement plan, you’ll want to start by selecting the plan letter that corresponds with the coverage you need. Use the chart below for reference. 

Once you’ve made that decision, you may have a few different carriers available in your area to choose from (some smaller cities may not have several options available). 

Our Medigap Plan Finder Tool is a great place to start.

2020 Medigap Comparison Chart
2020 Medigap Plan Comparison Tool

How to Find Medicare Plans in My Area

Finding Medicare Plans in your area just got easier. Our Medicare Plan Finder tool can help you not only see what is available, but see which options may be best for your unique needs. 

You can enroll by yourself, or you can meet with a licensed agent (for free) who can walk you through the process to make sure you don’t make any mistakes. The licensed agent can also talk to you about a variety of different plans in your area and answer all your questions. This unbiased approach is a great way to get the help you need when selecting a Medicare plan. 

To set up your free meeting with a Medicare Plan Finder licensed agent, call 833-438-3676 or click here.

Medicare Plan Finder Privacy Policy

Medicare Plan Finder Privacy Policy

Date of Last Revision: June 19, 2020

Thank you for visiting MedicarePlanFinder.com (the “Website”), which is owned and operated by Medicare Health Benefits, LLC (“MedicarePlanFinder”). We recognize that your privacy is important and have created this Privacy Policy (“Privacy Policy”) to inform you about our data collection and use practices, including personal information that we collect from you and through your use of the Website and the services provided on the Website. 

The Privacy Policy is presented to provide you information regarding the collection, storage and use of your personal information. Accordingly, please read this Privacy Policy carefully. This Privacy Policy may be changed by us from time to time without notice to you, and the governing version will be posted on the Website. Please review this Privacy Policy on a regular basis as your use of the Website will be governed by the then-current Privacy Policy. Please also be aware that this Privacy Policy does not apply to the practices of companies that we do not own and/or control or to people that we do not employ or manage.

Throughout this policy, we use the term “personal information” to describe information that can be associated with a specific person and can be used on its own or with other information to identify, contact, or locate a single person, or to identify an individual in context. We do not consider personal information to include information that has been aggregated and/or anonymized so that it does not identify a specific user.

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Is Medicare Better Than Individual Plans?

Is Medicare Better Than Individual Plans?

One survey about Medicare satisfaction vs. private insurance satisfaction found that people with Medicare were happier with their health plans than people with individual plans. Will you find the same to be true?

Types of Plans

As you turn 65 or otherwise become eligible for Medicare, you probably have a lot of questions. What’s going to change? Will I lose or gain new benefits? The good news is that signing up for Medicare does not necessarily mean giving up your plan flexibility or your favorite doctors. There are plenty of Medicare options available, and we’ll explain why it’s worth it to go ahead and get signed up as soon as you can. 

Employer Coverage

You can purchase health insurance through your employer, as long as it meets the coverage limits set by the federal government. If you’re retiring but aren’t eligible for Medicare yet, you can use COBRA to hold you over. COBRA allows you to continue receiving your employer coverage for a short period of time (but your employer likely won’t help you pay for it except for in some unique cases). 

You can also technically have Medicare and employer coverage at the same time, if you become eligible for Medicare while you are still employed. That might make sense for some people and not others. 

Private Coverage

You can purchase insurance from an exchange like Healthcare.gov, directly from your state, or directly from a health insurance company. Generally, purchasing private insurance is more expensive than employer coverage, and much more expensive than Medicare and Medicaid.

TRICARE/VA Coverage

Veterans and veteran’s families may be eligible for free or low-cost healthcare through the Department of Veteran’s Affairs (VA). You or your spouse must have served for at least 24 continuous months or teh full length of time that you were called to serve for. You can also qualify if you were honorably discharged. To get TRICARE, you must already be enrolled in Medicare Part A and Medicare Part B. Click here to read more about coverage for veterans.

Medicaid

Medicaid is a federal health program. Each state has slightly different rules and each state has its own funding. The program can cover any person of any age with low income (according to the Federal Poverty Level and with some adjustments in each state). Most Medicaid beneficiaries will have either no or very small premiums. If you have a low monthly income AND are over 65, you may qualify for both Medicaid and Medicare! In that case, you can get what is called a “Dual-Eligible Special Needs Plan,” which is low-cost and tailored to your needs. 

Medicare

Original Medicare is a federally funded health program that can cover any adult over the age of 65 as well as some adults with disabilities, such as end-stage renal disease.

 Most people with Medicare will start with parts A and B. Part A provides hospital coverage, and Medicare Part B provides medical coverage. Anyone who wants more coverage can opt to enroll in either a Medicare Advantage plan or a Medicare Supplement (also called Medigap) plan. Medicare Advantage is sometimes referred to as “Part C” because you have to have Part A and Part B first to enroll in it, and it can cover a lot of services that parts A and B do not.

Unless you enroll in a Medicare Advantage plan that includes prescription drug coverage, you’ll want to enroll in a separate drug plan. These plans are referred to as “Medicare Part D,” because they are completely separate from the other “parts.” Part D plans only cover prescription costs. 

Some people may qualify for no or low-cost Medicare coverage, but others will have to pay premiums. Most people will not have to pay nearly as much for Medicare as they would with an individual or private health plan.

You may think that individual plans provide more coverage due to the higher premiums, but that is not always the case. All Medicare plans include preventative services. Plus, you can choose to enroll in Medicare Advantage, which is like a private plan for Medicare. With Medicare Advantage, you can roll all your benefits – medical, dental, vision, prescription drugs, and even fitness – into one convenient plan. 

How is Medicare different from other health insurance?

Medicare is vastly different from other health insurance options for a lot of reasons, ranging from the way you pay for your coverage to when you can enroll. 

For starters, the Medicare enrollment period is different from the ACA enrollment periods and your employer’s enrollment periods. The Medicare Annual Enrollment Period runs from October 15 through December 7, but be sure to not confuse it with the ACA Open Enrollment Period, which runs from November 1 through December 15 of each year. 

Another thing that is different is that some people can have their Medicare Part A payments automatically deducted from their Social Security check. 

Employer Health Insurance vs. Medicare

It’s hard to even compare Medicare vs. employer health plans because the only thing they have in common is that they provide health insurance. If you’re turning 65 or otherwise preparing to make the switch from your employer plan to Medicare, you should know the pros and cons of each option. 

For starters, Original Medicare is the same for everybody. Technically, there are not separate plans to choose from within the government Medicare program. Once you’ve enrolled in Original Medicare, you can decide to add coverage through a private Medicare Advantage or Medicare Supplement plan. Some people may see this as a great thing because you can enroll right away without stressing about all your options. Others don’t like it, because one plan clearly cannot work for everybody. However, that’s what the private plans are for (and many of them are incredibly cheap compared to employer plans – some even have $0 premiums). 

The advantage of private health insurance for Medicare (Medicare Advantage or Medicare Supplement) is that you can pick and choose which benefits are most important to you so that you aren’t paying for coverage that you don’t need. Plus, some people will qualify for Medicare Special Needs Plans which are specifically designed for people with special financial or medical needs and are usually relatively low-cost plans. Private Medicare plans can closely resemble individual marketplace plans or employer plans. 

The disadvantages of private health insurance for Medicare-eligible people are that they sometimes have limited doctor networks and that some areas might have a limited number of plans to choose from. Typically, people who live in rural areas may have fewer plan options when it comes to private Medicare coverage. 

Medicare vs. Medicaid

Both Medicare and Medicaid are government programs that are regulated by CMS (Centers for Medicare and Medicaid Services). They both provide health insurance for medically necessary services.

The main difference between Medicare and Medicaid is who qualifies. It is possible to qualify for both programs, but Medicaid qualifications are based on income while Medicare qualifications are based on age and disability. Another difference is that while the Medicare qualification rules are federal, Medicaid qualification rules can change slightly by state. 

Medicare Versus Spouse Insurance

A lot of people who are newly qualified for Medicare wonder if it might be better to stay on their spouse’s insurance plan. The fact is, it depends on how good your spouse’s insurance is. However, if you do qualify for Medicare, Part A (the part that covers hospital costs) has a $0 premium for anyone who has worked and paid Medicare taxes for at least ten years. If you haven’t worked that long but your spouse has, you might still qualify. If that’s the case, there’s no reason not to go ahead and enroll in Medicare Part A as soon as you become eligible. 

Additionally, if you wait too long to seek out further Medicare coverage, your costs may go up. You can be charged a penalty of up to 10% of your premium if you don’t enroll in Medicare Part B when you first become eligible. Plus, Medicare Supplement plans can charge more or deny coverage based on preexisting conditions if you wait too long to enroll. So if you think you might want to enroll in a Medicare Supplement plan, don’t wait too long to start looking. 

Medicare vs Other Health Insurance: The Benefits

If you are eligible for Medicare coverage but considering alternative health insurance, you should start by learning what Medicare does and does not cover. Medicare Part A and Part B are the same for all who enroll. They cover preventative healthcare, like your annual wellness visits and flu shots at 100%. 

Part A also covers 60 consecutive hospital days at 100%. After the 60th day, you’ll start to owe co-payments. Part B covers mental health, lab tests and X-rays, emergency transportation, and medical equipment. 

Medicare A and B do not include prescription drug coverage, dental, vision, hearing, podiatry, or any service that is not deemed medically necessary either for treatment or prevention. For additional health coverage, millions of Medicare beneficiaries enroll in Medicare Advantage

Since Medicare Advantage plans are owned by private companies, they can add in benefits like dental, vision, hearing, etc. – any of those extra benefits that you might be accustomed to from having private health insurance. Some Medicare Advantage plans also cover prescriptions. If you want prescription coverage but don’t care about all of the extra benefits, you can enroll in a stand-alone prescription drug plan instead. However, you cannot have both a Medicare Advantage plan and a Medicare prescription drug plan at the same time, so choose wisely. 

Medicare vs Other Health Insurance: The Costs

The good news about Medicare is that as long as you or your spouse have worked and paid Medicare taxes for a certain number of years, your Part A Medicare costs will be low. 

  • If you or your spouse has worked and paid Medicare taxes for at least 40 quarters, you’ll owe $0 in Part A premiums.
  • If you or your spouse has worked and paid Medicare taxes for 30-39 quarters, you’ll owe $252/month in 2020 in Part A premiums.
  • If you or your spouse has worked and paid Medicare taxes for less than 30 quarters, you’ll owe $458/month in 2020 in Part A premiums.

Part B premiums are standard for all Medicare beneficiaries. It can change each year, but the Part B monthly premium in 2020 is $144.60, and the deductible is $198. Most services that Part B covers are covered at 80%, so you may owe 20% coinsurance or doctor co-payments.

If you choose to enroll in a prescription drug plan, a Medicare Advantage plan, or a Medicare Supplement plan, you may face an additional premium. 

Medicare vs. Private Insurance Costs

If you’re choosing between enrolling in Medicare Part B versus private insurance, remember that delaying your Part B enrollment can leave you with up to a 10% increase in your premium when you do decide to enroll.

If you decide to add on private Medicare insurance through a Medicare Advantage or Medigap plan, remember that you’ll still have to pay your Medicare Part A and B monthly premiums (unless you qualify for a savings program such as QMB). You cannot enroll in MEdicare Advantage without enrolling in Medicare parts A and B first. 

Medicare Advantage and Medicare Supplement plans are completely separate and therefore come with separate bills. You’ll owe a premium (which in some cases can be $0), and you’ll likely have a deductible as well as co-payments for certain services. 

Many private health insurance plans also have out-of-pocket maximums, which means that if you have a lot of health care costs, you can reach a point where you stop having to pay out-of-pocket for services. Those out-of-pocket expenses can really start to add up even with Medicare if you’re someone who needs a lot of medical care!

Why is Medicare cheaper than private insurance?

A lot of new Medicare beneficiaries do find that their Medicare costs are cheaper than what they were paying before they qualified. The biggest reason for that is the way Medicare is funded. While you or your spouse were working hard for all those years, you were paying Medicare taxes. Your low premiums today are because of all that hard work! Plus, the Medicare office does not incur nearly the same amount of administrative costs that many healthcare companies do. 

Is it better to have Medicare or private insurance?

Is Medicare a good insurance option? Is private health insurance better? It depends on who you ask. This is a great question to ask an insurance agent who knows what sort of medical expenses you have and what your budget is. 

The main difference you have to remember when you’re wondering if private insurance or Medicare is better is that private insurance gives you more plan options. To get a private Medicare Advantage plan, you’ll have to enroll in Medicare A and B, first. Then, you can choose if you want to personalize your coverage and add benefits by enrolling in additional medical insurance. 

If you’re stuck between Medicare and keeping your employer plan, remember that you could face penalties if you don’t enroll in Medicare when you first become eligible – and nothing says you can’t keep both!

Is Medicare or private insurance better for people with dependents?

If you have dependents, Medicare isn’t going to help you. But that doesn’t mean you shouldn’t enroll. Medicare only provides individual coverage – there are no family plans or spouse Medicare plans. However, your Medicare Part A might be free. If that’s the case, you might want to consider enrolling in Medicare for yourself first, and then taking a look at options for your dependents. 

If you have access to an employer plan, do the math to figure out if it may be more cost-effective for you to have your group vs. individual Medicare Advantage coverage. In some cases, it might even make sense for you to keep both. If your Medicare Advantage premium is low enough, you can keep that for yourself but also hang onto your group coverage for as long as you can to support your family. An insurance agent can help you figure out what’s best for you. 

Can I drop my employer health insurance and go on Medicare?

If you become eligible for Medicare while still receiving employer health insurance, you can and should still enroll in Medicare to avoid penalty fees. 

First, find out if you’re currently in one of the Medicare enrollment periods. Medicare open enrollment is different from your employer’s open enrollment period. 

If you just became eligible, you’ll have a few months for your “Initial Enrollment Period.” If you’re aging into the program, this period begins three months before your 65 birthday and ends three months after. If you’ve already missed that period, don’t panic – you can enroll for the first time from January 1 through March 31 of each year. 

Once you’re enrolled, the “Annual Enrollment Period,” is when you can add or make changes to your Medicare coverage. It runs from October 15 through December 7 of each year. This period is not for enrolling in Medicare for the first time – it’s only for adding or making changes to your private Medicare coverage. 

According to Medicare.gov, some people will be automatically enrolled in Medicare Part A upon becoming eligible. If you are not automatically enrolled, you can apply for Medicare on the Social Security website.

How Medicare Works with Other Insurance

Millions of Medicare beneficiaries opt to enroll in Medicare Advantage or Medicare Supplements on top of their Medicare coverage. In these cases, the private insurance companies act as the “secondary payers.” Health benefits that Medicare does not cover will be automatically billed to the private company, but anything else will go to Medicare first. If you have both employer insurance and Medicare, Medicare might actually be the secondary payer. Check with your employer or your employer’s health insurance plan to be sure. 

Both Medicare and private insurance coverage will have limitations – so having both is a great way to keep yourself and your families financially covered in case of a medical emergency.

How Medicare Plan Finder Can Help You

We specialize in Medicare and serving the underserved senior and Medicare-eligible population. Do you or a loved one need help selecting a Medicare plan that truly helps? Set up a free appointment with one of our licensed agents in your area to get bias-free assistance. Call us to set it up at 1-844-431-1832.

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We’ve Enrolled more than 800,000 Medicare-eligible individuals into a plan.

Special Needs Plans (SNP)

What Are Medicare Special Needs Plans?

A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan that provides enhanced treatments to people who need targeted care. Three different types of SNPs can offer a coordinated care plan for those who need it. The targeted populations include:

  • An institutionalized individual
  • A dual-eligible (qualifies for both Medicare and Medicaid)
  • An individual with a severe or disabling chronic condition, as specified by the Centers for Medicare & Medicaid Services (CMS)

First established in 2003, SNPs generally provide coverage for doctor visits, hospital services for people who have Original Medicare Part A and Part B, and live in the service area of a Medicare SNP plan.

Here’s what you need to know about SNPs:

How Medicare SNPs Work

The Three Types of Special Needs Plans

Dual Eligible Special Needs Plans (DSNP)

How to Qualify for both Medicare and Medicaid

Medicare Savings Programs for Dual Eligibles

Do DSNPs Cover Dental Benefits?

Institutionalized Special Needs Plan (ISNP)

Chronic Condition Special Needs Plan (CSNP)

Benefits of a Medicare Special Needs Plan

Do All Medicare SNP Plans Have Drug Coverage?

Special Needs Plans Costs for 2020

Getting Help with Special Needs Plans Costs

Qualifying for the State Pharmaceutical Assistance Program 

Significant Changes in 2020 SNPs

How and When to Enroll in a Special Needs Plan

What Happens If You No Longer Qualify for an SNP?

Let Us Answer Your Questions About Special Needs Plans

How Medicare SNPs Work

Medicare SNPs are a type of Medicare Advantage Plan similar to an HMO or PPO. You will get care from providers in your SNP network (except if you need emergency care).

However, each SNP limits its membership to targeted and specific groups. For example, a Medicare SNP might be created to serve only people with cancer or congestive heart failure. 

The plan would offer targeted access to providers who specialize in treating that particular condition. This would be augmented by drug formularies to include medications that also specifically address that condition.

In addition to covering all the things that Original Medicare covers, SNPs should be offered to provide services beyond that level of coverage, including specific health benefits and provider networks. This might mean lower cost-sharing, long covered benefit periods, additional wellness programs and preventative health benefit offerings, and more. 

In many cases, SNPs use coordinated care providers to oversee your condition and make sure you see the right specialists and get the right information. For an SNP covering diabetes, this could mean the coordinator checks with a patient regularly to make sure they are following their diet, getting exercise, monitoring their blood sugar, and getting the right prescriptions to minimize complications.

If you don’t have a care coordinator, you will probably be required to choose a primary care doctor. The doctor or care coordinator will assist you with referrals to see a specialist in your SNP.

Every year, Medicare SNP providers drop in and out of the program. That means coverage could change from location to location and from year to year. Insurance companies decide where they will do business, so SNP coverage may not be available by some providers in all parts of the country. Insurance companies can also offer more than one plan in an area with different costs and coverages. 

Also, you can only stay enrolled in an SNP as long as you meet the particular set of requirements for that plan. If you no longer qualify, you’ll have a short grace period to find a different form of coverage.

The Three Types of Special Needs Plans

There are three main types of Special Needs Plans:

Dual Eligible Special Needs Plans (DSNP)

DSNPs are mostly for those who are eligible for both Medicare and medical assistance from a state plan under Medicaid. Coverage and costs will vary from state to state. People who qualify for both are referred to as dual-eligibles. 

It’s estimated that about 20% of Medicare beneficiaries are also eligible for Medicaid. When you have a claim, Medicare is the primary payer and Medicaid pays last.

You can either be eligible for full Medicaid or a Medicaid Savings Program (MSP) based on your income.

Since Medicare does not provide coverage for many types of long-term or custodial nursing home care, but Medicaid does, many low-income seniors are dual-eligible. Medicaid coverage for at-home care varies from state to state. 

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How to Qualify for Both Medicare and Medicaid

Eligibility for Medicaid is a means-based program determined on a state-by-state basis. The federal government determines Medicare eligibility. CMS administers both Medicare and Medicaid.

You can qualify for both Medicare and your state Medicaid program if you meet the Medicaid eligibility limits in your state (based on your health and finances) and you meet at least one of the following:

  • You are 65 or older
  • You have ESRD (End-Stage Renal Disease) or ALS
  • You have received Social Security Disability Insurance for more than 24 months.

There is an overlap between the two programs. People generally qualify for Medicaid once they have exhausted their financial resources and can then meet strict income and asset limits. These people are known as full benefit dual-eligibles.

In other cases, a dual eligible beneficiary may be able to qualify for a Medicare Savings Program (MSP). These plans are offered by state Medicaid programs to help pay for some Medicare costs. 

The MSPs are not as comprehensive as the combination of Medicare and full Medicaid, but they do offer attractive benefits and are less restrictive with higher asset and income limits.

People who qualify for an MSP are known as partial-benefit dual-eligibles.

Medicare Savings Programs for Dual Eligibles

You may qualify for one of the following MSPs:

Qualified Medicare Beneficiary without Medicaid (QMB): You do not receive Medicaid but have an income at 100% of the federal poverty level, and your assets total no more than twice the social security limit. Through the QMB program, Medicaid can pay your Medicare Part A and B premiums, deductibles, and coinsurance.

QMB Plus: You meet QMB eligibility but are also eligible for Medicaid benefits. Medicaid can pay your Medicare Part A and Part B premiums, deductibles, and coinsurance.

Specified Low-Income Medicare Beneficiary Without Medicaid (SLMB Only): Your income is between 100 and 120% of the federal poverty level, and your assets total no more than twice the social security limit, but you are not eligible for Medicaid. Medicaid can pay your Medicare Part B premium.

Qualifying Individual (QI): Your income is between 120 and 135% of the federal poverty level, and your assets total no more than twice the social security limit.

Qualifying Disabled and Working Individual (QDWI): You returned to work and lost your Medicare Part A benefits but are eligible to enroll now. Your income is no more than 200% of the federal poverty level, and assets are no more than twice the social security limit. You are not eligible for Medicaid, but Medicaid will pay your Part A premium.

Other Full Benefit Dual Eligible (FBDE): You do not meet the criteria for either QMB or SLMB but are eligible for Medicaid. You can receive a Medicare Advantage Special Needs Plan during any time of the year.

CMS expects DSNPs to add value for the enrollees by augmenting or bridging a gap between Medicare and Medicaid covered services. CMS may approve flexible supplemental benefits that: 

Are appropriate for individuals who need assistance with activities of daily living (ADL), including eating, drinking, dressing, bathing, grooming, toileting, transferring, and mobility. 

Are appropriate for individuals who need assistance with instrumental activities of daily living (IADLs), including transportation, grocery shopping, preparing food, financial management, and medication management.

Do DSNPs Cover Dental Benefits?

Depending on the plan, a DSNP also covers a range of preventive services with no cost-sharing for a member. This may also include routine dental, routine vision, non-emergency medical transportation, and other related services. 

Institutionalized Special Needs Plan (ISNP)

ISNPs are for those who live in an institution for at least 90 days or are expected to need a level or services provided by:

  • a long-term care (LTC) skilled nursing facility (SNF)
  • an LTC nursing facility (NF)
  • an SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD)
  • an inpatient psychiatric facility

Chronic Condition Special Needs Plan (CSNP)

CSNPs restrict enrollment to special needs patients with specific severe or disabling chronic conditions. A CSNP must offer services that go beyond basic Part A and Part B coverage.

About two-thirds of Medicare enrollees have multiple chronic conditions requiring coordinated care among primary providers, including: 

  • medical and mental health specialists
  • inpatient and outpatient facilities
  • extensive ancillary services related to diagnostic testing and therapeutic management

To qualify for a CSNP, you must have a qualifying disabling condition, and you must already have Medicare parts A and B. If you don’t qualify for Medicare A and B, you cannot enroll in a CSNP. 

CMS has approved the following 15 specific chronic conditions that are eligible for CSNP coverage:

  1. Chronic alcohol and other drug dependencies
  2. Autoimmune disorders limited to polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, and systemic lupus erythematosus 
  3. Cancer, excluding pre-cancer conditions or in-situ status 
  4. Cardiovascular disorders limited to cardiac arrhythmias, coronary artery disease, peripheral vascular disease, and chronic venous thromboembolic disorder 
  5. Chronic heart failure 
  6. Dementia
  7. Diabetes mellitus 
  8. End-stage liver disease 
  9. End-stage renal disease (ESRD) requiring dialysis 
  10. Severe hematologic disorders limited to aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, sickle-cell disease (excluding sickle-cell trait), and chronic venous thromboembolic disorder
  11. HIV/AIDS
  12. Chronic lung disorders limited to asthma, chronic bronchitis, emphysema, pulmonary fibrosis, and pulmonary hypertension 
  13. Chronic and disabling mental health conditions limited to bipolar disorders, major depressive disorders, paranoid disorder, schizophrenia, and schizoaffective disorder 
  14. Neurologic disorders limited to amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia), Huntington’s disease, multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal stenosis, and stroke-related neurologic deficit
  15. Stroke

These chronic conditions are reviewed periodically, and it’s best to check with CMS to see if health care research has demonstrated advancements in chronic condition management that may change the contents of this list. 

Medicare Advantage providers are not allowed to enroll people with ESRD unless an SNP provider gets a waiver from CMS to open enrollment for people with ESRD.

The SNP provider must arrange access to services specifically targeted to people with ESRD, including nephrologists, hemodialysis centers, and renal transplant centers.

Medicare Plan Finder

Benefits of a Medicare Special Needs Plan

SNPs are required to at least offer the same level of coverage as Medicare Part A and Part B. They must also offer prescription drug coverage as well. Many plans also offer enhanced benefits that provide additional coverage beyond Original Medicare.

With some SNPs, you will have a care coordinator who will provide you with a higher degree of personalized attention, helping you to stay focused on your treatment as dictated by your doctors.

SNPs also provide greater access to specialists who focus on the particular conditions of the SNP you enrolled in. The same goes for drug formularies, where certain SNP providers tailor drug offerings to meet the need for a particular condition best.

Many plans require that you use in-network providers, but some plans do offer the option of seeing doctors out-of-network as well.

Do All Medicare SNP Plans Have Drug Coverage?

By law, SNPs must follow existing Medicare Advantage program rules. This includes regulation 42 CFR 422 related to prescription drug plan program rules. 

As such, all SNPs must provide Part D prescription drug coverage. This important provision is in place because special needs patients must have access to prescription drugs to manage and control their special health care needs. Unless there are provisions to the contrary, SNPs must abide by guidance in existing Part C and D rules. 

Special Needs Plans Costs for 2020

Unless you qualify for financial assistance, your SNP plan may come with a premium cost in 2020. The exact cost will vary by the type of plan and provider you choose. Costs will be in addition to a Medicare Part B premium you will also need to pay.

You may also need to pay an extra monthly premium for prescription drug coverage and additional benefits. 

Depending on the plan, you may also have cost-sharing fees like copayments, coinsurance, and deductibles. However, SNP costs are generally lower than those of regular Medicare Advantage plans. Also, you may need to pay more for out-of-network care, so it’s best to check with your plan before you see an out-of-network provider.

If you are in a DSNP, you won’t pay any more for your DSNP Medicare Advantage plan than you would with Medicaid. If you do have Medicaid, there is a chance that Medicaid will cover all of your DSNP Medicare Costs.

SNPs cannot charge more than Original Medicare for some types of care, such as chemotherapy and skilled nursing facility care. But they can charge more for other things such as home health or durable medical equipment. 

Getting Help with Special Needs Plans Costs

Depending on your income and assets, and if you have Medicare and Medicaid, you may be able to get some or all of your costs covered through Medicaid. You may also qualify for a Medicare Savings Program to help pay for premiums, copayments, deductibles, and coinsurance. 

To find out about getting help with SNP costs, call your state Medicaid office or call 1-800-MEDICARE (TTY users 1-877-486-2048), 24 hours a day, seven days a week.

Qualifying for the State Pharmaceutical Assistance Program 

People who qualify for Special Needs Plans may also be eligible for the State Pharmaceutical Assistance Program (SPAP). 

SPAPs are not available in every state, and every state program operates a little bit differently. 

In some states, SPAP works with your Part D Medicare plan. In these cases, the program may be able to help you pay for your Part D premium, deductible, and copayments. 

Enrollment is different in every state, but our SPAP chart can tell you whether or not the program is available near you and how to enroll.

Significant Changes in 2020 SNPs

About 13% of SNPs will be discontinued in 2020. But the offset of this is that overall, there will be a 19% increase in total nationwide coverage. Gains in other areas will offset SNP losses in some counties. Overall, there are more than 850 SNPs available in 2020, with the vast majority being DSNPs.

The highest concentration of SNP offerings is available in a few counties located in New York, Florida, and California.

The Bipartisan Budget Act of 2018 permanently reauthorizes SNPs as well as introduces further reforms aimed at cost-containment and improving quality.

There are also some changes related to quality control benchmarks that CSNPs and DSNPs must meet starting in 2020.

How and When to Enroll in a Special Needs Plan

Before you can enroll, you must meet eligibility requirements, which vary by the type of SNP.

CSNP eligibility requirements

You must get a doctor’s note from your doctor confirming you have the condition addressed by the SNP. The CSNP may enroll you before getting confirmation from your doctor, but confirmation must take place by the end of your first month. If not, you will be disenrolled from the plan at the end of the next month. You will have a Special Enrollment Period to enroll in a new plan if your existing plan disenrolls you.

ISNP eligibility requirements

You must live for at least 90 days in long-term care (LTC) facility that is served by the SNP (i.e., nursing home or an intermediate care facility for the mentally disabled). Or, you meet your state’s guidelines for requiring nursing home-level of care for at least 90 days, whether you live in an institution or a community setting (i.e., at home or in a group residence). You can still qualify for an ISNP if you haven’t received care for at least 90 days if it is likely that you will need long-term care for at least 90 days.

DSNP eligibility requirements

You must verify that you have Medicaid. Some DSNPs only serve beneficiaries with Medicare and full Medicaid benefits. If you’re enrolled in an MSP, you must find a plan that serves people with MSPs. If you meet the SNP’s eligibility requirements, you can join the plan during regular Medicare Advantage enrollment periods.

Qualifying for a Special Needs Plan means you automatically qualify for a Special Enrollment Period. You may be eligible for a Special Enrollment Period if you:

  • Have Medicare and Medicaid. The Special Enrollment Period lasts as long as you have Medicare and Medicaid.
  • Have a severe, disabling, or chronic condition. You can enroll in an SNP that serves that condition at any time.
  • Are entering an institution that qualifies you for SNP coverage or develops the need for a nursing home-level of care. You can enroll in or disenroll from an ISNP at any time.

You can also enroll in an SNP during the Medicare Annual Election Period from October 15 to December 7 every year. During this period, you can enroll in an SNP for the first time, switch plans, or disenroll from your plan.

Once you have determined you meet eligibility requirements for an SNP, to enroll call Medicare at 1-800-633-4227, or the plan directly, or Medicare Plan Finder at 833-438-3676.

The SNP will require periodic proof that you continue to meet these criteria.

What Happens If You No Longer Qualify for an SNP?

For a variety of reasons, a person enrolled in an SNP may become ineligible for the plan when they lose their special needs status because you no longer meet the special conditions served by the plan. 

For example, with a DSNP, you may lose your Medicaid eligibility because you have gone over the assets and income limits. You would be forced to disenroll unless you become eligible for Medicaid again during the plan’s grace period. These grace periods are at least one month long but can be longer depending on the plan. 

You will be eligible for a Special Enrollment Period if you lose your plan eligibility.

This Special Enrollment Period starts when your SNP notifies you that you’re no longer eligible for their plan. It continues during the grace period. If you’re disenrolled from the SNP at the end of the grace period, it continues for two months after your coverage ends. 

Let Us Answer Your Questions About Special Needs Plans

Get your questions answered and see if you qualify to enroll by speaking with one of our licensed benefits advisors. We’re happy to guide you through the process.

There is no cost to you, and you’re never under any obligation to enroll. 

To speak with one of our Medicare Plan Finder benefits advisors, send us a message or give us a call at 833-438-3676.

Medicare Plan Finder

Select Your Plan

Medicare Plan G: Costs and Benefits (2020 Update)

What is Medicare Plan G?

Medicare Plan G is one of several Medigap Plans you can buy from a private company to pay healthcare costs not covered by Medicare Part A and Medicare Part B. Medigap plans are often referred to as Supplemental plans as well.

These plans help cover co-payments, deductibles, and coverage during international travel.

Medigap plans are identified by letter, A through N. Current offerings include Plans A, B, C, D, F, G, K, L, M and N. Plans E, H, I, and J are no longer available to new subscribers.

It’s important to note that Medigap Plans A, B, C, and D are not the same as Medicare Parts with the same corresponding letters. Medicare has four parts, but Medigap policies are referred to as plans.

Overall, about 1 in 5 Medicare enrollees also purchase a Medigap plan.

Each plan is different in terms of exact coverage and costs. There are a variety of plans so that you can buy a plan that best fits your individual needs.

Plan G is characterized by providing excellent benefits to beneficiaries who want to pay a small annual deductible. That protects them from spending more on out-of-pocket expenses for unexpected health issues.

It is similar to Medicare Plan F, which is the most popular Medigap plan.

Medicare Plan Finder Tool
Compare Medigap Plans

Medicare Plan G: Who is it for?

Many people choose Plan G because it has relatively low premiums. The other great thing is that Plan G tends to have more moderate rate increases from year to year than the more popular Plan F.

However, to decide if Plan G is right for you, it’s best to take a closer look at the specific benefits. You may also want to look at other plans to see if one is better suited for you as well.

What Medicare Plan G covers

Plan G covers all the gaps in Part A and Part B coverage, except for the Part B deductible. Specifically, those benefits include:

  • Part A deductible
  • Part A coinsurance and hospital costs
  • Part B coinsurance and co-payments
  • Blood work, and the first three pints of blood for medical needs
  • Hospice care co-payments and coinsurance
  • Foreign travel medical emergencies (up to $50,000)
  • Skilled nursing facility coinsurance
  • Outpatient medical services such as lab work, diabetes supplies, durable medical equipment, doctor visits, ambulance services, and more.

All Medigap plans do not include prescription drug coverage. You will need to buy a Part D plan to be covered unless medications are prescribed as part of Plan B coverage and include drugs such as for chemotherapy or autoimmune diseases that must be administered in a clinical setting.

Also, Medigap plans do not cover routine dental care.

How Medigap Plan G works with Original Medicare

To sign up for a Plan G policy, you must first be enrolled in Medicare Part A and Part B.

Original Medicare will pay its share of the Medicare-approved amount for covered services. Plan G will then pay its share.

It’s important to note that you cannot have a Medicare Part C plan and a Medigap plan in force at the same time.

Unlike Medicare Advantage plans, Medigap plans are all the same no matter from which company you buy a policy. This means you’ll get the same coverage if you buy a Plan G policy from Cigna or buy a Plan G policy from Aetna, or any other provider.

If you live in Wisconsin, Minnesota, or Massachusetts, you may not have access to Plan G. Medigap policies are standardized differently in these states:

The Cost of Medicare Plan G

Even though by law, Medigap Plan G policies must cover the same thing, premium costs can vary. These costs will depend on the carrier, zip code, age, gender, and whether or not you smoke.

Plans are typically priced between $80 and $170 per month and are in addition to your Part B premium. If you go with a high deductible Plan G, your premiums will be less.

Like other Medigap policies, a Plan G policy only covers one person. If you and your spouse both want Plan G coverage, you will both need to buy policies.

You’ll need to work with a licensed agent to plug in all the variables and come up with the best and most affordable plan for your particular needs.

Also, keep in mind that if you don’t enroll during your Initial Enrollment Period, there’s no guarantee you’ll get coverage, and if you do, it could cost you more. If you can get coverage and you have a pre-existing condition, you may have to wait for up to an additional six months for coverage to kick in.

One other important thing to know is that if you buy a Plan G policy and drop it, there’s no guarantee you be able to re-enroll.

Medigap Plan G vs. other Medicare Supplement plans

Here’s how Plan G stacks up against other Medigap plans.

Medicare Supplement Comparison Chart

Is Medicare Plan G better than Plan F?

Plan G and Plan F are almost identical to each other.

The only difference is that Plan F covers the Medicare Part B deductible. However, Plan C and Plan F are being phased out, and only people enrolled in those two plans before December 31, 2019, get to keep those plans.

The good news is that Plan G is cheaper than Plan F with almost identical benefits, so many beneficiaries prefer Plan G anyway because it is viewed as a better overall value.

For example, you will need to pay the Part B deductible, but with lower monthly premiums for Plan G, you could save $400 or more each year.

The standard Part B deductible in 2020 is $198, but Medicare also introduced a high deductible Plan G with an annual deductible of $2,340 in January 2020.

When Can I Get Medicare Supplement Plan G?

The best time to get a Plan G policy is during your Initial Enrollment Period. You are guaranteed coverage for any plan that’s available in your neighborhood, regardless of any existing health conditions.

You can enroll at any other time during the year, but an insurance company can charge you more for existing conditions or deny you coverage outright.

Your best bet is to speak with an agent who will give you complete details.

What you need to know before enrolling in Medigap Plan G

One of the most important aspects of all Medigap plans is that they are guaranteed renewable, even if you develop health problems. You can’t be canceled by an insurance company as long as you pay your premium.

Also, guaranteed issue rights are in play in certain situations. This means an insurance provider must offer you certain Medigap policies when you are not in your Medigap Open Enrollment Period.

If you qualify, a provider must sell you a policy, cover your pre-existing conditions, and can’t charge you more even if you have past or present health problems.

Typically, guaranteed issue rights are available when you lose other health coverage or your existing coverage changes. You also have a trial right if you decide to buy a Medicare Advantage plan and want to change your mind and return to a Medigap policy.

Guaranteed issue rights are federal law. Many states also provide additional Medigap rights.

Plan G policies are not going away per se, but first dollar coverage is, due to deductible coverage no longer being offered for Part B. High Deductible Plan G is also a new change for 2020 as well.

If you have questions about Medigap coverage in your state or to make sure you qualify for all benefits, contact your State Health Insurance Assistance Program (SHIP).

Medicare also published a comprehensive guide to choosing a Medigap policy that may answer several questions as well.

Finding Affordable Medicare Supplement Insurance plans

To buy an affordable Medigap plan, you need to compare policies to see which one best meets your needs. Your best bet is to work with a licensed insurance agent in your area.

You can also use the Medicare.gov website to find a Medigap policy or call your SHIP for information.

An agent will help you compare costs once you decide which plan to buy. Keep in mind all coverage by letter is the same, but premium costs can be different.

When you buy a policy, the insurance company must give you a plain-language summary of your benefits. Read it and make sure you understand everything. If you don’t, be sure to ask questions.

Companies that offer Plan G

You have several choices when deciding which Plan G to buy. Price is a significant factor. And there are also several A, and B rated companies that offer policies.

Overall, consider that companies with higher ratings have plans with higher ratings. Outstanding customer service is an essential factor.

Based on those factors, here’s a list of some of the top rated Medigap carriers for 2020:

  • AARP
  • Aetna
  • Amerigroup
  • Cigna
  • Humana
  • Mutual of Omaha
  • WellCare

The top of this Medicare supplement list doesn’t necessarily mean the best rates or the best claims ratio. The list is written in alphabetical order from top to bottom.

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