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 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:
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.
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.
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:
Mutual of Omaha
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.
Prescription Discount Cards 101
Do you have a high deductible or copayment for your prescription drugs? Did you get a new prescription that is not covered by your insurance? Well, great news! A discounted prescriptions network may help cover some of those costs.
What is a discounted prescriptions network?
A discounted prescriptions network provides prescription discount cards. These discount cards for prescriptions are available to everyone and can prove to be an easy way to save on your prescriptions.
Many top-rated prescription discount cards can be emailed or texted directly to you for immediate use.
You may be able to enjoy prescription savings in the long run by understanding the truth about these cards and knowing the best prescription discount cards available. Visit websites that offer the best prescription discount card reviews to choose the right one for your particular needs.
Your free prescription card could be a Walgreens prescription discount card, a GoodRX discount coupon, a SingleCare discount card, and so on.
Sometimes generic drugs provide the same value as the original drug at the lowest price. Brand name prescription drugs don’t cost more because they are better, but because companies have to pay for safety, effectiveness, animal, and clinical studies.
What is a pharmacy benefit manager?
A pharmacy benefit manager (PBM) is the middleman between the pharmaceutical company and the pharmacy. They negotiate drug pricing from the pharmaceutical company for the pharmacy.
This means that there may be a significant cost difference for the same drug in different stores and locations.
Pharmacies will negotiate prices depending on their customer base. If one pharmacy has many older adult customers, they may charge less for heart medication.
However, they might charge more for another drug that has a lower demand to make up the price difference. This is why comparing drug prices and utilizing prescription discount cards is important.
The Truth About Prescription Discount Cards
A prescription discount card can be useful to many people, but as Medicare scams continue to rise, it’s understandable why you may be hesitant to use them.
Some prescription discount cards can be misleading and claim higher savings. However, a large portion of free prescription discount cards are credible, can be used at thousands of pharmacies across the US, and don’t require your personal information.
Are prescription discount cards legitimate? A legitimate prescription drug discount card program has the following signs:
The website offers an easy pricing tool for brand and generic medications.
Pharmacies near you accept the card.
The website offers a home delivery option via a trusted website.
The discounted amounts are comparable to other discount program card program websites.
What are the best prescription discount cards?
Don’t confuse a health insurance card with prescription drug discount cards. A health insurance ID card is proof of insurance to use when you visit a health care provider, physician, or hospital while a drug card helps you fill a prescription at a discounted price.
Not all prescription discount cards are created equal.
Some prescriptions may be covered by one discounted prescription network and not the other. The best prescription discount card is the one — or combination of several cards — that can save you the most on the medications you take every day.
The amount of savings, number of eligible pharmacies, and number of prescriptions available will vary by the discounted prescriptions network. You may want to consider these cards:
With the GoodRx app, prescription drug price comparison is available right at your fingertips. GoodRx compares prices for every FDA-approved drug at more than 70,000 pharmacies across the US.
Coupons can be printed, emailed, or texted to you and all you need to do is show the pharmacist your coupon to save up to 80% on your prescriptions.
US Pharmacy Card
This card is completely free and does not require any personal information. The US Pharmacy Card is accepted at roughly 59,000 pharmacies nationwide. You can have your card printed, emailed, or texted to you. Fun fact: this card can also be used on prescriptions for your pets!
Discount Drug Network
The Discount Drug Network card can save you up to 85% on your prescriptions with or without insurance. The only personal information you need to supply is your name, email, and address.
Your free prescription discount card will be mailed to you. Plus, the drug pricing tool on their website makes comparing prices a breeze.
A SingleCare prescription discount card is a savings card honored by a network of pharmacies across the country. Choose a pharmacy near you and present your card to the pharmacist at the counter.
If one of the participating pharmacies is Walmart, then show your prescription discount card at Walmart. Or if one of the participating pharmacies is CVS, then show your prescription discount card at CVS.
How to Use Your Drug Discount Card
When you want your prescription filled, go to one of U.S. pharmacies contractually obligated to honor your card. Visit participating pharmacies, such as Walmart, CVS, Walgreens, or Rite Aid, to get your discount.
A drug discount card mobile app may also be available for iPhone and Android.
If you haven’t already, click here to download your free prescription discount card. Then you can browse local pharmacies’ prices for your prescribed medications.
Prescription Drug Price Finder
Once you’ve downloaded your discount card, click here. Then type in your prescribed drug. For our purposes, we’re using rosuvastatin (Crestor), which is one of the best-selling drugs in the United States. Then enter your zip code. We used 37209, which the zip code of our headquarters in Nashville, Tennessee.
Then select your dosage and amount. We chose 20 mg and 30 tablets.
According to GoodRx, the average price without insurance for a 30-day supply of 20 mg is $161.64 as of March 2020. As you can see, you will pay just $8.44 at Walmart for the same thing with your free prescription discount card.
*Prices may vary. Always check with your pharmacist to find out the exact discounted price of your prescription.
Prescription Discount Cards and Medicare
Medicare and prescription drug coverage can be confusing. Fortunately, a licensed agent can help explain your prescription coverage options. If you’re interested in arranging a no-cost, no-obligation appointment with an agent, fill out this form or call us at 844-431-1832.
This post was originally published on November 27, 2018, by Kelsey Davis. It was last updated on April 9, 2020, by Troy Frink.
Does Medicare Cover Genetic Testing for Cancer?
Cancer is the leading cause of death worldwide and impacts millions of patients and families each year. Fortunately, genetic testing for cancer, which is growing in popularity, can be a great tool for understanding your risk of developing cancer.
Does insurance pay for genetic testing of cancer? Yes, but coverage determination depends on certain circumstances.
The American Cancer Society estimates that 1 in 3 people in the United States will develop cancer at some point in their life. Data and research show that cancer risk is highest for those between the ages of 65 to 74 years and accounts for the largest portion of new cancer cases found each year.
While you may have a smaller chance of developing cancer if you are under the age of 65, it is still a good idea to get tested as early as possible so that you can make smart decisions about health insurance and your future.
Is Cancer Hereditary?
About 10% of cancers occur in someone who has inherited gene mutations. Hereditary cancer syndromes are caused by mutations in certain genes passed from parents to children.
Researchers have found mutations in more than 50 hereditary cancer syndromes.
These mutations are found in the genetic code of DNA and are represented by the letters A, T, C, and G. These codes can be long – for example, the BRCA 1 code is over 10,000 letters long.
However, not every mistake in the “code” should raise concern for cancer.
Reasons to Consider Genetic Testing for Cancer
If you have an inherited gene mutation, that doesn’t necessarily mean you’ll get cancer. It only means that you’re at a higher risk of developing certain types of cancer.
If your personal history or family history of cancer suggests you are at risk, find out how genetic counseling and genetic testing can help you understand and manage your concerns.
The following populations should also ask for specific types of genetic testing:
Those whose family members have had gynecologic cancer should get tested for fallopian tube cancer. This very rare cancer only affects about 1,500 to 2,000 women worldwide and only about 300 to 400 women are diagnosed with it every year in the United States.
Certain factors may make it more likely that you and your family members can pass cancer on to your loved ones including:
Many cases of the same kind of cancer (especially if the type of cancer is rare) — like ovarian cancer caused by BRCA1 and BRCA2 gene mutations
Cancers that occur much sooner than usual – like breast cancer in a teenager
One person who has multiple types of cancer (like a man who has both colon and prostate cancer)
Cancers that occur in pairs of organs (both kidneys or both breasts, for example)
Siblings who have childhood cancers
Cancer that occurs in the opposite sex of the one usually affected (breast cancer in a man, for example)
Cancer that occurs in several generations (like in a grandmother, mother, and daughter)
Hereditary Genetic Testing for Cancer
The estimated number of new cancer cases in 2018 was 1,735,350. If you are curious about your risk of developing cancer, consider hereditary cancer testing.
Hereditary testing kits can help you understand any mutations you may have and allow you to better prepare for any issues that may arise in the future. Plus, knowing about an inherited mutation gives you the power to take the necessary steps to reduce your risk of cancer or to help detect it at an early stage.
Kits often include a saliva collection kit and a prepaid return label. The testing kits analyze over 30 genes that can contribute to the most common hereditary cancers.
A certified medical professional will review your sample and provide clear results of the absence or presence of any cancer-causing mutations. This information is personalized to you and provides information on how your genetic makeup can impact your family.
Medicare Cancer Test Kits
Fortunately, you can complete a cancer genetic test in the comfort of your own home. This can help alleviate any stress that may come from testing in a doctor’s office.
Most at-home test companies provide return labels so the entire process is convenient and stress-free. However, if you prefer to go into a doctor’s office for your genetic testing, that is also an option.
If you decide to use a Medicare cancer test kit to screen for covered screenings, be sure to follow the test’s directions to the letter. This helps ensure that your test results will be accurate.
Breast Cancer Genetic Testing & the BRCA Testing Cost
It is easy to learn your genetic risk of the most common hereditary cancers, including BRCA 1 and BRCA 2 genes. BRCA stands for BReast CAncer genes. BRCA 1 is on chromosome 17 and BRCA 2 is on chromosome 13.
All it takes is a small DNA sample through saliva.
Plus, the test can be conveniently mailed to you and completed in the comfort of your home. The cost of a hereditary cancer testing kit can range from $100 to $200.
There are multiple genetic testing companies, including Color and 23andMe, but not all are approved by the FDA.
Aging and Cancer
The risk of cancer increases with age, but it’s never too early to start screening. According to the Dana-Farber Cancer Institute, the average age for a breast cancer diagnosis is 61 years.
The average age for a prostate cancer diagnosis is 66 years.
There is no single explanation as to why age and cancer correlate, but researchers believe sunlight, radiation, environmental chemicals, and ingredients in our food are large factors.
Physical exercise, a healthy diet, and adequate sleep can help lower the risk of cancer as you age.
Medicare Coverage and Genetic Testing for Cancer
Medicare beneficiaries who need genetic counseling can get it covered under Medicare Part A and Part B only if it has been ordered by a physician before starting medication covered under Part D or if it is medically necessary in a skilled nursing facility.
Medicare covers certain genetic cancer tests if they’re medically necessary. In 2020, Medicare will cover genetic testing if:
You have recurring, relapsed, refractory, metastatic, or advanced stage III or IV cancer
You have not used the same genetic test for the same cancer diagnosis previously
You have decided to seek further cancer treatment such as chemotherapy and radiation
You have signs or symptoms of a cancer like colorectal cancer that can be clarified or verified with diagnostic testing
You have a first-degree relative who has a known mutation such as Lynch syndrome
Does Medicare Cover BRCA Testing?
How much does the BRCA test cost? The price ranges from $475 to $4,000. Fortunately, Medicare covers FDA-approved genetic testing for BRCA 1 and 2 for those with a personal or family history.
So, it covers hereditary breast, tubal, epithelial ovarian, or primary peritoneal cancer tests as well.
Does Medicare Cover Genetic Testing for Melanoma?
Medicare currently covers the Myriad Genetics myPath and Castle Biosciences DecisionDx genetic tests for melanoma.
Medicare also covers screenings for lung, breast, prostate, and cervical cancer. Screenings are used to detect potential disease and a diagnostic test establishes the presence or absence of the disease.
Does Medicare Cover Genetic Testing for Prostate Cancer?
Medicare covers prostate cancer screening for men over 50 every 12 months. If cancer is detected, Medicare Part B coverage includes a variety of options, including genetic testing to help physicians distinguish between an aggressive and a non-aggressive tumor.
This essential information helps physicians design an optimal treatment plan for their patients.
What Happens During a Genetic Test for Cancer?
A genetic test for cancer may provide some insight into your medical history and the possibility of passing mutated genes on to your loved ones.
Your doctor will first ask you questions about your personal and family medical history such as, “Have you or an immediate family member been diagnosed with cancer?” Based on your answers, your doctor may refer you to a genetic counselor. (A genetic counselor is someone who has advanced training in medical genetics and counseling.)
2. Informed Consent
Before your test, you must give informed consent, which means that you’re aware of and that you agree to the following items:
The genetic test’s purpose
The type and nature of the genetic condition being tested
Possible screening or treatment options depending on the test results
Further decisions you might need to make once the results are back
The possible consent to use the results for research purposes
Availability of counseling and support services
Your right to refuse testing
3. Collecting the Sample
Depending on the test, you may need to provide a saliva, blood, hair, cheek cells (usually a swab from inside your mouth), urine, or stool sample. Once your healthcare professional collects your sample, he or she will send it to the lab for testing.
4. Getting the Results
Once the results are in, your genetic counselor or healthcare provider will tell you about your test results and the next steps you should take.
Questions to Ask Yourself About Medicare DNA Cancer Screening
Does Medicare pay for DNA cancer screening? Yes, because the Centers for Medicare & Medicaid Services (CMS) covers a broad range of FDA approved diagnostic tests, CMS cancer screening is available to detect many types of DNA cancers.
However, as with any type of medical screening, you should know what you’re getting into before you take the test. Before you take a Medicare cancer swab test, ask yourself:
Is this test legitimate? Unfortunately, genetic kits including Medicare cancer swab tests are the latest trend in Medicare fraud, according to many state and federal agencies. Your doctor can tell you what type of test to buy.
Is this test FDA-approved? Medicare will only cover FDA-approved tests.
How will this information benefit future generations? You may not want to know if you have genetic mutations that could lead to cancer. However, that information could help your children and grandchildren. If you have gene mutations associated with cancer, you can have Medicare cancer screening. Many forms of cancer can be treated if they’re detected early.
We Can Help You Find the Best Medicare Plans for Cancer Patients
A Medicare Advantage (MA) plan is a great option if you are looking for additional benefits like genetic testing beyond BRCA 1 and 2 and myPath.
Some may even offer fitness classes like SilverSneakers®, which can help promote a healthy, physically active lifestyle and help lower your risk of cancer.
If you’re diagnosed with cancer, you may be eligible for a type of MA plan called a Chronic Special Needs Plan (C-SNP). These plans are specially designed for people with certain chronic illnesses and conditions. Your C-SNP will involve a network of healthcare providers that will coordinate your treatment plan with each other.
If you are interested in arranging a no-cost, no-obligation appointment with a licensed agent to discuss your options for MA plans including C-SNPs, call us at 833-438-3676 or fill out this form.
This post was originally published on November 29, 2018, by Kelsey Davis and updated on March 24, 2020, by Troy Frink.
Medicare for the Blind
In a world full of technology, it is easy to assume we all have equal access to Medicare information. For those who are blind or visually impaired, this isn’t always the case. In 2016, three blind Medicare beneficiaries changed the path for blind seniors and Medicare eligibles.
National Federation of the Blind vs. Centers for Medicare and Medicaid Services (CMS)
What happened in 2016 to change Medicare for the blind? Three blind beneficiaries decided to challenge how Medicare information is provided to those who are blind or have low vision.
This dispute brought attention to those who are Medicare-eligible and blind and highlighted that they are not provided with equal access to Medicare information. They explained that there was a lack of materials available to someone who was blind or had vision disabilities
The Case Results in New Medicare Benefits for the Blind
Two years later, NFB and CMS reached an agreement that requires CMS to provide materials for blind or visually impaired beneficiaries in formats such as Braille, large print, and audio. CMS is also now required to extend any time restraints for beneficiaries who have difficulty accessing time-sensitive information.
CMS has responded quickly and implemented critical procedural policies, including training employees in compliance with Section 504 of the Rehabilitation Act of 1973. They are also testing the accessibility of materials on Medicare.gov, providing e-books, and establishing Customer Accessibility Resource Staff.
Medicare and Disability for Blindness
Blind beneficiaries may qualify for benefits from the Social Security Administration (SSA) paid through Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). These monthly payments can be used to help ensure you have what you need.
The SSA is the organization that administers Medicare benefits for most enrollees. Eligible retired railroad employees get Medicare benefits through the Railroad Retirement Board.
Legally Blind Meaning for Medicare
The Social Security Administration defines blindness as, “vision [that] can’t be corrected to better than 20/200 in your better eye or if your visual field is 20 degrees or less in your better eye for a period that lasted or is expected to last at least 12 months.”
Medical coverage at the state and federal level do not cover service animals. The average service animal costs between $15,000-$30,000 to adopt. So if you’re on a restricted income, this might be too costly. What can you do if you need a service animal and can’t afford one?
There are numerous nonprofit organizations that raise, train, and offer service animals for reduced costs. Some organizations provide a service animal free of charge if you qualify.
Additionally, while Medicare benefits won’t pay for the obtaining, feeding, or care for the animal, disability benefits may be able to help cover this additional cost. Other necessities, such as support canes, may also be covered by these disability benefits.
The Americans with Disabilities Act (ADA) does not consider “emotional support animals, or companion animals” to be service animals. In order for your service animal qualify, it must be a dog, and help you “perform specific tasks” directly related to your disability. For example, many service animals are guide dogs that help blind owners get from point A to point B.
Qualifying for Medicaid & Medicare Benefits for the Blind
Medicaid is a state and federal program that provides medical benefits to people who meet certain income eligibility requirements. Medicare is public health insurance available to most people 65 and older, and most people who have ALS, ESRD, or who have received SSDI for at least 25 months.
Your DSNP SEP allows you to make one change per quarter from January to September. You can still make changes to your coverage from October to December, however, but you can only make a change during AEP. The changes you make during this period will take effect on January 1 the following year.
Do you have the right Medicare coverage?
Are you looking for an insurance plan that provides benefits specific to you? Our licensed agents can explain your coverage options and help you find a plan that best fits your needs and budget.
If you are interested in arranging a no-cost, no-obligation appointment with an agent, complete this form or give us a call today at 844-431-1832.
This post was originally published on August 23, 2018, by Kelsey Davis. The latest update was on January 2, 2020, by Troy Frink.
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.
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?
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%)
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.
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.
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.
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.
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 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.
Winter Wellness Tips for Seniors and Medicare Eligibles
Winter often consists of lower temperatures, less sunlight, and more time indoors. The same weather that is bothersome to most can prove to be dangerous for others.
Winter Safety Tips for the Elderly
Seniors and Medicare eligibles face several dangers including falling on ice or snow, frostbite, and hypothermia. Use these winter wellness tips to help ensure you are healthy, safe, and able to enjoy the holidays with your friends and family.
Falling on Ice or Snow
According to the Centers for Disease Control and Prevention, falls are the leading cause of injury and death in older adults. Fall prevention is important outside and in your home, but snow and ice can easily blindside you. Tips to protect yourself from falling on ice or snow include:
Understand the side effects of your medications. Some medicines can cause dizziness or vision issues, so be cautious when leaving your home.
Wear weather-appropriate shoes. Make sure your shoes are the right size and have good traction.
Allow extra time when commuting to your destination. Don’t rush when you’re walking and take small deliberate steps.
Use sand or cat litter on sidewalks or walkways.
When going inside, wipe your feet off before you enter. Wet shoes can cause you to slip on dry surfaces.
Keep your hands free whenever possible. If you are carrying bags, take several trips so you do not overload yourself. Always ask for help if possible.
Have emergency numbers stored in your phone. Take your phone whenever you leave the house, even on short trips to your car or mailbox. If you fall, you can easily access your phone and call for help.
Frostbite and Hypothermia in the Elderly
As temperatures drop, there is an increased risk of frostbite and hypothermia in the elderly. Frostbite and hypothermia are a result of cold weather and can be difficult to notice. Understanding the differences, warning signs, and symptoms are important when practicing winter wellness.
Frostbite occurs when your skin is exposed during extreme winter conditions. The cold weather causes your tissues underneath your skin to freeze. Frostbite causes you to lose feeling in the exposed area, which is commonly your fingers, toes, nose, ears, cheeks, and chin. If your skin turns white or a grayish-yellow color, or feels firm or waxy, seek medical care immediately.
Hypothermia occurs when your body’s core temperature becomes abnormally low. Hypothermia in the elderly is more likely due to a decreased production of body heat.
Warning signs of hypothermia include shivering, exhaustion, confusion, memory loss, slurred speech, and drowsiness. If you are experiencing these warning signs, take your temperature if possible. If your temperature is below 95 degrees, seek medical health immediately.
Prevention is key to protect yourself from frostbite and hypothermia. Make sure your home is well heated and insulated and be sure to eat healthy foods to fuel your body.
If you need to go outside or travel for any given reason, check the weather, and if possible, avoid extremely low temperatures. However, if you must venture out, wear plenty of weather-appropriate clothing.
Senior Isolation in the Winter
Many seniors and Medicare eligibles may be unable to leave their home in the winter. This can lead to a lack of social interaction. Feeling isolated can disrupt sleep, raise blood pressure, increase the risk of depression, and lower your overall well-being. Tips to prevent isolation include:
Call, email, or FaceTime friends and family regularly.
Consider getting your meals delivered to encourage a healthy diet. Programs like Meals on Wheels are great options.
Reach out to friends, family, and neighbors.
If you really struggle with isolation, consider moving into an assisted living facility.
Home fires can start at any time but are more common in the colder months. It’s important to practice fire safety and have an emergency action plan in place. Here’s what you should remember:
Make sure you have smoke alarms in the appropriate areas of your home, especially near any sleeping areas. Test alarms regularly and have spare batteries on hand.
Never walk away from a room when cooking. Plus, you should always have a fire extinguisher handy.
Keep curtains and drapes away from any heat source.
Never leave a burning candle unattended.
If you have a fireplace, get it inspected annually.
Place space heaters in an area that is open and clear.
If you smoke, avoid smoking indoors and around oxygen tanks.
Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD) is a type of depression that’s associated with changes in seasons. The disorder begins and ends at about the same time every year, with symptoms starting in autumn and continuing until spring.
Symptoms of SAD
SAD symptoms may include:
Feeling depressed most of the day almost every day
Loss of interest in activities you’d normally enjoy
Having problems falling or staying sleeping asleep (or sleeping too much)
Changes in your appetite or weight
Feeling sluggish or irritable
Feeling hopeless, worthless or guilty
Frequent thoughts of death or suicide*
*If you or someone you love experiences thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.
Combat SAD With a Winter Fitness Plan for Retirees
Retirees and Medicare eligibles can fight SAD with a great fitness plan. According to Harvard Medical School, fitness is as effective as antidepressants in some cases. Although a gym membership with fitness classes may help, you can get a great workout at home. All you need is some dumbbells, resistance bands, or even a chair.
In some locations, going for a walk outside isn’t an option due to weather concerns. Have you considered going for a walk at the mall? Many indoor shopping centers open their doors to “mall walkers” before the stores open.
Winter Wellness and Medicare
Winter wellness is important in maintaining a healthy lifestyle through the holidays and into spring. However, it’s important to focus on your wellness year around. Medicare Advantage plans have additional benefits and coverage that can help you become the healthiest version of you!
Many plans offer hearing, dental, and vision coverage. Plus, some even offer fitness classes like through SilverSneakers®! If you’re interested in hearing more about these additional benefits or have any questions regarding your Medicare coverage, call us at 844-431-1832 or fill out this form to get in contact with a licensed agent.
This post was originally published on December 11, 2018, and updated on November 22, 2019.
Yoga for Seniors and Medicare Eligibles
Yoga for seniors and Medicare eligibles is an effective way to improve your mental and physical wellness. When some people think of yoga, they may picture complex poses with intricate twists. That image of an unattainable exercise may make the ancient practice seem intimidating.
However, yoga doesn’t have to be intimidating or unattainable. Yoga has many health benefits, and it can even be included in certain Medicare plans.
Health Benefits of Yoga for Seniors
Yoga combines physical movements, breathing, and meditation into one exercise. If you struggle with joint pain, balance issues, body stiffness, sleep issues, stress, or anxiety, yoga may be able to help! The health benefits of yoga for seniors and Medicare eligibles are as follows:
Balance and Stability
As you age, your risk of falling increases. Yoga focuses on slow and measured movements and the strengthening of your muscles. These exercises can help keep you upright and strong to avoid tripping or falling. Your focus, strength, and body alignment can all improve with yoga and increase your balance and stability.
At any age, stretching is important. Simple tasks, like tying your shoes, can quickly become difficult without proper daily stretching. Yoga allows you to increase your flexibility through each exercise.
Respiratory limitations can be developed when our oxygen level begins to deplete. Studies have shown that after twelve weeks of yoga, many seniors and Medicare eligibles have seen significant respiratory improvement. Plus, the deep breathing exercises that encompass basic yoga sequences and poses can improve overall lung function in a low-impact environment.
Stress and Anxiety
Yoga for seniors and Medicare beneficiaries can help reduce stress and promotes mental clarity. Yoga is so much more than just “stretching.” It is a practice that requires both the mind and body. Meditation and relaxation are heavily incorporated. These exercises can help you be more mindful and aware of the present moment in time.
Yoga for Obese Seniors
According to the Mayo Clinic, yoga may be a “useful addition to an overall weight-loss plan.” You may not burn as many calories with yoga as you do with aerobic exercise, but it can help improve your self-esteem and overall mood.
Obesity can put excess stress on your joints, and yoga may be a safe form of exercise that may not cause additional pain.
Yoga doesn’t have to be intimidating. There are gentle yoga poses for seniors and Medicare eligibles and some poses incorporate chairs to help aid any balance or stability issues.
Gentle Yoga Poses for Seniors and Medicare Eligibles
Simple yoga for seniors and Medicare eligibles is generally low-impact and great for beginners. There are numerous gentle yoga poses for seniors and Medicare eligibles that are available, but the most popular are as follows:
Seated Forward Bend: Sit on the floor and keep your legs straight in front of you. Inhale and lean forward as far as you can. To avoid potential injuries, never force or push your body. This pose can calm the brain and help relieve stress. It stretches the spine, shoulders, and hamstrings and stimulates your liver and kidneys.
Legs Up The Wall: Find a sturdy wall and bring your tailbone as close as possible and raise your legs. Stay in this position for 10-15 minutes and focus on your breathing. This pose reduces gravity on your body and helps calm the nervous system.
Easy Pose: This yoga pose has been depicted as far as 2,000 years ago. Keep your back straight and cross your legs. This pose is great for meditation and breathing exercises. This pose comes naturally to children, but as you age, it may become more difficult. With practice, you can open your hips and help your spine return to proper alignment.
Corpse Pose: Lie flat on your back with your feet spread shoulder-width apart. Have your palms facing upwards. This pose is usually done at the end of your yoga practice and is more than just laying down. It relaxes your whole body and can release any stress, fatigue, or tension you may have.
Chair Yoga Poses for Seniors and Medicare Eligibles
If the balancing aspect of yoga intimidates you – good news, a chair can help! Many yoga poses can be modified to incorporate a chair. There are still significant benefits to this type of yoga, and it is very popular among people who have balancing issues. The following are chair yoga poses for seniors and Medicare eligibles:
Forward Fold: Sit in a chair and bend forward. When you inhale, raise your arms over your head and reach as far as possible. This yoga pose stretches your hips, hamstrings, and calves. This pose calms the brain and relieves stress. Plus, it stimulates your livers and kidneys and improves digestion.
Spinal Twist: When you are sitting on a chair, reach back as far as you can and twist your torso. It’s important to keep a good posture while twisting. This can lengthen, relax, and align your spine. Plus, it stretches your entire upper body. This can prevent your spine from becoming stiff and can help you maintain a normal spinal rotation.
Pigeon: The normal Pigeon pose can be quite difficult for seniors to do, so a chair can help tremendously! Sit up straight in your chair and keep your feet shoulder-width apart. Bring your right or left leg onto the other knee. Push the knee downward, and if possible, pull your foot up slightly. Repeat this 3-5 times and then switch to the other leg. Pigeon pose helps open your hip joints and helps lengthen your hip flexors. It can also help prevent or relieve sciatica pain.
Cat and Cow: Keep your feet flat on the floor and keep your back straight. When you inhale, arch your spine and roll your shoulders back. When you exhale, arch your spine the other way and drop your chin to your chest. This is great for breathing exercises. This stretches the lungs and chest, which makes breathing easier. This also stretches the hips, back, and abdomen.
Chest Expansion: Sit as straight as possible and reach your hands to the back of your chair. Lift your chest and take a deep breath. Do this for 3-5 breaths and then repeat. This strengthens your hand, arm, shoulder, and back muscles.
For more yoga poses for seniors, check out this video “Yoga for Seniors” by Yoga With Adriene:
These plans are growing in popularity. According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003.
SilverSneakers ® Yoga Classes
Medicare SilverSneakers® is a fitness benefit found in many Medicare Advantage plans. SilverSneakers® hosts fitness programs for seniors that focus on general fitness, strength, flexibility, and walking ability for seniors and Medicare eligibles just like you. Medicare SilverSneakers® fitness events can also help seniors find new friends who also want to pursue an active lifestyle.
SilverSneakers® yoga classes provide a unique opportunity for seniors and Medicare eligibles to practice yoga in a judgment-free, inclusive group. These classes often incorporate chair yoga poses for seniors and Medicare eligibles.
More than 65% of leading Medicare Advantage plans include Medicare SilverSneakers.® This is generally provided at no cost.
Plus, there are over 11,000 locations across the US that offer SilverSneakers® yoga classes. Once you are enrolled in a Medicare Advantage plan that includes SilverSneakers® yoga, you will have access to any participating facility.
How to Find SilverSneakers ® Yoga Classes Near You
The SilverSneakers® website has a location finder so you can find participating gyms with classes near you. To get started, click here. You’ll come to the SilverSneakers® homepage, which looks like this. Click on the magnifying glass with the word “Locations” under it.
That will lead you to the location finder tool. Enter your zip code in the search bar as shown in red. We chose 37209, which is the zip code for our corporate offices in Nashville, TN. Then click the carrot shown in green. After you do that, select SilverSneakers® as shown in blue. The final part of this step is clicking the magnifying glass shown in yellow.
The next page lists the SilverSneakers® partners in your area. Clicking the listed gym names will show you the amenities at each location. We only clicked on the first location for demonstration purposes.
Here, you can see that the Gordon Jewish Community Center offers SilverSneakers® yoga classes in red. Use the contact information shown in blue to learn how to get started.
Enroll in Medicare Advantage
If SilverSneakers® yoga is something you’re interested in, then you should consider enrolling in a Medicare Advantage plan.
If you interested in enrolling in the best MA plan for your needs and budget, fill out this form or call us at 833-438-3676 to speak with a licensed agent. These appointments are no-cost to you and obligation-free. Our licensed agents can answer any questions you may have, and best of all, make sure you get SilverSneakers® yoga.
This post was originally published on October 25, 2018, by Kelsey Davis and was updated on November 18, 2019, by Troy Frink.
Does Medicare Cover Hospice Care?
More than 1.7 million Americans use hospice each year to maintain or improve their quality of life due to a terminal illness. Hospice care plans address physical, emotional, and spiritual pain and offer support to caregivers during the grieving process.
Hospice decisions can take an emotional and financial toll on you and your family, so you may be asking… “Does Medicare cover hospice?”
How does Medicare cover hospice care?
If you are enrolled in Medicare Part A (hospital insurance), you may qualify for hospice care. However, you must meet the following criteria:
Your doctor certifies that you are terminally ill (with a life expectancy of less than 6 months)
You accept palliative care (for comfort) rather than try to cure your condition
You sign an agreement choosing hospice care over other Medicare-covered benefits to treat your illness
You are not eligible if you had already made a hospice election or have not previously received pre-election hospice services (evaluation of your need for pain and symptom management).
If you meet the above criteria, the following services may be part of your hospice care plan and are covered in part by Medicare:
Other services focused on pain and symptom management
There may be a co-payment of $5 for your prescription drugs or other pain relief. You may also need to pay five percent of the Medicare-approved amount for respite care. However, the following services are not covered by Medicare:
Hospice is intended for people who have six months or less to live. To receive hospice care, you can not receive curative treatment.
If you decide to receive treatment, your hospice care is no longer covered. However, you can withdraw from your hospice care at any given point, and you can resume treatment as long as you are still eligible.
Prescription Drugs Intended to Cure
Just like you can’t pursue curative treatment, you can not take prescription drugs that are intended to cure your illness when receiving hospice care. Hospice only covers drugs that are intended for pain relief and control.
Care for Any Hospice Provider That Wasn’t Arranged by the Hospice Team
You are only eligible to receive care from the hospice team that you initially select.
You cannot get hospice coverage from a different provider unless you go through the switching process. However, you can still visit your regular doctor if they have been appointed to supervise your hospice care plan.
You can only switch to a different hospice provider once per benefit period. If you are interested in switching, be sure to do your research and pick a hospice team you feel comfortable with.
Does Medicare cover hospice room and board?
Medicare does not cover room and board regardless if you live at home, in a nursing home or inpatient assisted living facility, or inpatient hospice office. The only exception is during short-term inpatient or respite care stays in which Medicare will help cover the costs.
Emergency transportation is not covered by Medicare’s hospice benefits. Medicare will not cover emergency inpatient hospital care unless they are arranged by your hospice team or unrelated to your terminal illness.
Does Medicare cover hospice in a nursing home or at home?
If you are eligible, Medicare will cover hospice care regardless if you receive the care in your home, nursing home, or inpatient facility. Some nursing homes work directly with a hospice team. In a nursing home setting, your hospice team can help with the following:
Regular visits to the nursing home
Consultations by specialized hospice physician as needed
Pain and medication management
Educating staff on symptoms, medications, and care
Emotional and spiritual support
Coordinating care across all patient’s medical providers including doctors, hospice team, and nursing home staff
How long will Medicare pay for hospice care?
Hospice care is intended for people who have less than an estimated six months to live. If you still require hospice care after six months, you can continue to receive benefits if a hospice doctor recertifies your terminal illness in a face-to-face meeting.
You can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods.
Level One: This level includes basic care under Medicare’s hospice benefit. Services include nursing services, medical equipment & supplies, and medications.
Level Two: Medicare designates people who need continuous care such as home health care. The home health aide stays in the patient’s home for eight to 24 hours a day, but it’s short-term care. The patient’s needs are re-evaluated once every 24 hours.
Level Three: The third level of Medicare hospice coverage is general inpatient care. Some people have short-term symptoms that are so severe that they can’t get adequate treatment at home. With level three care, the patient has 24-hour care available.
Level Four: This level of care is more for the family than the patient. If the patient doesn’t meet the criteria for inpatient care and the family needs a break from daily care duties, respite care may be an option. Respite care provides caregivers temporary relief by admitting the patient to a hospital.
Medicare Palliative Care vs. Medicare Hospice Care Coverage
Medicare can cover palliative care for helping relieve symptoms in accordance with curative care. Some organizations define palliative care as “specialized medical care for people living with a serious illness” with the focus of care being symptom relief rather than to find a cure.
The difference between palliative care and hospice care is that palliative care can occur in conjunction with curative care.
Medicare may cover palliative care, but not under the Medicare hospice benefit.
Hospice and Medicare Supplements
Medicare Supplements can help cover the gaps in hospice care that Original Medicare may not, like prescription drugs for pain relief and respite care. After your Medicare coverage, you will likely be responsible for five percent of your total respite care costs and a $5 copay per prescription drug. Medicare Supplements can cover some, or all, of these gaps.
Medicare Supplement Plans A, B, D, G, M, N cover 100 percent of hospice coinsurance and copayments. Medigap Plan K covers 50 percent and Plan L covers 75 percent.
If you are interested in enrolling in a Medicare Supplement plan, or have questions on how these plans work with your correct coverage, click here to get in contact with a licensed agent.
Hospice and Medicare Advantage
If you enroll in a Medicare Advantage plan, you will have the same hospice care coverage as with Original Medicare. However, Medicare Advantage plans can offer extra benefits like vision, hearing, and dental coverage. They may also offer fitness programs like SilverSneakers®.
If you are interested in enrolling in a Medicare Advantage plan, fill out this form, or give us a call at 844-431-1832. There is no cost to you to meet with one of our agents and there is never an obligation to enroll.
This post was originally published on April 16, 2019, and updated on November 18, 2019.
Retirement and Medicare Eligibility
What happens to your health insurance when you retire? Medicare and retirement can seem intimidating, but we’re here to ease some of your concerns and answer your questions.
There are currently an estimated 70 billion baby boomers who are nearing retirement. Planning for retirement is crucial to living a comfortable and healthy life. An annual estimate by Fidelity shows the average couple retiring at age 65 will need $280,000 to cover health-related costs. Fortunately, Medicare can help, but there is a set of guidelines and regulations regarding enrollment.
How Medicare and Retiree Coverage Work Together
Some employers may offer retiree health coverage, which can be a good option if you are not yet 65 and do not meet other Medicare eligibility requirements. If you are 65, it may be time to enroll in Medicare.
If you are already 65 when you retire and are interested in having both retiree coverage from your employer AND Medicare, the two can work together.
Your Medicare coverage will always come first. Your retiree coverage will work as extra coverage to backup your Medicare plan – kind of like a Medicare Supplement plan.
While retiree coverage is not a Medicare Supplement plan, it is very similar. It can cover things like copayments and deductibles, or even extra hospital stay days. All retiree plans are different, though, so look over your plan and call your insurance agent (or your former HR representative) to find out what it covers.
Do Retirees have to Pay for Medicare?
There are two parts to Original Medicare – Part A and B. If you have worked and paid Medicare taxes for at least 40 quarters (about 10 years), you can have premium-free Part A. If you did not work the 40 quarter minimum, then you will have to pay the Part A premium. For 2020, the Part A premium is $458 for 30+ quarters or $252 for 30-39 quarters.
The standard Part B premium for 2020 is $144.60, but you may pay more or less based on your own set of circumstances. An estimated 3.5% of beneficiaries will have a lower premium due to the Social Security “hold harmless” provision which prevents premiums from exceeding Social Security benefits. Plus, if you make more than $87,000 a year, your monthly Part B premium will be adjusted based on your income. The income-based 2019 Part B premiums are as follows:
Do you Automatically get Medicare When you Turn 65?
If you currently receive Social Security benefits, you will be automatically enrolled in Medicare Parts A and B the month you turn 65. However, if you do not receive Social Security benefits, you will need to enroll yourself. Medicare enrollment begins three months before your 65th birthday and will end three months after. This is called your initial enrollment period.
It’s important to act right away because delaying your enrollment can result in a 10% Part B premium increase for every year you’re eligible but don’t enroll. If you don’t select prescription drug coverage and later enroll, you may have a penalty of 1% the national base Medicare Part D monthly premium for each month you were not enrolled.
Health Insurance After Retirement Before Medicare (Early Retirement)
Should you keep working or retire early? Your decision may be influenced by your age, health, budget, Medicare eligibility, social security benefits, and employer coverage.
Employer Retiree Coverage
Some employers offer retiree coverage after you leave the company. However, retiree coverage and Medicare are not the same. Retiree coverage is health coverage that is provided to former employees of a company. This typically pays second to Medicare, which means you still need to enroll in Medicare to be fully covered. However, retiree coverage can help with health-related expenses if you retire before 65.
Not every employer offers retiree coverage. Since it isn’t required, your employer (or former employer) can cancel or change your retiree plan at any time. It’s safest for you to have Medicare as well. Plus, if you don’t enroll in Medicare when you first become eligible, you will face a penalty fee. Some retiree plans automatically stop when you turn 65 and become eligible for Medicare.
If your employer does not offer retiree coverage, retiring or losing your job gives you a SEP. A Special Enrollment Period means that you don’t have to wait for AEP, the Annual Enrollment Period, to buy coverage. You will have 60 days from your last day of work to enroll in a marketplace health plan. After those 60 days are over, you’ll have to wait until AEP (October 15 – December 7) to buy a marketplace plan, at which point you will be charged a penalty fee for having a lapse in coverage.
FERS/CSRS Retirement and Medicare
The CSRS, or Civil Service Retirement Act, became effective on August 1, 1920. It was replaced by the Federal Employees Retirement System (FERS) on January 1, 1987. Some people may still belong to CSRS. Both programs are for government employees only.
Both FERS and CSRS allow you to retire at age 62 if you have five or more years of service or at age 60 if you have 20 or more years of experience. Under FERS, you can retire between ages 55 and 57 (depending on your birth year) if you have 30 or more years of service.
Regardless of your FERS or CSRS status, if you’re 65, you’ll qualify for Medicare. You’ll also qualify for Medicare if you have a qualifying disability. If you are under 65 and do not qualify for Medicare, you can receive your FERS or CSRS benefits but will have to wait until you reach Medicare qualifying age.
Until then, you may qualify for the Federal Employees Health Benefits Program (FEHB). Once you do become eligible for Medicare, you may want to enroll in Part A anyway because there is no premium if you’ve worked for at least 40 quarters.
When you leave your job, you’ll also have the option to enroll in COBRA. COBRA allows you to continue to belong to your employer’s group plan for a temporary period after you leave the company. The company can “kick you off” at any time, so this is not a permanent option. However, COBRA can help you out while you figure out what your other options are.
Ask your employer or your HR representative to find out what COBRA might look like for you.
Can you get Medicare at age 62?
It’s important to understand the differences between Social Security and Medicare. You can start to receive Social Security retirement benefits at the age of 62. This amount is typically reduced until you reach the age of 65. The average person does not qualify for Medicare until age 65, but there are exceptions.
You are automatically enrolled in Medicare once you have received Social Security benefits for two consecutive years. This means if you started receiving benefits at age 62, you will qualify for Medicare at age 64. Plus, you may qualify for Medicare before 65 if you have Lou Gehrig’s Disease (ALS) or End-Stage Renal Disease.
Importance of PlanningforRetirement
It’s never too early to start planning for retirement and Medicare. Our licensed agents can help explain your coverage options and answer all of your questions. Plus, they can provide bias-free assistance with a wide range of plan options because they are licensed with all major carriers in your state. Start planning now! Call us at 833-438-3676 or fill out this form to arrange a no-cost, no-obligation appointment.
This post was originally published on December 27, 2018, and was last updated on November 15, 2019.
How to Get Paid to be a Caregiver for Parents
There are close to 34 million Americans providing care for their parents, and many are not compensated for their time. The value that caregivers provide for “free” is estimated to reach $375 billion annually. That’s double the amount of what is actually spent on homecare services.
Being a caregiver is rewarding, but it comes at a cost. The average caregiver spends 20 hours a week caring for their loved ones and spends an average of $5,500 each year out-of-pocket.
At Medicare Plan Finder, we know how hard you work and how much you deserve financial support, and we want to help you understand how to get paid to be a caregiver for parents.
Can Caregivers Get Paid by Medicare?
Currently, Medicare does not pay caregivers. However, some state Medicaid programs do pay family members to provide care.
Medicaid Caregiver Compensation
Medicaid caregiver pay varies per state, but all states (and the District of Columbia) offer Medicaid waivers that allow qualified individuals to manage their own care. This means your parent can hire and fire their own caregivers. Certain states will permit a family member to be hired to provide the care.
The eligibility, benefits, coverage, and rules will vary depending on which state you live in. Some may pay for family caregivers but exclude spouses or in-laws. Others may only provide compensation if you do not live in the same house as the person in your care.
When you are researching programs in your state, be conscious of program names. Each state will have a different name (Self-Directed Care, In-Home Supportive Services, etc.).
To start the process, your parent(s) must qualify for Medicaid and meet state caregiver qualifications. Contact your state Medicaid office to start the application and learn about eligibility.
Your parent(s) will be assessed for risks, needs, strengths, and capacities that meet the requirements by the Centers for Medicare and Medicaid Services (CMS).
You and your parent(s) will write a service plan that details the type of daily assistance that will be provided. This can include bathing, dressing, meal preparation, feeding, laundry, driving, and other daily tasks. When this plan is set, you will be approved or denied for the state’s Medicaid compensation program.
Getting Paid to Be a Caregiver for Veterans
If your parent is a veteran, they may qualify for the Veteran Directed Home & Community Based Care program. This program is available in 37 states and the District of Columbia. It provides several medical benefits to people who need a high level of nursing facility care, but want to live at home with a caregiver.
The average monthly allowance is $2,500. The veteran will choose the caregiver. This can be a family member, including spouses, siblings, or children/grandchildren.
Another program that can help provide financial compensation is Aid and Attendance (A&A). This program provides benefits to veterans who qualify for a VA pension and have served at least 90 days in active duty and one day during a wartime period.
The program is intended to supplement the pension and help cover the cost of a caregiver. The caregiver can be any family member.
To qualify for A&A, at least one of the following must apply:
Confined to bed due to a disability
Be in a nursing home due to physical or mental limitations
Have limited eyesight (Corrected 5/200 visual acuity or less in both eyes)
Require the aid of another person to assist with daily living activities (bathing, dressing, feeding, etc.)
Long-Term Care Insurance and Caregivers
Long-term care insurance is a policy that helps cover the cost of long-term care. These costs can include assisted living, nursing homes, or in-home care (including caregivers). Plan benefits will vary, but if home care coverage is included in the plan, homecare caregivers may be covered as well.
However, it is important to note that all plans are different, and some plans may exclude these benefits. Additionally, some plans may have restrictions on who qualifies to be a paid caregiver. Some plans may exclude spouses or in-laws, and others may exclude family members altogether.
Other Paid Family Caregiver Options
If your parent does not qualify for any of the above programs, don’t worry! There are other ways to get some type of compensation. The following are round-about ways that explain how to get paid to be a caregiver for parents:
Tax Deductions: It may not be the same as a monthly paycheck, but tax deductions can help you save money each year for certain expenses you incur. You may be able to write off certain expenses like dental costs, medical costs, home modifications, and transportation costs.
Payment From a Family Member: Asking for payment from your parents or another family member may be awkward or uncomfortable. Put all of these feelings aside and discuss needs, wages, schedule, etc. Create a contract that includes the wage and services provided.
Area Agencies on Aging: Each state has a local Area Agency on Aging. You can find your closest office by searching your city in their directory tool. The staff at each location can help you find additional programs that you or your loved one qualify.
Paid Leave: If your parent’s needs are short-term, you may be eligible for a paid leave through your employer. This is not guaranteed, but there is no harm in talking to your HR representative to see what type of paid leave policies are offered by your company. Something as small as a few weeks of pay can still provide a financial cushion and allow you to go back to work in the future.
Remote Work: Paid leave can only help for a short time, and may not be the best solution for you and your family. Talk to your employer and see if telecommuting is an option. Again, each company will vary, but there is no harm in asking. Working full-time and acting as a caregiver can be difficult, so consider your workload when making these decisions and having these conversations.
Caregiver Support and Power of Attorney
There’s no doubting the weight that caring for a loved one can put on your shoulders. If you’re a caregiver, it’s crucial you feel supported so you can continue to help your loved one on a daily basis.
Medicare Plan Finder’s Caregiver Support page provides caregiver information specific to your loved one’s needs. Learn about how you can receive support for yourself while caring for your loved one, stress relief tips, support groups you can join, and Power of Attorney (POA) information.
Being a caregiver does not automatically grant you the ability to make certain medical, legal, or financial decisions on behalf of your parent. To do so, you will need to become their Power of Attorney.
If your parent is mentally competent, they can sign their rights over to you. If they are not, you will need to go before a judge and have their rights granted to you.
Medicare Coverage and Caregivers
As a caregiver, one of your biggest concerns, among understanding how to get paid to be a caregiver for parents, may be making sure your loved one has the best possible health plan for their unique needs and budget. At Medicare Plan Finder, we want to help make that happen!
We specialize in educating seniors on Medicare Advantage, Medicare Supplements, and Part D plans. Our licensed agents are contracted with all of the major carriers so you know your parent is being shown the best plans at the best price. Give us a call at 844-431-1832 or click here to get in contact with an agent.
This post was originally published on May 30, 2019, and updated on October 23, 2019.