While this is probably the easiest way to explain Medicare, most people don’t know how complicated it can be once you dive below the surface. Here we’ve broken down the 7 most important facts about Medicare that you may have never heard before!
1. There are multiple parts of Medicare
Perhaps the biggest misconception about Medicare is that it’s one gigantic program. In truth, what we refer to as Medicare actually has four distinct components, or “parts.” You might hear some different names used but usually these parts will be designated as A, B, C, or D.
The Original Medicare program consists of Part A and Part B. Part A primarily covers inpatient hospital care, while Part B handles outpatient services like doctor visits. These two components of Original Medicare represent the basic coverage that is available to you when you turn 65.
Part C, often called Medicare Advantage plans, are offered by private health insurance companies. These allow recipients of parts A and B to also receive benefits like dental, vision, and prescription drug coverage depending on the plan they choose.
Part D, sometimes called a prescription drug plan (PDP), offers prescription drug coverage to beneficiaries enrolled in Medicare. These are offered by private insurance companies as an addition to the Original Medicare benefits, as Original Medicare does not include any drug coverage.
To see these different Medicare plans explained in even more detail, check out our more in-depth blog here on finding the best types of Medicare plans for you in 2020!
2. You can’t enroll whenever you want
Unfortunately, Medicare is not a program you can just enroll in at any time. It’s true that you are eligible for Medicare when you turn 65, but unless you qualify for automatic enrollment, you will need to sign up during one of the five designated enrollment periods.
The Initial Enrollment Period (IEP) is usually your primary opportunity for Medicare enrollment. If you are aging into the program, this IEP begins three months before your 65th birthday and extends to three months after, giving you seven months in total to enroll.
There is actually a second IEP, sometimes called IEP2, available for those who are eligible for Medicare before they turn 65, such as those with disabilities. This period also lasts seven months and gives these beneficiaries an opportunity to make changes to their plan.
The General Enrollment Period (GEP) is offered for first-time Medicare enrollees who did not join during their IEP. This period occurs every year from January 1 to March 31. Coverage applied for during this period begins on July 1st.
The AEP, or Annual Enrollment Period, starts every October 15 and runs until December 7. This period provides an opportunity for those already enrolled in Medicare to make changes to their coverage, such as adding a Part D plan or converting your Original Medicare to a Medicare Advantage plan.
Special Enrollment Periods (SEPs) allow Medicare beneficiaries to make changes to their coverage outside of AEP. During these periods, people who are enrolled in a Special Needs Plan or who have recently lost a job can add to or switch their coverage. Check out the handy graphic below to see if you qualify for one of these SEPs.
In 2019, a new enrollment period was introduced, called the Open Enrollment Period, or OEP. This period lasts from January 1 to March 30, and lets those who enrolled in Medicare Advantage during AEP make changes in their coverage without having to wait for the next AEP.
3. You may have to pay if you delay
If you do miss your IEP, you may have to pay penalties when you finally do enroll. The amount you will pay and the duration you will have to pay depends on which part of Medicare you enroll in and how long you waited.
The Part A penalty is incurred if you do not qualify for free, automatic enrollment and you fail to sign up for it when you are eligible. This penalty will be added to your premium to the tune of 10%, which you will have to pay for twice the number of years that you neglected to sign up.
If you enroll late in Part B, your premium will go up by about 10% for every year you were eligible but didn’t sign up. You will then have to pay this increased premium for the entire time you have Medicare Part B. You may also have to pay a penalty if you do not enroll in a Part D plan within the first three months that your Parts A & B are active. However, some of these penalties may be avoided if you qualify for a Special Enrollment Period.
4. Original Medicare only covers 80%
Once you are finally enrolled, you might wonder: “How much does Medicare cover?” The unfortunate truth is that it will not fully cover your medical expenses. Parts A & B will only cover up to 80% of the cost of Medicare-covered services, leaving you to pay the remaining 20% coinsurance.
This might not be too much trouble for routine doctor visits, but in the case of a medical emergency or hospital stay, the amount you pay out-of-pocket can skyrocket quickly. To cover that last 20%, consider purchasing a Medicare Supplement plan to add on to your Original Medicare coverage.
5. Original Medicare doesn’t cover dental, hearing, or vision
Many people might not realize that Medicare covers very little in the way of dental and hearing expenses, and virtually nothing when it comes to vision. Part A will sometimes pay for specific dental services if you have to get them while you are staying in a hospital, but will not pay for cleanings, fillings, dentures etc.
Medicare will sometimes cover diagnostic hearing exams if your physician orders it as part of their treatment, but will not cover hearing aids under any circumstances. For vision coverage, your options with Original Medicare are even more limited, as it will not pay for eye exams, glasses, or contact lenses.
There are some options that can provide vision, hearing, and dental coverage for seniors. A DVH (or Dental, Vision, Hearing) plan can be purchased to add to your Original Medicare benefits, or you might look to a Medicare Advantage policy to consolidate all of that coverage into one plan.
If you think Part C might be the best coverage option for you, click here or give us a call at 844-431-1832 to have a licensed agent help you compare Medicare Advantage plans!
6. Original Medicare will not cover you abroad
Aside from a few very specific circumstances, Medicare Parts A and B will not cover your health care while you are traveling outside the United States. Medicare Part D plans are also invalid once you are more than 6 hours away from a U.S. port.
But there are some Medicare coverage options available for foreign travel, primarily in the form of Medicare Supplement (Medigap) plans.
7. Supplement plans have the same coverage, different cost
Medicare Supplement, or Medigap, insurance can be used to cover the out-of-pocket costs you may have to pay with Parts A and B. Insurance carriers offer many different types of Medigap plans, often sorted alphabetically, but they all must follow the same government regulations.
This means that Plan F from one carrier must provide the same benefits as Plan F from another carrier. Below is a quick breakdown of all the benefits covered by the different Medigap plan types.
Once you have found a Medigap plan type that meets your needs, you must consider the price. Insurance carriers must cover what is mandated by the government guidelines, but may charge very different rates for that coverage.
To find the best price, reach out to one of our licensed agents here or at 844-431-1832 to have them run a personalized quote, or use our Medicare Plan Finder Tool to compare all the plans offered in your state and county!
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.
How to Switch From Medicare Advantage to Medigap
Medicare Advantage and Medigap are similar in some ways but very different in others. If you’ve enrolled in a Medicare Advantage plan and you don’t like it, you may think switching Medicare plans and enrolling in Medigap is a great idea. It’s important to understand the differences between the two, so you can make the best choice.
What is Medicare Advantage?
Medicare Advantage, also called Medicare Part C, is a type of private Medicare plan. When you first enroll in Medicare, you’ll start with Medicare Part A (the part that covers hospital care), and then most people will enroll in Medicare Part B (the part that covers doctor’s appointments).
Medicare parts A and B are limited, so adding Part C can give you additional benefits like:
No two Medicare Advantage plans are the same. In fact, there are several different types. You’ll have to look at what you’re eligible for and decide which benefits you need most and how much you’re willing to spend.
Medicare Part C doesn’t always mean spending more money, though. Some plans might even have $0 premiums!*
*Even with a $0 Medicare Advantage premium, you’d have to continue paying your Part B premium.
What is a Medigap plan?
Medicare Advantage plans sound fantastic, but some people will find that Medigap plans work best for them. Medigap coverage is what can “fill the gap” between what Medicare covers and what you owe out of pocket. These plans are also called “Medicare Supplement” plans because they supplement your existing Medicare Part A and Medicare Part B coverage.
Some Medigap plans may provide a few extra “perks,” but generally speaking, they do not provide additional health benefits in the same way that Medicare Advantage plans do. Instead, supplemental insurance covers your Medicare Part A and Medicare Part B deductibles, copayments, coinsurance, etc.
You’re probably thinking, “great!” I’ll just go ahead and get Medigap and Medicare Advantage. However, you can’t have both. That decision can be tough, but it all comes down to how much you’re able to spend each month and whether or not you can afford a medical emergency. For example, Medigap premiums tend to be a bit higher than Medicare Advantage, but if you’re in the hospital all the time, it might pay off.
Can I switch from Medicare Advantage to Medigap?
If you enroll in a Medicare Advantage plan and decide that a Medigap plan might be better, you can switch – but there are a few things you’ll need to keep in mind.
Mainly, Medigap plans come with medical underwriting. In other words, you can be denied for pre-existing conditions. Meanwhile, you will never be denied or charged more for a Medicare Advantage plan based on your preexisting conditions. There are two times when your preexisting conditions won’t affect your Medigap enrollment: when you’re enrolling in Medicare for the first time, and if you are forced out of your current plan and need to find a new one quickly. That rule is called “guaranteed issue rights.”
You’ll also have to keep in mind that if you had a Medicare Advantage plan with prescription drug coverage and you want to switch to Medigap, you will lose your prescription drug coverage. The only way to have a prescription benefit with Medicare Supplements is to also invest in a Part D (prescription drug) plan.
One of the many benefits to Medicare Advantage is that most of your benefits will be rolled into one plan, whereas if you have Medigap, you may have to seek alternative plans for your prescription drugs, dental, vision, etc.
Can I switch from a Medigap plan to an Advantage plan?
Just like switching from Medicare Advantage to Medigap, switching from Medigap to Medicare Advantage is possible, but there are some things to be aware of.
One of the first things you’ll notice when you switch plans from Medigap to Medicare Advantage is that your copayments might rise. This will all depend on what plans you have. For example, if you had Medigap Plan G (which covers Part B copayments), and then you switched to a Medicare Advantage PPO plan that had a $20 copayment for doctor visits, you might feel like your costs are rising. However, your Medicare Advantage plan might have a lower premium than your Medigap plan did, making your overall costs lower.
Confused? Your insurance agent can walk through these numbers with you before you switch plans to help you decide which type of plan is truly best for you.
Is it better to have Medicare Advantage or Medigap?
The question should read, “Is it better for ME to have Medicare Advantage or Medigap?” That may not be the answer you were looking for, but it is different for every person. What you may see as disadvantages of Medicare Advantage might be great for someone else. Common Medicare Advantage disenrollment reasons, like trouble finding a doctor in-network or the lack of one very specific benefit, may not apply to you.
While Medicare Advantage usually provides more covered benefits, Medigap can result in lower hospital bills and lower overall out-of-pocket costs.
Your decision should be based on your health history, your budget, and the quality of plans available in your area. Try sitting down and writing a pros/cons list for Medicare Advantage vs. Medigap, like this:
Pros: Prescription drug coverage can be included
Cons: Stricter network
Pros: Copayments can be covered
Cons: Higher premiums
Add in any items specific to you, like a specific benefit that you need or a specific cost that you are worried about. Then, circle the items that are most important to you. Whichever column has the most circled items is likely the best option for you.
Why should I switch Medicare plans?
There are plenty of reasons to switch Medicare plans. Everything from network size to costs and benefits can be a factor.
You may want to switch Medicare plans if:
Your plan doesn’t cover all of your healthcare needs.
The premiums are too high.
Your favorite doctors are not in-network.
The costs are not worth the benefits you’re receiving.
A better plan becomes available in your area.
You become eligible for a cheaper or more specialized plan.
When can I switch from Medicare Advantage to Medicare Supplement?
Unfortunately, switching Medicare plans is not always easy. If you have a Medigap plan, you can switch to another Medigap plan at any time. However, if you already have Medicare Advantage and want a new Medicare Advantage plan, or if you have Medigap but want to switch to Medicare Advantage, you’ll have to wait for one of three* Medicare Advantage enrollment periods:
Annual Enrollment Period: October 15 – December 7 of every year, applies to all Medicare beneficiaries, any change is allowed
Special Enrollment Period: Applies only to those with specific circumstances, such as a special medical or financial need, and allows enrollments at specific times outside of AEP and OEP
Open Enrollment Period: January 1 – March 31 of every year, allows those with Medicare Advantage to make one switch to a different Medicare Advantage plan or drop coverage
*The fourth Medicare Advantage enrollment period is when you first become eligible for Medicare and is called the Initial Enrollment Period. This is when you would enroll in Medicare Part A and Part B for the first time and can choose to also enroll in Medicare Advantage (or Medicare Supplements and Part D).
When can I switch from Medicare Advantage to Medigap without losing guaranteed issue rights?
When you lose your current coverage for reasons beyond your control
Additionally, Medicare.gov identifies a few specific circumstances that can grant you guaranteed issue rights, including:
Your Medicare Advantage plan leaves your service area, or you move out of the plan’s service area.
You have Part A and Part B, and now your employer coverage is ending.
You joined either a Medicare Advantage plan of PACE (Programs of All-Inclusive Care for the Elderly) upon turning 65 and decided to switch within the first year.
You switched from Medigap to Medicare Advantage and want to switch back within less than one year.
Your policy’s company mislead you or broke a rule.
When You Can Change Medicare Advantage Plans
If you don’t want to switch between Medigap and Medicare Advantage and you simply want to disenroll from a Medicare Advantage plan or switch to another, you can do that during one of the Medicare Advantage enrollment periods.
CMS added the Medicare Advantage disenrollment period in 2020 to give beneficiaries another chance to switch without having to wait a full calendar year. This Medicare disenrollment period is actually the “Open Enrollment Period” lasting from January 1 through March 31. You are only eligible if you already have Medicare Advantage.
If you’d prefer to switch from Medigap to Medicare Advantage or make any other types of changes, you can do that during the annual election period in the fall, which is sometimes referred to as “Medicare open enrollment,” though it should not be confused with the Open Enrollment Period.
If you qualify for a Special Enrollment Period (SEP), you can make changes outside of the traditional enrollment periods. Common reasons that you might qualify are if you moved to a new plan service area (or your plan leaves your service area, you move into or out of a long-term care facility, you are also eligible for Medicaid, or you have a medical condition that qualifies you for a Special Needs Plan.
Can I Change my Medicare Advantage Plan If I Move?
You can (and may have to) change your Medicare Advantage plan if you move. Medicare Advantage plans are confined to specific service areas. Some are confined to specific counties or zip codes, while others are state-wide. If you leave that service area, you will need to change plans.
Additionally, moving to a new service area grants you a Special Enrollment Period. That means that from the date that you are officially living in the new area, you will have 60 days to switch Medicare Advantage plans. If you wait too long, you will have to wait until the Annual Enrollment Period rolls around again.
Switching Medicare Advantage Plans with Pre-existing Conditions
If you have preexisting conditions and want to switch into a new Medicare Advantage plan, you do not have to worry about medical underwriting. Medicare Supplement (Medigap) plans are the only type of Medicare plan that may require medical underwriting. Original Medicare (parts A and B), Prescription Drug Plans (Part D), and Medicare Advantage plans (Part C) all cannot deny you coverage based on your health history.
How to Switch Medicare Plans: Step by Step
When you think you’re ready to switch Medicare plans, follow these steps to ensure a successful switch:
Review your current benefits and make notes about what you like and what you don’t like about your current plan.
Choosing a Medicare plan is a very personal process. Your Medicare coverage goes beyond copayments and deductibles. It can determine how prepared you are for emergencies, it can affect the quality of care you receive, and it can alter your lifestyle based on the benefits included.
Some people might find that traditional Medicare (parts A and B alone) is all they need, but most people will likely want to look for a prescription drug plan or some other benefits as well. No two health plans are the same. Some are very simple, covering basic needs and prevention, and others are complex, offering unique benefits like gym memberships and meal delivery.
When choosing your Medicare coverage, keep the following tips in mind:
What works for your spouse or friend may not work for you.
Always make sure your favorite doctors are in the plan network before you enroll.
Before selecting a prescription drug plan, verify that the prescriptions you need are covered.
Remember to look at all costs: premiums, copayments, deductibles, and coinsurance. It’s easy to get excited when you see one low number, but everything together can add up.
It doesn’t cost you anything to meet with an insurance agent who already understands the plans. They might even be able to help you save money.
We Can Help You Decide Which Coverage You Need
Changing your Medicare plan from Medicare Advantage to a Medicare Supplement is a big decision. Our licensed agents are highly trained, and they can help you find the plans available in your area. Your agent can discuss the pros and cons of MA and Medigap and help you make the decision that best fits your needs. To set up a no-cost, no-obligation meeting with an agent, call 1-844-431-1832 or contact us here today.
2019 Medicare Donut Hole: Part D Changes and Costs
According to the Henry J Kaiser Family Foundation (KFF), 43 million Medicare beneficiaries are enrolled in a Part D plan. This accounts for 72% of Medicare beneficiaries nationwide!
Medicare Part D started in 2006, and back then, you were required to pay 100% of the costs for brand name drugs. That percentage has lowered over the years, and better yet, 2020 brings super exciting news regarding the Medicare Part D donut hole.
How Does the Medicare Part D Donut Hole Work in 2019?
The Medicare donut hole is a gap in your Part D plan that starts after you’ve spent your deductible ($415 or less) and exceeded the initial coverage limit ($3,820) in total out-of-pocket costs.
You are in the gap until you reach the annual out-of-pocket threshold ($5,100). During this time, you are required to pay more for your prescriptions. This encourages you to choose generic options whenever possible.
Once you pass the donut hole and reach the catastrophic coverage period, you only have to pay 5% of all drug costs for the remainder of the year.
How Much Is the Donut Hole in 2019?
In 2019, you will pay 25% of brand-name drugs in the donut hole. This is the same as what you would pay before you enter the donut hole, meaning the Medicare donut hole is completely closed for brand-name drugs.
However, you will be responsible for up to 37% of generic drug costs in 2019. The plan is for this to decrease to a max of 25% in 2020, effectively closing the donut hole. Other Medicare donut hole 2019 costs include:
Initial Deductible: increasing by $10 ($405 to $415)
Initial Coverage Limit: increasing by $70 ($3,750 to $3,820)
Out-of-Pocket Threshold: increasing by $100 ($5,000 to $5,100)
How Will I Know If I’m in the Donut Hole?
In 2019, you’ll know if you’re in the donut hole based on your “EOB” notice. The EOB is an “Explanation of Benefits.” If you have a Part D plan, you should be receiving this every month.
The notice will tell you how much you’ve spent for the year on covered drugs and whether or not you’ve reached the coverage gap. Some people may never reach it – it depends on how much you’re spending on your prescriptions.
What Drugs are Covered in the Hole?
Your “formulary” does not change when you’re in the donut hole. The drugs that are listed on your formulary are the drugs that you can receive coverage for.
When Is the Donut Hole Going Away in 2020?
The Medicare Part D donut hole is scheduled to close completely in January 2020. Thanks to the Bipartisan Budget Act of 2018, the gap has closed a whole year ahead of schedule. However, the gap is only closing for brand-name drugs.
The gap for generic drugs will decrease, but will not be completely eliminated until 2020. This is great news for beneficiaries like you because generic drugs already have a lower price point – it’s the brand-name drugs that typically cause hardship in the donut hole.
What Will My Part D Costs Be in 2020?
The standard Part D deductible is $435 in 2020. After you meet the deductible, you’ll pay 25% of both brand name and generic drug prices.
Once you pay $4,020 out-of-pocket, you’ll still only pay 25% of your prescription drug costs, instead of entering the donut hole.
After you pay $6,350, you enter Catastrophic Coverage, and you’ll pay 5% of your prescription costs.
What Are Your Medicare Part D Donut Hole Coverage Options?
Original Medicare (Part A and B) does not cover prescription drugs. If you are looking for prescription drug coverage, you have two options. You can enroll in either a Medicare Advantage or Part D plan.
If you are exclusively looking for prescription drug coverage, Part D may be right for you. If you are looking for prescription coverage along with other benefits like hearing, dental, or vision coverage, a Medicare Advantage plan is probably best for you.
Trying to decide between Medicare Advantage or a Part D plan can be difficult. Our licensed agents can help you enroll in the plan that best fits your unique needs and budget.
They can answer any questions or concerns you may have. Plus, our agents are contracted with most major carriers in your state, so there is no bias when we help you select a plan. If you’re interested in arranging a no-cost, no-obligation appointment, call us at 844-431-1832 or contact us here.
This post was originally published on January 10, 2019, and updated on October 16, 2019.
A Guide to Medicare Coverage for Dementia
A Guide to Medicare Coverage for Dementia
Dementia is a decline in mental capacity that becomes severe enough to hinder a person’s ability to function. According to the Alzheimer’s Association, one-third of Americans die with some form of dementia.
Medicare Parts A and B (Original Medicare) will cover everything that’s medically necessary for dementia patients, but many other services won’t be covered.
Original Medicare dementia care may be limited, but certain Medicare Advantage plans offer coverage for more services that can include unexpected offerings like meal delivery.
Medicare Coverage for Dementia Patients Clarified
An Original Medicare plan will cover services that your doctor deems medically necessary. Medicare Part A covers inpatient hospital care, and Medicare Part B covers outpatient care and medical expenses such as doctors’ appointment costs.
Original Medicare will pay for the first 100 days of care in a skilled nursing facility (there may be some associated fees), and some Medicare Advantage (Part C) plans may include long-term care coverage as well as skilled nursing care.
Private insurance companies offer Medicare Advantage plans, so they have the freedom to cover benefits Original Medicare doesn’t. Medicare Part D or certain Medicare Part C plans cover prescription drugs such as cholinesterase inhibitors that can temporarily improve symptoms of dementia.
Medicare Supplements (Medigap) plans can help cover the expenses that Original Medicare does not. Unlike Medicare Advantage plans, Medigap plans do not cover medical expenses, but they cover financial items such as Part A and B coinsurance and copayments. Even though Medigap and Medicare Advantage are two different types of plans, you cannot enroll in both at the same time.
Does Medicare Pay for Dementia Testing?
Medicare Part B covers cognitive testing for dementia during annual wellness visits. A doctor may decide to perform the test for patients who are experiencing memory loss.
The test consists of about 30 questions like, “What year is this?” to assess the patient’s memory and awareness. The test can be used as a baseline evaluation for future wellness visits and can be a valuable tool for catching dementia early.
Medicare Testing for Alzheimer’s
Dementia is a symptom that can result from many different diseases. Alzheimer’s disease is just one cause of dementia. The risk of developing Alzheimer’s increases with age and with a family history of Alzheimer’s.
There is a correlation between genes called apolipoprotein E (APOE) and Alzheimer’s, but those genes do not necessarily cause the disease. Medicare will not cover genetic testing for APOE genes.
Dementia as a SEP-Qualifying Condition
Medicare eligibles with dementia also qualify for specific Medicare Advantage plans called Chronic Special Needs Plans (CSNPs). These health insurance plans involve coordination and communication between the patient’s entire medical team to help ensure the patient gets the best possible care.
The best way to sort through the thousands of plans available and find the right CSNP for you is enlisting the help of a qualified professional by contacting us here.
If you’re diagnosed with dementia and already enrolled in Medicare Parts A and B, you will qualify for the Special Enrollment Period (SEP). The SEP allows you to enroll in new Medicare coverage or make changes to your existing CSNP whenever you need to instead of having to wait for certain times of the year.
Eligibility for Medicare Coverage for Dementia
If you meet the eligibility requirements for Medicare Parts A & B, you will also be eligible for the dementia coverage provided by Medicare. You can obtain Medicare coverage for dementia services if you are:
Age 65 or older
Any age and have a disability, or end-stage renal disease (ESRD)
Dementia patients are also eligible for other specific Medicare plans once they are officially diagnosed with the condition, like special needs plans (SNPs) and chronic care management services (CCMR.)
Medicare can also cover home health care that dementia patients often need. In order to receive this coverage, it must be certified as necessary by a doctor. The patient must also be classified as homebound, meaning they have trouble leaving the house without help.
Does Medicare Cover Memory Care?
Memory care is a specific type of long-term care for Alzheimer’s patients or people with dementia. Original Medicare will cover occupational therapy but does not cover assisted living facilities. However, certain Medicare Part C plans may include coverage for Medicare dementia care services such as adult day care or help to get dressed or to bathe.
Medicare dementia coverage is split between its component parts. Part A helps cover the cost of inpatient hospital stays, including the meals, nursing care, and medication that you need while you’re there. Meanwhile, Part B will cover the doctor’s services that you might receive during your stay in the hospital, such as testing or medical equipment.
Even more services can be covered by Part C, also called Medicare Advantage. In addition to everything covered by Parts A & B, these plans can also offer options for long-term and home care for dementia patients.
How Much Does Medicare pay for dementia care?
Each different part of Medicare will pay for its benefits in different ways. For example, Part A will cover the entire cost of your hospital or skilled nursing facility stay for the first 60 days. After this period, you will need to pay 20% coinsurance until day 90, when Part A will stop paying entirely.
Part B, on the other hand, will usually pay for 80% of all services that it covers. Medicare Supplement plans are often purchased to cover the remaining costs, and can also provide additional benefits to the patient.
Does Medicare cover long term care for dementia?
The long-term care insurance offered by Medicare depends on the nature of the service being provided to the patient. In many cases, the long-term care needed by dementia patients is classified as custodial care and won’t be covered by Medicare.
However, if your doctor prescribes a long-term care service as “medically necessary,” Medicare may help cover the costs. These exceptions can include services like hospice care, and part-time nursing care or occupational therapy provided in the home.
Does Medicare Pay for Home Health Care for Dementia Patients?
It is usually difficult to obtain coverage from Medicare for elderly care at home. However, it can completely cover some home health services that are deemed medically necessary by your doctor, including:
Physical and occupational therapies
Part-time skilled nursing care
Medicare social services
Most nursing home care is also classified as custodial care by Medicare, meaning it will not be covered. Medicare will cover custodial home health care for dementia patients only if it’s a part of hospice care.
Medicare Advantage plans, however, can offer many different home health benefits for those who suffer with dementia. Examples include personal care assistance, homemaker services, and meal delivery.
Does Medicare Cover Assisted Living for Dementia?
Original Medicare will not cover any services that are deemed custodial or personal care, including any that aid in typical activities of daily living, such as:
Using the restroom
This rule also applies to assisted living and memory care facilities which provide these services. But depending on your state and the facility of choice, Medicaid may be able to help cover the cost of long-term custodial care provided in assisted living facilities.
Medicare Dementia Hospice Criteria
In order for Medicare to cover hospice care, your doctor must first document that you have less than six months to live. You or your durable power of attorney must sign documents indicating that you agree to accept care for comfort and that you waive other Medicare benefits.
What dementia services does Medicare not cover?
In almost all cases, Medicare will not cover any non-medical care services, such as:
Assisted-living or long-term care
Custodial services provided in a facility or in the home
There are exceptions to these rules, but the service in question must be recommended as medically necessary by your doctor. Medicare Advantage plans may offer coverage for these and other personal care services not covered by Medicare.
How to Cover the Gaps with Medicare and Dementia
Paying for dementia care can be daunting, even for Medicare beneficiaries. Both Parts A & B have deductibles you have to meet, and Part B only pays for 80% of its covered services. At the end of the day, a patient and their family may be left wondering how to pay for Alzheimer’s care.
The answer may come in the form of Medicare Part C, also called Advantage plans, which can pay for many of the custodial care costs not covered by Original Medicare. Another option may be a Medicare SNP, or special needs plan, which are geared toward patients with certain chronic conditions such as dementia.
Early Signs and Symptoms of Dementia
Dementia can have a variety of symptoms depending on the cause, as well as if the patient is in the early stages or late stages of the disease. However, some common signs symptoms include:
Loss of memory
Difficulty finding the right words during conversation
Getting lost while driving to and from familiar places
Difficulty with logical reasoning or solving problems
Difficulty with completing complex tasks
Difficulty with planning and organizing day-to-day activities
Difficulty with muscular coordination and motor functions
Being confused or disoriented
Changes in personality
Inappropriate or irrational behavior
How to Find Memory Care
Medicare.gov has a tool to find nursing homes that accept Medicare for medical services. To get started, click here. Not all of these facilities have dedicated memory care teams, so you’ll need to contact them to verify their services.
Once you’re on the nursing home finder tool page, enter your zip code as shown below in red. We used 37209, which is our corporate headquarters’ zip code in Nashville, Tennessee. Then click “Search,” shown in yellow.
Then you’ll reach a list of nursing homes in your area. The nursing home finder tool lets you sort facilities by star rating, which is based on a scale of one to five.
Basically, the higher the rating, the better the care the facility provides. For demonstration purposes, we only chose to see homes that have a five-star rating (shown below in red) and that take Medicare insurance (in green.)
You may have to contact more than one facility to find the right one for you. Ask about costs and how they help patients with dementia. If one seems like it may be a good fit, ask to tour the home to really get a feel for it.
Resources for Families
Family members of dementia patients have access to a wide variety of resources to help them cope. The first step for helping your loved ones is to educate yourself about the disease and to learn how you can be the most supportive.
You should also look into support groups for your family so they can find like-minded people who are having similar experiences. Dementia should not be dealt with alone.
If you are a caregiver for a parent with dementia, you should consider important things such as who will have the power of attorney and make financial decisions for the patient at the end of his or her life. If you haven’t enrolled in a life or a final expense insurance policy, you should consider doing so now.
We Can Help You Find Medicare Coverage for Dementia
Dementia is difficult for everyone involved. If you or a loved one has dementia, we can help you navigate Medicare dementia care and find a Chronic Special Needs Plan that’s right for you. Set up a no-obligation appointment with a licensed agent by calling 833-438-3676 or contacting us here today.
2020 Medicare Changes & Trump’s Executive Order
Every year, CMS (Centers for Medicare and Medicaid Services) reserves the right to make changes to the Medicare program. Rules and regulations around enrollment periods, penalty fees, marketing, and plan benefits are released in late summer and early fall for the following year. Costs can rise, and brand new plans can enter or leave the market.
Medicare is confusing as it is. When you add these yearly changes into the mix, choosing the right plan can be stressful. Our goal is to make all of this less stressful for you. Our website is a great educational tool, and our licensed agents can provide free assistance!
Alex Azar, Health and Human Services (HHS) Secretary, said that Trump told HHS to take “specific, significant steps” towards improving Medicare funding and improving healthcare for American seniors. These steps include lowering Medicare Advantage costs, allowing savings accounts, and improving access to new medical technology. It also leaves room for more plan options, more telehealth, more wellness benefits, and a stronger financial model.
In his post-executive order speech given in Florida yesterday morning, Trump stated, “In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens.” That was the intent of the executive order.
Is Medicare Going Up in 2020?
New 2020 Medicare premiums and costs for 2020 have not been released yet. The new numbers are usually released in early fall of the year prior, so we are expecting to see them over the coming months. The Wall Street Journal reported in April that 2020 Medicare Part B premiums are likely to increase by $8.80/month to a total of $144.30, but this is not final.
We will continue to update this post with new 2020 costs as they are released. Thank you for your patience!
2020 Medigap Changes
Just like the Original Medicare program, private plans like Medicare Advantage, Medicare Supplements, and standalone benefit plans can change every year.
Plan availability may not be the same for everyone. Medigap eligibility, in particular, can depend on your age when you enroll, preexisting conditions, and where you live. Plans can be different not only in every state but also in every county and zip code.
Starting in 2020, you will no longer be able to purchase Medigap Plan F or Medigap Plan C. Plan F was one of the most popular plans, and Plan C was fairly similar. The plans are going away because they include coverage for the Part B deductible (only $185 in 2019).
You might here plans C and F referred to as “first-dollar” plans because they virtually eliminate out-of-pocket costs. CMS decided that taking away the Part B deductible coverage was a smart move to discourage people from overusing their primary physician offices and costing the Medicare program a lot of money for unnecessary doctor’s visits.
If you already have Medigap Plan F or Medigap Plan C, you can be grandfathered in. That means that you will not lose your coverage in 2020. However, if you leave your Plan F or Plan C in favor of a different Medigap plan, you won’t be able to re-enroll in F or C.
Will Plan F Premiums Rise After 2020?
As Plan F sees less and less enrollees, Plan F premiums will likely begin to rise. We can’t say this for sure and we will certainly have to wait and see what happens, but generally less enrollees means higher costs for the companies, resulting in higher premiums.
Will There be a High Deductible Plan G in 2020?
Since people will not be able to purchase Plan F or Plan C in 2020, CMS did want there to be another option with similar benefits. Plan G was already that option, given that the only difference is that Plan G does not cover the Part B deductible.
The other difference is that previously, Plan G was not offered with a high-deductible. If you typically have low medical costs, you may prefer a high-deductible option. Having a high deductible often means that your premiums will be lower. This way, you don’t have to pay as much until you start experiencing health concerns. The high deductible Plan G option can replace the high deductible F option.
Donut Hole Closing in 2020
In addition to all of these plan changes, the infamous “Donut Hole” will be effectively closing in 2020. The Bipartisan Budget Act of 2019 closed the coverage gap for brand-name drugs in 2019, and the generic drug coverage gap will be eliminated in 2020. This basically means that, if you have a Medicare Part D plan, you will only be responsible for 25% of your covered prescription drug costs instead of 44%.
2020 Medicare Advantage Changes
There may be more Medicare Advantage plan changes to come in 2020, but we wanted to make sure you had heard about the changes from last year.
On October 12, 2018, the Centers for Medicare and Medicaid (CMS) announced the 2019 Original Medicare premium and deductible increase, but what about Medicare Advantage (MA) plans? Unlike Medicare Part A and B, beneficiaries enrolled in MA plans may see a decrease in their premiums in 2019 and 2020 compared to 2018.
2020Medicare Advantage Cost Changes and 2020 Premiums
In September of 2018, CMS announced that on average, Medicare Advantage premiums will decrease by 6%. This is great for beneficiaries interested in affordable vision, dental, and hearing coverage or even fitness classes like SilverSneakers®!
CMS estimated that 83% of beneficiaries would have equal or lower premiums for 2019 and 46% will have a $0 premium! Premiums for MA plans have steadily declined, and this is the lowest premium we’ve seen in three years. This is a perfect example of a private and public collaboration that allows beneficiaries to drive and define the value. The 2019 Medicare Advantage changes are a quick glance of what you can expect to continue in the future.
2020 cost changes for Part A and B premiums and deductibles have not officially been released yet but are not expected to increase by very much. We will continue to monitor this information and will update as soon as the cost changes are officially announced.
New Medicare Benefits 2020
Early in 2018, CMS (Centers for Medicare and Medicaid Services) released new rules that allow Medicare Advantage plans to offer a few benefits, like “daily maintenance,” transportation, telehealth, and durable medical equipment.
Some plans in 2020* are really going above and beyond, offering benefits like new air conditioners and pest control!
*These benefits are not included in all MA plans. Your agent may be able to help you find a plan that includes more.
The addition of the “daily maintenance” benefit means that Medicare Advantage plans are now able to offer at-home care items, such as wheelchair ramps and other home modifications. Tied in with that benefit are other forms of durable medical equipment, like hospital beds, oxygen equipment, blood sugar monitors, etc, as well as “non-skilled” services. Non-skilled refers to items that do not require a licensed doctor or nurse, such as aides who can assist with bathing and dressing or homemakers who can help with cleaning and cooking.
Non-Emergency Medical Transportation Coverage
CMS has also added the ability for MA plans to provide non-emergency transportation coverage, a service that several Medicaid plans provide. This benefit (if your plan covers it) will allow you to receive free or low-cost rides to medical appointments and pharmacies. In most cases, you can only qualify for this benefit if you do not have another adequate means of transportation. The appointment that you are requesting a ride to must be for a Medicare-covered service.
Telemedicine and Telehealth
MA plans can now provide coverage for telehealth. That means you can have live video interaction with your doctor through digital clinics like HealthTap, Teladoc, and MDLive. Telehealth can also include health alerts delivered to your phone, health education apps, electronic medical data transfers, mail-order prescriptions, digital appointment scheduling and exam reminders, and more.
New Enrollment Period (OEP)
Before 2019, most people were only able to switch into new Medicare Advantage plans during the Annual Enrollment Period in the fall. Now, if you already have a Medicare Advantage plan, you may be eligible to make a change during OEP. OEP, or the Open Enrollment Period, takes place from January 1 through March 31. During this time, you can switch from one Medicare Advantage plan to another or drop your Medicare Advantage plan in favor of Original Medicare (Part A and Part B only).
Future of Medicare Advantage Plans
According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003 and continues to grow each year. CMS estimates that MA enrollment will hit an all-time high of 22.6 million beneficiaries in 2019 (an 11.5% increase)!
As enrollment continues to increase, plan selection and variety increase too, with approximately 600 new plans offered in 2019! 99% of seniors and Medicare-eligibles have access to a MA plan – and 91% can choose from 10 or more plan options. Beneficiaries will not only see more plans to choose from, but also new supplemental Medicare benefits!
Enroll in a Medicare Advantage Plan in 2020
Are you interested in getting coverage beyond Original Medicare? Along with the new benefits, many Medicare Advantage plans offer dental, hearing, and vision coverage.
Our agents at Medicare Plan Finder can contract with nearly every carrier in your state! This means that you can enroll in the MA plan that best fits your needs and budget.
The Annual Enrollment Period runs from October 15 through December 7. Start looking over your plan benefits now so that you’re ready to enroll before December 7!
Ready to learn more? Call us at 833-438-3676 or fill out this form to arrange a no-cost, no-obligation appointment with an agent in your area.
*This post was originally posted on November 8, 2018, and was last updated on October 4, 2019.
How Medigap is Unique in Minnesota, Wisconsin, and Massachusetts
In most of the United States, Medigap (also called Medicare Supplements) can be characterized by eight different types of plans (A, B, D, G, K, L, M, N). However, there are three states that work completely differently: Massachusetts, Minnesota, and Wisconsin.
A lot of the information you’ll see on the internet about Medicare Supplement plans talks about those eight plans, but we haven’t forgotten about you, Massachusetts, Minnesota, and Wisconsin! If you live in one of those three states, this guide is for you.
Psst…click below to read more about Medicare programs in each state:
If you already have a basic understanding of Medigap, you can skip ahead to the section about your state below.
Medigap is a type of private Medicare insurance that is not technically part of the government-sponsored Medicare program. Medigap plans are also called Medicare Supplements. The two terms can be used interchangeably. To enroll in Medigap, you have to enroll in Original Medicare first.
Additionally, you cannot have a Medicare Supplement plan and a Medicare Advantage plan at the same time. Click here to find out if Medicare Advantage is better for you than Medicare supplements.
What Does Medigap Cover?
Uniquely, Medicare Supplement plans do not typically provide additional health benefits. Instead, Medigap plans provide additional financial protection. For example, let’s say you get sick and have to go to the doctor at least once per month for treatment. Original Medicare may not cover the entire cost for you. You might have to pay your deductible first ($185 for Part B in 2019) and then 20% coinsurance on every visit.
If you have a Medicare Supplement plan that includes deductible and coinsurance coverage, you may not have to pay that $185 and 20%. Instead, you’ll only have to pay your Part B* premium and your Medigap premium.
Medigap and Preexisting Conditions
You may have heard that you cannot be denied Medicare coverage based on your age or preexisting conditions. While that’s true, Medigap is a little different. If you enroll in a Medicare Supplement plan during your Initial Enrollment Period (the time when you first become eligible for Medicare), that holds true. However, if you wait too long to enroll, there is a chance that your plan will be put through underwriting and your prices may increase, or you may be denied coverage based on your age and preexisting conditions.
*Some people may have a Part A premium as well.
Minnesota Medicare Supplement Plans
While you can’t get the same eight plans (A, B, D, G, K, L, M, N) in Minnesota that are offered in other states, there are technically modified versions of plans K, L, M, and N available.
Additionally, Minnesota offers two unique plans: The “Basic Plan,” and the “Extended Basic Plan.”
The preexisting conditions underwriting may apply. However, you’ll get a 6-month Medigap enrollment period (where age and preexisting conditions do not apply) if you return to work or if you drop Part B in favor of your employer’s health plan.
80% of foreign travel emergency, then 100% after you spend $1,000 per year out-of-pocket
80% of “usual and customary fees,” then 100% after you spend $1,000 per year out-of-pocket
So you’re probably wondering, if the Minnesota Medigap Basic Plan and the Extended Basic Plan both always offer the same benefits, why would you choose one Basic Plan over another?
The answer is that costs can vary and plans are allowed to add some extra benefits. There are four additional benefits that plans are permitted to add to the Basic and Extended Basic plans: Part A inpatient deductible, Part B deductible (no longer available in 2020), usual and customary fees, and non-Medicare preventive care.
At least $30,000 for kidney disease treatment (dialysis, transplants, etc.)
Insulin pumps, self-management training, and other diabetes care
50% and 25% cost-sharing plans are also available, which are similar to Medigap Plan K and Medigap Plan L (which would be available in other states).
So, you might be wondering why you have multiple options to choose from for Wisconsin Medigap plans if they are all supposed to be the same “basic” plan. The answer to that is that plans ARE allowed to add additional benefits other than what is in the basic plan, and the costs can vary. Companies are allowed to add the following benefits:
Why Can’t I get Part B Deductible Coverage in 2020?
When MACRA (The Medicare Access and CHIP Reauthorization Act) passed in 2015, a couple of changes were made that didn’t take effect right away; Losing Part B deductible coverage was one of them.
Congress made the decision to not allow plans to cover the Part B deductible starting in 2020. This decision saves money for the Medicare program and doesn’t have an astronomical effect on you. The Part B deductible was only $185 in 2019. All this means is that you will have to pay $185 out-of-pocket before the rest of your coverage kicks in.
It also means that if you are already enrolled in one of the plans listed above that includes the Part B deductible, you won’t lose that coverage. However, if you decide to switch plans or drop that coverage at any time, you won’t be able to get back into it starting in 2020.
How do I Decide Which Medigap Plan is Right For Me?
Regardless of which state you live in, we have a plan finder tool that can help you compare your options. Visit https://www.medicareplanfindertool.com/ to start looking at Medigap plans available in your area.
We also have licensed agents available to answer your questions and help you make your final decision. To find out if there is an agent near you that you can meet with, call 833-438-3676 or send us a message by clicking the “let’s chat” button in the bottom right corner.
Medicare Advantage vs. Medicare Supplement
Medicare Advantage and Medicare Supplements (also called Medigap) are very different insurance plans with distinct benefits. The answer to the question “is Medicare Advantage better than Medigap?” depends on your circumstances and needs.
What is Medicare Advantage?
Medicare Advantage plans are private plans (not owned by the federal government) that can offer additional health benefits. To have Medicare Advantage, you have to enroll in Original Medicare first. You may have to continue to pay your Medicare Part B premium even if you have Medicare Advantage (MA), but MA premiums can be as little as $0.
Medicare Advantage plans are not all the same, but they can provide benefits like (click on the links to learn more about each one):
A preferred provider organization (PPO) is also a network of health-care providers and facilities but typically you do not need to select a primary care physician, and you have more flexible options regarding out-of-network care.
A private fee-for-service (PFFS) plan is a mode of benefit delivery where you are not limited to a network. However, there are no guarantees that your doctor or hospital will accept the plan. If you choose to receive your Medicare health coverage through a private Medicare Advantage plan, you must continue paying your Part B premium regardless, because you remain enrolled in Original Medicare (Part A and Part B), even after joining a Part C plan.
What is Medigap?
Medigap is more different from Medicare Advantage than you might think. While Medicare Advantage plans are able to offer health benefits, Medicare Supplement plans (also called Medigap) offer financial benefits. For example, some Medigap plans can cover your Part B premium.
The chart below explains the differences between available Medigap plans in 2020. You can also use our Medicare Plan Finder search tool to compare plans in your area.
Comparing Medicare Advantage vs. Medicare Supplement plans
Let’s look at Medicare Advantage vs. Medigap. In short, the difference between Medicare Advantage and Medicare Supplement plans is that one can supply health benefits while the other can supply financial coverage.
Medicare Supplement Insurance is a policy that’s added to Original Medicare, Part A and Part B, to provide additional financial coverage. Medicare Advantage is a private plan option that may provide you with other health benefits that Original Medicare does not cover (like dental, vision, fitness programs, etc.).
You cannot have both Medicare Advantage and Medigap at the same time.
A given plan type (e.g., Plan F) has the same benefits regardless of the insurance company that provides the policy, or the state in which you reside. This is not true of Medicare Advantage plans, however, because coverage details may vary by plan.
Excluding prescription drug coverage, any standard Medigap plan with Part A and B will have more benefits than a standard Medicare Advantage plan. However, as mentioned above, some Medicare Advantage plans offer benefits beyond those found in Part A and Part B.
Some Medicare Advantage plans offer prescription drug coverage (often for an additional monthly cost). With a Medigap plan, in contrast, you would need to enroll in a separate prescription drug plan. When comparing plan options, consider your costs for drug coverage. In some cases, Medigap with a stand-alone prescription drug plan has lower total costs than a Medicare Advantage plan with drug coverage. In other cases, the reverse might be true.
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Real-Life Examples: Medicare Advantage vs. Medicare Supplements
Let’s take a look at some real-life examples to help you decide whether Medicare Advantage or Medicare Supplements are right for you.
If you have Medicare Parts A (hospital coverage), B (medical coverage), and D (prescription coverage) and you are hospitalized for cancer treatments for 90 days, you may have out of pocket costs. The Part A deductible means you would pay well over $1,000 first. Once you meet your deductible, your costs will go down. However, after day 60, you’ll be responsible for a portion of every day that you stay there.
If you have Medigap Plan B, your deductible and many of your other hospital costs will be covered. This plan would be in addition to your Part B coverage, so it would all work together to provide extra coverage.
If you have Medicare Advantage, you may have additional health benefits. You’d still likely be responsible for some of those out-of-pocket hospital costs, but your plan might provide a home healthcare benefit, meaning you can get a private in-home nurse when you are released from the hospital. You might also have coverage for medical equipment, such as bathroom safety equipment or a walker.
Comparison is key: Medicare Advantage vs. Medicare Supplements
When choosing between a Medigap plan and a Medicare Advantage plan, take the time to do your research. Read the benefit descriptions of every Medigap and Medicare Advantage plan you are considering. Be certain to look at:
Doctor and healthcare facility restrictions
Anticipated plan costs given your typical use of health-care and hospitalization services
Prescription drug coverage cost sharing as it relates to your medication usage
In the end, your decision is going to be the one that you feel the most comfortable with. The challenge is often wading through all the material to get to the bottom line. Want to make that a little easier? Give us a call at 833-438-3676.
This post was originally published on October 23, 2018, and was last updated on August 29, 2019.
As you age, it can become difficult to perform everyday tasks such as bathing or getting dressed, and you may need assistance to do those things.
Long term care may consist of skilled nursing services or physical therapy immediately following an illness or injury, or it may consist of someone coming to your house to help you with day-to-day tasks.
Does Medicare Cover Long Term Care?
Original Medicare does not cover long term care unless it follows a hospital stay or is for necessary medical treatment.
However, you can use certain Medicare Advantage (Part C) or Medigap (Medicare Supplement) insurance plans to help pay for non-medically necessary long term care. Here’s what Original Medicare will cover:
Medicare Skilled Nursing Coverage
Medicare Part A will cover short stays (100 days or less) in skilled nursing facilities if you meet these qualifications:
You’ve been admitted to the hospital for at least three days
A Medicare-certified skilled nursing facility admits you within 30 days of the initial hospital stay
Your treatment plan involves skilled care such as physical therapy or skilled nursing services.
Medicare will cover 100 percent of the costs for the first 20 days. In 2019, your copay for days 21-100 is $170.50.
For Medical Treatment
In order for Medicare to cover long term care for medical treatment, your doctor must first deem it medically necessary. Medicare Part B will cover the following services:
Intermittent and part-time skilled nursing care
Your durable medical equipment (DME) can be covered if your doctor prescribes it and it will be used for at least three years. Medicare Part B also covers mental health services to help manage the psychological and cultural issues that come with having an illness.
There is no limit on how long you can receive the above services if your doctor reorders them every 60 days.
For Chronic Illnesses
Chronic Special Needs Plans (C-SNP) will cover long term care services for people with chronic illnesses. The covered services for conditions such as Parkinson’s and ALS are to help prevent and slow the progression of the symptoms.
Original Medicare will NOT cover prescription drugs for chronic illnesses, however. Prescription coverage falls under Medicare Part D and certain Part C plans.
Medicare Hospice Coverage
If you have a terminal illness with no chance of improvement, are expected to live less than six months, and are looking for peace instead of a cure, Medicare will cover hospice care.
In order for Medicare to cover drugs to control the symptoms and to relieve pain, you must be receiving care from a Medicare-approved hospice provider.
You can receive hospice care at your home, in a nursing home, or in a hospice care facility. When you enter hospice care, you will have an entire team of people focused on your overall comfort and well-being including your spiritual and emotional needs, not just your physical needs.
Long Term Care Coverage With Medicare Supplement Vs. Medicare Advantage
Private insurance companies offer plans that can go beyond what Medicare Parts A and B will cover. For non-medically necessary long term care, you won’t be able to use Original Medicare, and, for the most part, you won’t be able to use Medicare Supplements, either. If you want long term care coverage, a Medicare Advantage plan may be your best option.
Long Term Care Medicare Supplement
Medicare Supplements (Medigap) plans are designed to fill in the financial gaps Original Medicare creates. For example, you are financially responsible for that $170.50 copay. You can use a Medicare Supplement to help make those payments easier.
Medicare Advantage (MA) plans are insurance plans that can cover medical services Original Medicare does not. While Medigap plans are strictly for help paying for out-of-pocket costs, MA plans are for additional medical coverage. Certain Part C plans can include coverage for DME and non-medical long term care, so it’s critical you know what your options are.
Note: You cannot have both a Medicare Supplement and a Medicare Advantage plan, so having someone help you sift through the thousands of plans out there and find the right one for you is extremely important to your overall health and well-being.
Why It’s Important to Have a Plan
Long term care can easily cost hundreds or thousands of dollars a month, and those costs will only increase. By 2050 the baby boomer population in the US will be 80 million, and that means more competition for home health care and therefore steeper prices. Having a health insurance plan to help with those costs might not only help you stay in good health, but also give you peace of mind.
Get Medicare Long Term Care Coverage Today
Are you looking for Medicare long term care coverage? One of our licensed agents can answer your questions and help you find the right plan for you. Fill out this form or call us at 833-438-3676 for a no-obligation appointment today.
Original Medicare vs. Medicare Advantage
The Annual Enrollment Period is quickly approaching and starting October 15, you will be able to switch Medicare Plans. Which do you favor in the battle of Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each, you will be better prepared to make that decision.
What is Medicare?
Medicare is operated under the federal government and covers a variety of health care expenses and provides benefits for seniors over 65 as well as those with Social Security benefits or certain health conditions. There are many parts, policies, and new standards associated with Medicare. We get it – it’s confusing! It’s important to understand the history of Medicare Part A B C D, because AEP is right around the corner!
Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage).
Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.
Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.
If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescription drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.
History of Medicare
National health coverage wasn’t even discussed until President Roosevelt in 1912. He ran on a platform that included providing health coverage to anyone who needed it. Flash forward to 1945 when President Truman took office. Within seven months, he called for a national health fund that would be available to all Americans.
Truman fought hard, but it took another 25 years before anything went into effect. In 1965, Lyndon B Johnson signed legislation that provided benefits for seniors over 65. As of 2018, the Centers for Medicare and Medicaid Services (CMS) estimate that over 58.5 million people benefit from Medicare. As more policies and new standards go into effect and technology creates healthcare innovations in this industry, Medicare will continue to evolve.
Medicare Part A B C D
Medicare is broken into specific parts and each part is unique. Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy.
Most beneficiaries receive Part A for free and Part B is covered by a monthly Medicare premium. Beyond Original Medicare, there are Parts C and D. Part C is Medicare Advantage (MA).
MA plans combine Part A (hospital fees insurance) and Part B (medical insurance) and usually prescription drug coverage. Part D is a standalone plan that is purchased separately on top of Original Medicare. It can help cover the cost of prescription drugs.
What is Medigap?
If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan. What is Medigap? Medigap plans help pay some of the cost that Original Medicare does not cover. This can include copayments, coinsurance, and deductibles. Medigap plans generally don’t cover vision or dental care but may include prescription drug coverage. They are sold by private insurance companies. You cannot be enrolled in a Medicare Advantage plan and Medigap, so it’s important to compare and evaluate your budget and needs.
Pros and Cons of Medicare
Some people love Medicare, and others don’t care for it.
Why Medicare is Awesome
Premiums: If you worked for most of your life, you won’t have to pay any premium for Medicare Part A!
Healthcare Innovation: Medicare has increased healthcare innovations in the medical market tremendously. Thanks to Medicare, millions of Americans suddenly have access to health coverage they otherwise would be unable to afford. Millions of dollars have been invested in healthcare innovation and development!
Medicare “Rules:” CMS has steady Medicare rules that help prevent fraud, waste, and abuse. Without breaking the Medicare Rules, Medicare agents and plans can’t take advantage of you!
Why Some People Dislike Medicare
Hospital Fees: Even with the help of Medicare, hospital fees can still cost a pretty penny. Medicare beneficiaries typically pay 20% of the total fee. Additionally, Medicare typically does not have a cap. This means that if you have a series of health issues within a year, you may be spending more than you originally budgeted.
Prescription Drug Coverage: Medicare does not cover prescription drugs. If you are looking to purchase drug coverage, you will need to purchase separate prescription drug coverage through Medicare Advantage or Part D.
Limitations: Original Medicare provides the same health coverage for everyone. There is no personalization or choosing the exact benefits you want, unless you enroll in Medicare Advantage. If you are seeking more than basic health coverage, an MA plan could be perfect for you.
What is Medicare Advantage?
The history of MA plans is relatively short compared to Original Medicare. Just like Medicare, MA plans have benefits for seniors over 65 and certain disabled persons. These plans are rising in popularity and may be the best option for you!
Medicare Advantage plans can allow you to have a monthly premium for all your additional benefits, like dental, vision, and prescription drugs. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors and other Medicare eligibles. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
The History of the Medicare Advantage Program
Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.
Medicare Advantage (Part C) Popularity
According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even fitness programs like SilverSneakers®. These plans have a set network of Medicare providers you must choose from, but don’t worry! There are many different networks and plans available.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.
An HMO, or Health Maintenance Organization, has a closed provider network. You’ll have to select one primary provider for most of your healthcare needs. HMOs may require you to get a referral for more severe injuries or illnesses.
PPOs, or Preferred Provider Organizations, allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.
Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
Pros and Cons of Medicare Advantage
Why Medicare Advantage Plans are Awesome
Premiums:KFF reported that half of Medicare Advantage beneficiaries in 2019 pay no premium at all, and most others pay between $20 and $100.
Out-of-pocket Max: Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have a limit for your out-of-pocket costs, saving you even more in the long run!
Prescription Drugs: Prescription drug coverage is often included in Medicare Advantage plans. This allows you to bundle your health coverage – saving you money and creating more convenience for you!
Unexpected Benefits: Some Medicare Advantage plans even include cool benefits like gym memberships!
Flexibility: There is a broad range of Medicare Advantage plans out there, so you may be able to choose between a few options to get the one that’s right for you.
Why Some People Don’t Like Medicare Advantage Plans
Limited Networks: There is usually no nationwide coverage with Medicare Advantage plans. This can be an issue if you frequently travel within the US. Additionally, your network may require that you only see specialists that your doctor refers you to.
Price Fluctuation: The specifics of your Medicare Advantage plan varies per provider. You may still be required to pay copays and coinsurance fees. Additionally, your Medicare premiums and copayments may change each year.
Medicare Advantage vs. Medigap
When comparing Medicare Advantage vs Medigap, it’s easy to get confused. Medigap can only be purchased alongside Original Medicare. You cannot have a Medicare Advantage and Medigap plan at the same time. Medigap plans cost an additional monthly Medicare premium, but they help fill the cost gaps in coverage – this means less out of pocket costs for you.
Medicare Advantage vs Medigap prices can vary. If this is something you’re interested in, it’s important to compare policies.
Difference Between Medicare and Medicare Advantage
What is the difference between Medicare and Medicare Advantage? It is easy to confuse the two. The main difference is that while Original Medicare is the federal program, Medicare Advantage plans are privately owned. Medicare Advantage plans still have to follow all the rules determined by CMS (Centers for Medicare and Medicaid Services), but they are able to offer benefits that the federal program cannot. med
How to get Medicare Advantage
Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon!
From October 15 to December 7, anyone with Medicare can make changes to their plans. If you’re interested in purchasing a Medicare Advantage plan or hearing more about how to get covered, complete this form or call us at 833-438-3676 to arrange a free, no-obligation appointment with an agent and get covered today.
*This blog was originally published on September 20, 2018, and updated on July 28, 2019.
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