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Medicare 101
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Medicare 101

by Jagger Esch
written by Jagger Esch

While most individuals embrace the aging process, Medicare is excellent coverage that many seniors look forward to obtaining. Medicare has been providing health insurance coverage since 1965 for individuals 65 and older as well as certain disabled Americans.

Over 15% of the country is currently enrolled in Medicare today and that’s a definite bonus after having worked for most of our lives. Being on Medicare means having Hospital and outpatient coverage for many services.

Although, many seniors are unaware of the coverage they have and what expenses they’re responsible for paying. Having a Medicare Supplement could help you plan your health care expenses better.

Traditional Medicare Benefits

Medicare consists of two main parts:

  • Part A (Hospitalization)
  • Part B (Outpatient and DME supplies)

 

Medicare Part A is typically premium-free and provides coverage for your hospitalizations and skilled nursing facility stays. Additionally, Part A benefits provide coverage for home health and hospice care.

Part B premiums are ever-changing, typically they go up annually based on inflation. However, the government takes into consideration individual incomes, paid taxes and annual expenses. Many people with Part B don’t pay the full Part B premium.

Extra Help is available to those that qualify.

Part B benefits cover your outpatient costs for doctors’ visits, lab work, diagnostic testing, physical therapy, and outpatient surgeries.

Regardless of whether Medicare Part A or Medicare Part B is being used, each plan only covers at 80%. The remaining 20% leftover is the Medicare beneficiary’s responsibility to pay.

Both Plan policies only take effect after the Part A and Part B deductibles have been met. Each year the deductible cost changes so you can log onto Medicare.gov to see the exact rate for each deductible.

How to Qualify for Medicare

To become eligible for Traditional Medicare benefits, individuals must be at least 65 years of age.

When enrolling in Traditional Medicare you have a seven-month Open Enrollment Period (OEP). The OEP begins the three months leading up to your 65thbirthday, continues through your birthday month, and the remaining three months after turning 65.

Failing to enroll for Medicare Part A or Medicare Part B during the Open Enrollment Period can result in penalty fees.

Medicare Part A Penalty:

If you have Part A premium, an extra 10% is added for each year gone without Part A benefits. Based on how long one goes without Part A benefits will determine the number of penalty fees.

Medicare Part B Penalty:

With the Medicare Part B penalty, the monthly premium is increased an extra 10% for every year without Part B benefits. With the Part B penalty, the increased premium rates are paid for the entirety of having part B benefits.

Medicare is also available for certain individuals with end-stage renal failure and certain other disabilities. For those individuals who also receive social security benefits or certain Railroad Retirement Benefits, you’re automatically eligible and enrolled in Medicare Parts A and Part B after two years.

Part C Medicare Advantage Plans

Medicare Advantage Plans are provided by private insurance companies within your area. Premiums are based on the individual plans offered.

Part C Plans are oftentimes referred to as Medicare Supplement Plans as their benefits will take over coverage for that of Traditional Medicare Part A and Part B.

Oftentimes, Medicare Advantage Plans come with cheaper premium costs. So, those living on a fixed income find the sound of these policies appealing.

However, with the cheaper premium prices come at a price.

Medicare Advantage shortcomings include:

  • Restrictions
  • Referral requirements to see a specialist
  • Coverage limitations
  • Limited doctor, pharmacy and hospital networks
  • Limited coverage areas.

 

What seems like being more valuable, can end up costing more for the individual when it comes to their out of pocket cost. Coinsurance, deductibles and copayments are commonly discussed when you enroll in these plans.

Medicare Part D

Traditional Medicare offers no insurance benefits for prescription medications. With medications, especially brand name, the out of pocket costs at the pharmacy can be downright astronomical!

By obtaining a Medicare Part D Plan, AKA, a Medicare Prescription Drug Plan (PDP), you can get those medically necessary prescriptions at a lower price. In some cases, you can get them at no cost whatsoever.

Offered by the individual health insurance companies, you can pick the best Part D Plan to suit your prescription medication needs. Depending on the policy will depend on your premium prices.

Another bonus of enrolling in a Medicare Part D Plan is you will avoid the penalty fees.

Like the penalty fees of Original Medicare, failing to enroll during your 7-month initial enrollment period will result in an increase in the Part D premium charge.

Depending on how long one went without drug coverage will determine the additional premium fees each month.

Medicare Supplement Plans

There are also Medicare Supplement Plans, that like Advantage Plans, are purchasable through your local private insurance carriers.

With Medigap Plans, they work alongside the already excellent Traditional Medicare benefits. These plans provide extra coverage for those items not originally covered by straight Medicare.

Pending on which Plan is chosen, items like deductibles, coinsurance, copayments and other items not covered by Medicare can cost less for the beneficiary. In some cases, there are plans that offer complete coverage.

There are ten letter plans available to choose from and depending on your individual healthcare needs will depend on which plan best suits you.

For example:

Plan F

This plan provides 100% coverage of both your Medicare Part A and Medicare Part B deductibles.

It has the added benefit of paying for:

  • Medicare Part B’s copayments
  • Foreign travel emergency coverage
  • The remaining 20% coinsurance for your Part A and Part B fees

 

While Plan F is the most popular due to the great additional benefits, it also comes with a higher premium price tag.

High Deductible Plan F

There is also a Medicare Supplement Plan F High Deductible version that provides the exact same benefits, just with a deductible. The added bonus of this specific plan is there is a lower monthly premium so it’s cheaper for those on fixed incomes.

Plan G

This plan is another great Supplement Plan that’s also comparable to Plan F, however, there is no Medicare Part B deductible coverage.

Many times, the savings in Plan F premiums is more than the Part B deductible, meaning you get comprehensive coverage at a great price. Besides, Plan G typically has lower annual rate increases when compared to other plans.

Plan N

With this specific policy, it’s considered, “cost-sharing”. While the Medicare Part A deductible is completely covered, the beneficiary will be required to pay a small copayment for ER and doctor’s office visits.

It’s important to research all Medicare plans available, prior to picking your “perfect” plan. What works for one individual, may not work for another.

There’s plenty of information available regarding not only Traditional Medicare benefits, but also Medicare Advantage as well as Medicare Supplement Plans.

Medicare low Income Plans

While Medicare offers good healthcare coverage, those living on a fixed income may find it hard to afford monthly premiums, deductibles, coinsurance and copayments.

Even with lower premiums associated with Medicare Advantage plans or more coverage with Medicare Supplement Plans, the out of pocket costs can still be quite burdensome.

Those still struggling with healthcare costs there are Medicare Savings Programs that you may qualify for, applying is highly recommended when you meet the income requirements.

Additionally, each individual state has their own State Health Insurance Program, also known as SHIP. SHIP can provide financial assistance and relieve some of the stress associated with out of pocket costs for health insurance.

Changes in Medicare as of 2020

In the upcoming years there’s always the chance of change when it comes to not only premium and deductible prices, but also changes in policies.

The most major upcoming change will be the doing away with First-dollar coverage plans. What this means is that any of the Medicare Supplement Plans that leave a Medicare beneficiary without any out of pocket costs, will no longer be available.

This affects the 3 major first-dollar coverage Supplement Plans:

  • Medicare Supplement Plan C
  • Medigap F
  • High Deductible F policy

 

This change in 2020 is mainly due to congress feeling as though Medicare beneficiaries who have no deductibles or out of pocket costs, will then no longer overuse healthcare services they don’t necessarily need.

This upcoming change will only affect those eligible for Medicare benefits after 2020. Luckily for those who currently carry or are eligible prior to 2020, will be, “grandfathered in.” This means you may still reap the benefits of those first-dollar plans!

There will be other options available for those looking to enroll after 2020. You can still enroll in Medicare Supplement Plans with just some slight changes and a small overall increase in your out of pocket costs.

Getting good health insurance to converge should be simple. Traditional Medicare benefits, a Supplemental insurance plan as well as a Prescription Drug Plan can provide individuals with optimal healthcare coverage.

Medicare is readily available, easy to obtain and most providers take the insurance. Regardless of what you may have heard about Medicare in the past, take action and enroll in Medicare as soon as you become eligible.

The sooner you do the sooner you too can start benefiting from our government appointed healthcare!

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Medicare Plans

What are the different types of Medicare supplement plans?

by Kylie Johnson
written by Kylie Johnson

All Medicare supplement policies

Medicare supplement insurance, also known as Medigap, is designed to cover some or all of the costs a patient is responsible for before Medicare Parts A and B will pay anything, copays required by Medicare Parts A and B and amounts over the maximum that Medicare Parts A and B will cover. The different Medigap plans are standardized between companies, meaning consumers will receive the same coverage for Plan A (or whichever plan they select) regardless of which company they buy it from. There are 11 plans, each designated by a different letter, and each one covers different things. (Medigap plans are not labeled with letters in Massachusetts, Minnesota and Wisconsin, so-called waiver states.)

Plan A

Plan A covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care and up to three pints of blood.

Plan B

Plan B covers everything that Plan A does and also covers the deductible required by Medicare Part A.

Plan C

Plan C covers everything that Plan B covers as well as the deductible required by Medicare Part B, 80 percent of medical care costs occurred when traveling abroad and the coinsurance for stays in skilled nursing facilities.

Plan D

Plan D is the same as Plan C, but it does not cover medical care costs occurred when traveling abroad.

Plan F

Plan F covers everything covered by Plan C and also covers any excess fees charged by a doctor or hospital that Medicare does not cover.

Plan F—High Deductible

The high deductible version of Plan F has the same coverage as the standard Plan F, but individuals must pay a high deductible, often over $2000, before the policy covers anything.

Plan G

Plan G covers everything the standard Plan F covers except that it does not cover the Medicare Part B deductible.

Plan K

Plan K covers additional days in the hospital after Medicare benefits are exceeded and 50 percent of the following: Part B coinsurance, up to three pints of blood, hospice care, coinsurance for skilled nursing facilities and the deductible for Part A.

Plan L

Plan L covers the same things as Plan K, but it pays 75 percent on the services where Plan K pays 50 percent.

Plan M

Plan M covers additional days in the hospital after Medicare benefits are exceeded, copayments and coinsurance, hospice care, skilled nursing facility coinsurance and up to three pints of blood. It also covers 50 percent of the Part A deductible and 80 percent of charges while traveling abroad.

Plan N

Plan N is identical to Plan M, except it fully covers the deductible for Part A and requires a small copay for office visits and trips to the emergency room.

Medicare SELECT

A type of Medigap policy which typically charges lower premiums so long as the policyholders uses approved networks of hospitals and doctors.

Who should consider purchasing Medicare Supplement Insurance?

Retirees

Anyone reaching retirement age should begin researching health insurance options for those 65 and over. Deciding on a plan before turning 65 may allow some consumers to get special discounts.

Seniors

Older seniors may wish to purchase Medicare supplement insurance if they’re concerned about paying for an unexpected medical need.

People with qualifying disabilities

Individuals with qualifying disabilities, usually those that make them eligible for social security disability, may be allowed to purchase Medicare supplement insurance before they turn 65.

Affinity Group Members

Affinity groups like AARP may offer members advantages if they buy Medigap through the organization.

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Medicare Plans

Alternatives to 1st Dollar Coverage Plans

by Jagger Esch
written by Jagger Esch

We’ve lived our lives planning for our future and the future is now. Unfortunately, gone are 1stdollar coverage plans. Instead of paying a monthly premium that allowed us to close our wallet after writing that check we can expect to do a little more searching to find just the right plan. It’s back to the licensed insurance agent to review your needs and benefits against costs and risk.

If you aren’t familiar with 1stdollar coverage, we are referring to Medicare Supplement Plans F and C. Medicare Supplement Plans are sometimes referred to as Medigap Plans. Plan F covered everything not covered by Original Medicare. Plan C covered everything not covered by Original Medicare, except excess charges.

What Now

Nonetheless, there are great coverage options available to you. The most comprehensive Medigap Plans available for the 2020 year will be Plans G and N. Previously, these two plans were overlooked by many in favor of paying a higher premium and nothing more. Medicare Supplement Plans G and N will now be the sought-after coverage options.

Plan G

In 2019, the Medicare Part B deductible will be $185. For beneficiaries enrolled in a Medicare Supplement Plan G, that $185 deductible will be all they pay for covered services. Between Original Medicare and Medicare Supplement Plan G, everything else is paid for you.

This plan is like Medicare Supplement Plan F in that you can minimize your out of pocket risk. But by assuming the $185 deductible, you will save much more than $185 on an annual basis. Currently, the Plan G is the most popular plan.

The reason is that in most cases a Medicare Beneficiary will save considerably more every year by paying their Medicare Part B deductible out of pocket. In many cases, a Beneficiary can save $300 or more over the cost of the year, and that is even after the deductible is met. To Savy seniors, this plan has been the choice for several years now.

Plan G does cover any excess changes that could be imposed by a hospital or physician’s office. So, you are not giving up any peace of mind to save several hundred dollars. The protection is in this plan. You can find Medicare Plan G reviews here.

Plan N

Medicare Beneficiaries that want cost-effective coverage and are willing to use facilities and physicians that accepts Medicare assignment should consider Medicare Supplement Plan N. Plan N does not offer does not cover the $185 (2019) deductible or excess charges.

In addition, Plan N has small co-pays when seeing the doctor or going to the emergency room. The co-pay for a doctor visit, primary or specialist, is up to $20. The emergency room co-pay is up to $50.

The Plan N caters to seniors that do not go to the doctor often. Many times, the cost savings from the Plan N to the Plan G are significant as well. The only real gap in the Plan N is that it does not cover excess charges.

Most doctors do not charge them, but you will frequently see a cancer specialist, and specialty hospitals charging those charges. A Cancer policy can always be purchased, roughly $1 per day for about $10,000 in coverage, to help cover these charges if you were to be diagnosed with cancer. You can find Medicare Plan N reviews here.

Why the Sudden Change

The end of first dollar coverage plans has been several years in the making. Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.

There are several reasons for the birth of MACRA. People agree the single most important reason is to keep doctors on the Medicare program. Medicare Beneficiaries need a large pool of doctors from which to select the one that best fits their needs and personality.

It is important to mention that someone who is already enrolled in one of the plans being retired can keep it. It is even permitted to change to another carrier’s Plan F or C, depending on which plan they have currently. Provided they can medically qualify, up until 2020.

The last plan that was retired was the Plan J. The difference is when Plan J was retired, Medicare Beneficiaries were allowed a special enrollment period to change to the Plan F with no medical underwriting. This is not the case this time around.

If you want to know more about the elimination of Plans F or C, click here.

History has shown that members that elect to stay on retired plans will be subject to larger than usual rate increases. It may not occur right away but as people that are healthy leave those plans to more cost-effective alternatives and people that cannot medically change pass on, there are less people in the pool of that plan. In order to keep up with the increased claims of sicker people, the prices must increase more dramatically to cover the claims.

 

 

 

 

 

 

 

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What to do with the elimination of Medigap Plans C & F
Medigap

What to do with the elimination of Medigap Plans C & F

by Jagger Esch
written by Jagger Esch

For decades Medicare Supplement Plan F has been a top seller; it covers all the gaps in Medicare and leave beneficiaries with a $0 bill. With predictable healthcare costs, financial planning is easier. What to do with the elimination of Medigap Plans C & F
Plan C, like Plan F, is a very comprehensive plan. The only thing it doesn’t cover is the Part B Excess Charges. Plan C is not the same as Part C. Plan C is a Medicare Supplement plan and does not cover prescription drugs.

Why Plan C & F are Being Eliminated

Congress, wanting to cut spending, decided that by no longer allowing companies to cover the part B deductible, medical overuse could be prevented. Plan C & F are the only plans that cover the part B deductible. For 2018, the annual part B deductible is $183.
Cutting spending is not the only reason these plans are being phased out. The big issue Congress has been trying to avoid was, how to get doctors better paid for their Medicare services in the next few years. If the deductible is paid by the beneficiaries instead of the insurance companies, the doctors can be better paid.
Doctors that are not adequately paid are not going to want to work in the Medicare program, as you can imagine. Many health care providers made threats to quit the Medicare program if they were paid any less.
Congress created the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and signed it into legislation on April 16, 2015.
This bipartisan legislation created the Quality Payment Program which does several things:

  • Repeals the Sustainable Growth Rate
  • Changes how Medicare rewards clinicians for value instead of volume.
  • Arranges quality programs under the Merit Based Incentive Payments System.
  • Gives bonus’ for use of eligible alternative payment models.
  • MACRA is also requiring CMS to remove Social Security Numbers from all Medicare cards by April 2019.
  • Medicare Premiums for higher income individuals will also be increasing.

If you are going to be impacted by these changes, you have plenty of time to plan now to minimize any financial impact ahead.
This new legislation enacted by Congress should get doctors the fair payment they want for their Medicare services. The only difference is Plan F and C will be phased out and new enrollees will be responsible for the Part B deductible on Plan D or G.
Plan G is one of the top plans available to Medicare Beneficiaries. The savings usually makes it the most affordable plan for enrollees, depending on the state and enrollment type. The annual part B deductible is only $183, and sometimes a Plan F premium will be $200 more than a Plan G. Making plan G the more sensible plan anyways.
I don’t know if this is really going to cut the annual expenditure of Medicare, arguments on both sides of the spectrum have been given. nce 2020 comes we can all discover the real outcome.
If the beneficiaries are not experiencing higher than usual costs and doctors are paid fair compensation, then Congress found a great quid pro quo solution. If it doesn’t work in raising the pay for doctors, hopefully we will see more creative solutions.

MACRA and How It Impacts Providers

MACRA implements values-based initiatives aimed at improving care and access for Medicare and CHIP beneficiaries. The Quality Payment Program aims to transition the healthcare industry from fee-for-service to value-based care.
This means Medicare physicians, physician assistants, and nurses must participate in either a Merit-based Incentive Payment System (MIPs) or in Alternative Payment Models (APMs). The clinicians’ performance score will determine payment adjustment in later years. CMS will determine a positive, neutral or negative payment threshold.

Current Medicare Beneficiaries

If you are already enrolled in a Medicare Plan F or Plan C you should be “grandfathered” in to your plan and can keep your plan if you would like.
Some people are worried that the rates for Plan F and C will increase substantially, like in 2010 when plans H, I, and J were discontinued. The discontinuation of Plan F will be different in each state, some beneficiaries will still be able to change to other Plan F carriers in the future.
The states that follow the birthday rule or similar rule which lets them change Medicare Supplement companies during certain times of the year without going through any underwriting. This is the regulation in California, Connecticut, Missouri, New York and Oregon.
Only one Idaho has enacted legislation to be sure premium increases won’t affect Plan F beneficiaries specifically. The Idaho Department of insurance received misleading information from agents, telling people to switch plans now to avoid potential rate increases. Idaho Rule 18.01.54 protects Plan F policy holders from seeing a higher premium increase than other letter plan policy holders.

New to Medicare Enrollees

Congress believes that by implementing a mandatory deductible should make people think twice about visiting a doctor for a minor issue. Ideally this will mean fewer doctor visits, and lower Medicare spending.
Critics argue that by eliminating Plan F some people may choose to forego care altogether, resulting in even higher expenses later. If health conditions are not diagnosed early enough, Medicare could end up paying the price later.
The good news for Medicare beneficiaries is that the Part B deductible is not one of the biggest health care costs under Medicare. The Part B deductible for 2018 is only $183 for the year.
The Part A deductible is more than seven times the amount of the Part B deductible. In 2018 the Part A deductible costs $1,340 for each benefit period. Almost all standardized Medicare Supplement plans available in many of the states still cover at least 50% of the Medicare Part A deductible. Medicare Supplement Plan A is the exception, it does not cover the Part A deductible
For those new to Medicare, there are plans that are comprehensive and affordable; Plan G is one of them. You will be able to enroll in a plan G when you first become eligible for Medicare Part A and Part B.
Plan G covers everything Plan F covers, except for the Part B deductible. The doctor flexibility and $0 copayments give beneficiaries on this plan excellent coverage.
Plan N is another good option that is not getting discontinued. It is recommended that Medicare beneficiaries talk with an insurance agent about the plan that will be best suited for your individual healthcare and financial needs.

Things to Consider

The opponents of the legislation pointed out one brilliant thing; If someone has the money to purchase high-dollar coverage, they should be able to have that coverage. In theory, requiring beneficiaries to pay the Part B deductible should deter people from going to the doctor for minor problems.
Congress makes changes to the regulations on Medicare plans every so often. In 1990 they first made insurance companies standardized plan options for Medicare beneficiaries.
Then, in 2010 they removed some of the plan options like E, H I and J. The plans H, I and J were including prescription drug coverage; by eliminating that coverage option, congress was able to cut Medicare spending.
Congress can’t solve the Medicare-financing problem by borrowing funds. Debt in the Government is just a promise to raise taxes in the future. Younger workers will face massive tax increases if Congress does not cut Medicare spending.
With millions of people being affected by this change, at least Congress has given Medicare beneficiaries plenty of time to prepare. Legislation will always be changing and 2020 is still a few years away. What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F

What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F What to do with the elimination of Medigap Plans C & F

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