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Should You Still Enroll in Medicare Supplement Plan F?
Medicare Plans

Should You Still Enroll in Medicare Supplement Plan F?

by Kimberly Johnson
written by Kimberly Johnson
For years, conventional wisdom in senior insurance said that if you were going to purchase a Medicare Supplement plan, Medigap plan F was the way to go. But is purchasing Plan F now a smart move considering it will no longer be issued to new enrollees as of 2020? Should You Still Enroll in Medicare Supplement Plan F?

What is Medigap?

Medigap is actually a nickname for all of the lettered Medicare Supplement plans. They are designed to pay some or all of the fees not covered under Original Medicare. Medigap pays the fees or “gaps” that Original Medicare typically requires you to pay out of pocket, such as copays, coinsurance and deductibles. These costs can really add up. Should You Still Enroll in Medicare Supplement Plan F?

Difference between Medicare Plan F and G:

Each lettered Medigap plan is designed to pay for different gaps in coverage. Plan F is considered the gold standard because it offers everything that Medigap is legally allowed to cover at a historically great price. Plan G, America’s second most popular plan, covers everything that F does except for the Part B deductible which currently is $183.
There is some speculation that Plan F’s monthly premium will increase after 2020 if new younger members are no longer allowed to enroll. Since no one knows what will take place in the future, how do you choose between the two?
We suggest starting with the current price. Many insurance companies now offer Plan G at such a great price that you can save hundreds of dollars annually over plan F. If you can find a plan G that saves you more than $183 a year over F today, it’s most likely a smart move to go with it now.
If you are unable to find a competitively priced plan G, then go with Medigap plan F. You don’t want to overpay for G just because we are unsure about the future of plan F prices.
One final note: Not all Medigap plan prices are posted online, so check with a licensed insurance agent before you pull the trigger on Medigap to make sure you have the best-priced plan in your area.
About the Author: Amy De Vore
Amy is a licensed independent agent. Senior65 is dedicated to helping seniors understand Medicare and enroll in appropriate senior insurance health plans. Should You Still Enroll in Medicare Supplement Plan F?

Should You Still Enroll in Medicare Supplement Plan F?

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Do All Doctors Accept Medigap
Medigap

Do All Doctors Accept Medigap

by Garrett Ball
written by Garrett Ball

If you are turning 65 and comparing Medicare Supplement or Medigap plans, you will probably ask “do all doctors accept Medigap plans?“. This is one of the most common questions for people turning 65 – it can seem complex, but the answer is actually very straight-forward. Do All Doctors Accept Medigap
Put simply, when it comes to accepting Medigap plans, it all depends on if your doctor accepts Medicare itself. Medigap plans “follow” Medicare. So, if a doctor or hospital takes Medicare, they will accept your Medigap plan. It does not matter which company or plan you have since Medigap plans themselves do NOT have networks. Do All Doctors Accept Medigap
If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
This is not the case, obviously, with many other types of insurance which rely heavily on network arrangements to determine which doctors you can/can not see. For example, under-65 individual plans, group plans, and Medicare Advantage plans all typically use a PPO or HMO network of providers.

What If My Doctor Does Not Accept Medicare Assignment?

There is a difference in accepting Medicare and accepting Medicare assignment. Medicare “assignment” is the terminology that essentially means whether or not a doctor accepts the Medicare payment as payment in full. Medicare has a pre-defined payment schedule for each service or procedure. This is the amount that they will pay to a provider for a certain service or procedure, and it is based on where you are located (varies by location).
Most providers DO accept Medicare assignment (most estimates show that around 95-96% of doctors do accept assignment nationally). This means they accept the terms and conditions (and amounts) on the Medicare payment schedule.
If a physician does not accept assignment, however, he or she can charge up to 15% above the Medicare payment schedule. This is called a “Part B Excess charge”. This is typically billed to you after the doctor visit. There are a few states that have prohibited the charging of these excess charges, including CT, MA, MN, NY, OH, PA, RI and VT (as of early 2017). In those states, doctors can not charge above the Medicare payment schedule if they are going to accept Medicare patients.
Even when doctors do charge excess charges, many of the standardized Medigap plans cover these Part B Excess charges, including Plans F and G. Plan N is the most common plan among the plans that do not cover Part B excess charges.

Why Won’t My Doctor Accept My Medicare Supplement Plan?

We often get this question in January and February of each year. Inevitably, what has happened is the person is in a Medicare Advantage plan that they are mistakenly calling a Medicare Supplement. The Advantage plans all have networks and are typically PPOs or HMOs. Those networks change each year – sometimes even in the middle of a year – and if your doctor is not in network with the specific plan you have, you may have to find a new doctor.
This is one of many reasons why it is crucial to understand the differences in Medigap plans and Medicare Advantage plans.

Do All Doctors Accept Medigap Plans: The Bottom Line

So in summary, do all doctors accept Medigap plans? The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare. Do All Doctors Accept Medigap
Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

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Medicare Plans

The Basics of Medicare & Choosing the Right Plan

by Jeff Dailey
written by Jeff Dailey

shutterstock_109645904 (1)When you reach 65, you face an important milestone: You are now eligible for Medicare.
Contrary to popular belief, Medicare is not free, and it’s important to understand the ins and outs of Medicare before you sign up. Making the wrong choices can be expensive.
Even if you’ve been on Medicare for years, you may want to re-evaluate your options annually to make sure you’ve got the right plan. The annual open enrollment period, during which you can switch Medicare plans, runs Oct. 15 through Dec. 7.
“I think everyone should consider switching,” says Lita Epstein, author of “The Complete Idiot’s Guide to Social Security and Medicare.” “Plans change, benefits change, and the premiums change.”
It’s especially important to re-evaluate your options if you have a Medicare Part D drug plan or a Medicare Advantage plan because those plans can change significantly from year to year, dropping and adding drugs and doctors or changing copays and deductibles. “Even if they’re completely happy with their plan, they have to look because things change,” says Diane J. Omdahl, founder and Medicare expert at 65 Incorporated, which helps people choose Medicare coverage.
Medicare plans are actually broken into multiple parts:

  • Part A covers hospital care, skilled nursing, hospice and some home health care. If you or your spouse has at least 10 years of Social Security work history, this part is free. If you don’t have that work history, it can be up to $407 per month. Your premium amount is determined by how many Social Security work credits you have.
  • Part B covers doctor visits, preventive care, outpatient care and hospitals and some home health care. In 2015, this part cost $104.90 a month for Medicare beneficiaries whose incomes are $85,000 a year or less ($170,000 for a couple) and up to $335.70 for those whose annual income exceeds $214,000.
  • Part C is also known as a Medicare Advantage plan. It substitutes for parts A and B and, in most cases, Part D, the drug plan. Premiums range from $0 to more than $100 a month, varying by location and coverage. According to the Centers for Medicare & Medicaid Services, the average premium in 2016 will be $32.60.
  • Part D covers prescription drugs. Premiums are about $15 to $50 per month.

The first big decision Medicare beneficiaries must make is whether to go with traditional Medicare (parts A, B and D) or a Medicare Advantage plan (Part C). Medicare Advantage plans have lower premiums, but they usually require members to get their care only from network doctors and hospitals. Both options have deductibles, copays and co-insurance, where you pay a percentage of the bill.
“They look at their lives, they look at their health, they look at their pocketbooks, and they chose the parts they want,” Omdahl says.
Those who choose traditional Medicare usually add a Medigap policy, which is a supplemental policy that covers what Medicare doesn’t. There are 10 types of Medigap policies, offered by private insurers or via groups such as AARP, and costs vary considerably, based on gender, age, health, whether you smoke, location and company. Weiss Ratings found the national average for Plan F, the most popular option, was $162 to $5,674 annually.
“You can go through your life with just A and B, but the out-of-pocket costs will get you,” Omdahl says. The reason is Medicare lacks a maximum for out-of-pocket costs. But with a Medigap policy, most of those costs are covered.
About 32 percent of Americans are expected to choose Medicare Advantage plans next year, according to the CMS. Those plans, a combination of HMOs and PPOs, have an out-of-pocket limit. But customers tend to pay more in copays and co-insurance than they do with traditional Medicare, plus have access to fewer doctors and hospitals. Some of the plans include vision, dental and hearing coverage, which is not covered by traditional Medicare, but those services are offered from a limited network of providers.
“If you’re healthy and you’re younger … it can be cheaper,” Epstein says. “If you absolutely can’t afford to take a Medigap supplement, a Medicare Advantage plan is going to be the best option.”
Her advice to those who can afford it, however, is to choose traditional Medicare with a supplement because that option offers greater access to top specialists and doesn’t require the insurance company to approve specific treatments. “Managed health care is going to be managed by the insurance company,” she says.
“It’s very, very important that you look at those copays and compare them,” Epstein says. “By the time you figure in one hospitalization, it’s about the same,” she says of the total cost of traditional Medicare and Medicare Advantage plans.
No matter what your retirement age, you become eligible for Medicare when you turn 65 and you can sign up the three months before your birthday, your birth month and the three months after. If you don’t sign up during this seven-month period, even if you’re still working, you may face a long-term penalty. “They cannot wait until the last minute because of the backlog at Social Security,” Omdahl says.
If you start with traditional Medicare and a Medigap supplement, your supplement rate is not based on your health record. But if you start with a Medicare Advantage plan and then switch to traditional Medicare later, the company offering the supplemental coverage will base your premium on your health history and may even deny coverage. “It’s a real risk because everybody’s going to get something as they get older,” Epstein says.
Americans who are very low income may be eligible for extra help with Medicare premiums and health care costs. Beneficiaries in this financial situation can find additional guidance from Medicare.gov.
The system is complex, and most people should seek help when choosing a plan. There is lots of information at Medicare.gov, at AARP.org and on the Consumer Reports website. If you’re considering several Medicare Advantage plans, call the company that offers each one to verify that the coverage is what you think it is.
You can find ratings of Medicare Advantage plans from the National Committee for Quality Assurance. You can also get phone or in-person help from your State Health Insurance Assistance Programs. Those agencies often maintain office hours at senior centers or other locations.
By Teresa Mears of US News & World Report

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5 Programs that Lower Medicare Costs
Medicare Plans

5 Programs that Lower Medicare Costs

by Kimberly Johnson
written by Kimberly Johnson

5 Programs that Lower Medicare Costs

Even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. There are five federal programs that lower your costs for care even if you do not qualify for Medicaid: 5 Programs that Lower Medicare Costs
  1. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.
  2. Medicare Savings Programs: Depending on your income, these programs help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, vary somewhat by state. You should apply through your local Medicaid office.
  3. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, which pays for some or all of the cost of your drug coverage, so long as your income is under $1471 (individual) or $1991 (couple) and your assets are below $13,070 (individual) or $26,120 (couple). You get this automatically if you have Medicaid or a Medicare Savings Program. Some states have State Pharmaceutical Assistance Programsthat provide even more assistance.
  4. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and serve underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
  5. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. For information on Medicaid, click here. To learn more about these programs, free local resources, and other programs that could help, contact your State Health Insurance Program. To contact your state Medicaid office, click here.

Written by Diane Archer
Huffington Post

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Understanding Medicare through Supplemental Insurance
Medicare Plans

Fewer Doctors Taking Medicare Patients

by Jeff Dailey
written by Jeff Dailey

Fewer Doctors Taking Medicare Patients

 

Fewer Doctors Taking Medicare patientsIn a recent discussion with one of my doctors, he and I spent a few minutes discussing the ongoing changes and challenges facing physicians who practice medicine today, and more importantly the impact on new doctors just starting to practice. Fewer Doctors Taking Medicare patients

Many of today’s doctors leave medical school with a great deal of debt accrued during the pursuit of a medical degree, and few new graduates can afford to go into a sole private practice. A majority of recent graduates join a group or a hospital to avoid the costs of office rent, equipment purchases, liability insurance, staff costs and the monthly expenses involved in opening a new business.

Medicine used to be a patient-centered and was often a very lucrative career. But with hundreds of government regulations, and new reporting requirements increasing virtually geometrically in the past decade plus the impact of reduced reimbursements from private insurance and Medicare, it’s a whole new world of medicine.

Here’s one of the unintended consequences that has made the practice of medicine not only less enjoyable for many doctors, but will affect a number of boomers. While it might not impact everyone now turning 65 and becoming eligible for Medicare, it will add some challenges to doing so for some.

If you don’t already have a primary physician or might require a specialist, you may be surprised to learn when seeking a doctor, that a growing number won’t expand the current size of their current practice with new Medicare patients. So while you may soon be eligible for Medicare, you might struggle to find a doctor who will accept new Medicare patients.

The Kaiser Family Foundation conducted a research survey and found that 21 percent, or about one in five, physicians are not accepting new Medicare patients and 14 percent are not willing to take privately insured patients. Some physicians may or may not accept traditional Medicare patients that provide payments to those doctors based upon a fee schedule dictated by the government. Other physicians may not be willing to accept Medicare Advantage plans where paid fees are negotiated with private insurers, plans like the AARP United HealthCare, Humana and Blue Cross/Shield “Advantage” plans.

What this means to those of us that live in western North Carolina is that it might be a very good idea to make sure that your current physician, if you have one, will continue to see you when you become a Medicare patient and will accept the Medicare plan you choose. Not all doctors will accept all plans, especially certain Medicare Advantage plans.

If you’re going to become eligible for Medicare in the coming months, get in front of this potential problem. By doing that you’ll know that the doctor you have or choose will accept the plan you wish to select or help guide you in the selection of a plan that includes him or her.

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of Caring for a Loved One with Alzheimer’s Disease, available as a Kindle book on Amazon.com. His podcasts can be heard weekly at www.seniorlifestyles.net.

 

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Health Insurance

5 Things to Consider When Comparing Health Insurance Plans

by Kimberly Johnson
written by Kimberly Johnson

shutterstock_157876310Whether you’re in good health naturally or you rely on medication and specialists to stay that way, finding the right health insurance plan is key—and you could pay a penalty if you don’t have it. 5 Things to Consider When Comparing Health Insurance Plans
If you’re self-employed, your employer doesn’t offer health insurance, or even if you simply think you might be better off on a different plan than what your employer offers, you may find yourself buying individual health insurance. While shopping for your own health insurance may seem daunting, breaking down the plans can help you make a more informed decision.
“People need to be careful when comparing plans,” says Joel Cantor, director of the Center for State Health Policy at Rutgers University. “People tend to make the mistake of looking at the premium only and not cost-sharing. It’s a little more of a complicated calculation.”
Some individual plans may leave more money in your pocket than others, even though at first blush they may not look that way.
For example, if your employer does not offer health care coverage, you may qualify for tax credits and other subsidies in an individual plan, making your costs lower. Though less likely, you may be at an age and state of health where you can buy an individual plan that is less expensive than the one your employer offers.
If you are employed you are likely paying only 15 to 20 percent of the premium, says Paul Fronstin, director, health research and education program at Employee Benefit Research Institute in Washington, D.C.
“Premiums in the non-group [individual] market are age rated, and the younger you are, the lower the cost. But it still might be more than your work,” Fronstin says.
For those with health concerns, some individual plans may also offer more value than others, or even more than an employer-offered plan. These may allow you to find the right network, specialists, and prescription coverage for your needs.
Bear in mind, however, that you have to be on your toes when it comes to finding a healthcare plan that will really offer valuable savings, because plans and their costs change frequently.
The Kaiser Family Foundation, a health policy nonprofit, released an analysis in June 2015, projecting changes to premiums in the individual marketplace in 2016. The report found the most popular individual plans are increasing on average 4.4 percent from 2015 to 2016, which they said is moderate but a bigger jump in price from the previous year. The report stresses the value in shopping at each open enrollment period, as premiums fluctuate.
Open enrollment for 2016 begins Nov. 1, 2015 and extends to Jan. 31, 2016. It’s always worth considering all options, especially where your health and budget are concerned. Here are some things to consider when evaluating the pros and cons.

  1. Your medical needs: Make a list of any doctors, specialists, prescriptions, or other services you require to maintain your health or to prevent health issues.
  2. Your budget: Figure out how your budget will allow you to spend on health insurance and health care each month.
  3. Premiums + network + cost sharing: Check the premiums, network, and cost-sharing specifics of each plan. Cost sharing includes deductibles, co-pays, and coinsurance. Compare not only the premiums, but also whether all your anticipated medical costs are covered in-network or if you will have to pay for out-of-network to see your preferred doctors. Evaluate all of these costs to determine if there is a better savings (monetary) or value (more affordable access to your required specialists and prescriptions) in one plan vs. the other.
  4. State vs. federal coverage: Keep in mind that in most states, individual coverage is federally managed, while in a handful of others, it’s managed at the state level or some kind of hybrid between the two. If applicable, evaluate any benefits in your state’s coverage. For example, some coverage that may vary includes birth control, breastfeeding, dental and vision.
  5. Tax credits and other savings qualifications: Determine whether you qualify for tax credits and other savings offered in the state marketplace. This will be an important factor in determining whether an individual plan makes more sense for you, cost-wise. According to Healthcare.gov, your employer can tell you if its plan meets the standards of the Affordable Care Act, thereby disqualifying you from any savings on the individual plan.

Beth Shea Palmer is a reporter and editor based in Chicago.
Written by Equifax Reporter on September 17, 2015 in Insurance

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