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Medicare Plans

Are You Ready for Medicare Open Enrollment?

by Carol Marak
written by Carol Marak

It’s Medicare open enrollment period starting October 15 and through December 7, 2019. Your chance to change coverage (Medicare plans) if you want.

Medicare Part C plans, known as Medicare Advantage plans are private health insurance plans, mainly HMOs and PPOs, for people enrolled in Medicare. If you enroll in a Medicare Advantage plan, you still have Medicare, but you get all of your Medicare-covered benefits through a private plan.

Most Medicare Advantage plans also cover prescription drugs and may cover other services, like vision, dental, and hearing. If you have Part A and Part B and are covered under the Original Medicare program, then you do not need to sign up for a Medicare Advantage plan during Open Enrollment unless you want to get your Medicare benefits through a private plan.

Medicare Advantage plans restrict the health care providers that enrollees see (provider networks) whereas beneficiaries in the Original Medicare may see any doctor that accepts Medicare, without needing prior authorization or a referral from their primary care doctor.

Start Your Research

Now is the time to research and make preliminary calls to get an idea of what changes (if any) need to be made to your Medicare coverage. Gathering information now will prevent you from making knee-jerk decisions at the end of enrollment. Here are six steps to take:

  • Become familiar with each part of Medicare, Part A, Part B, Part C, and Part D. This glossary explains terms in the Medicare program, https://www.medicare.gov/glossary/.
  • If you have a Medicare Advantage Plan (Part C), are you happy with it? Be sure to read all mail from the carrier which arrives in September and October. Look for any changes to monthly premiums, deductibles, copays and provider groups.
  • If you have a Medicare Supplemental Insurance policy (Medigap), check for any changes or monthly premium increases. Some beneficiaries switch from Medigap to a Part C (Medicare Advantage Plan) at this time of year.
  • If you’ve spent a lot of money out-of-pocket on hospital visits and doctor’s appointments because you don’t have a Supplemental insurance plan or Medicare Advantage Plan, add up expenses to know if a more coverage would help save money. Or check with Medicaid, a state Medicare Savings Program, the “Extra Help” program, or the local State Health Insurance Assistance Program (SHIP).
  • Get up-to-date information on your health status. Is your annual visit with the primary care physician coming up? Will you need to see a specialist? Make a list of all your prescription medications. If any are brand name, ask the pharmacist if there are generic equivalent. If not, ask your insurance plan Part C or Part D for an exception if the expensive brand-name medication isn’t part of the drug formulary.
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Medicare Plans

Difference between Medigap Plans and Medicare Advantage

by Jagger Esch
written by Jagger Esch

When it comes to insurance, it would be fair to say you either pay now or pay later. If you pay now, you are choosing to pay a higher premium with the expectation your insurance plan will pay more when you file a claim. The pay later option means a lower monthly premium and leaves the Medicare Beneficiary with a greater out of pocket expense when seeking medical treatment. Difference between Medigap Plans and Medicare Advantage
There are several reasons to choose a Medigap Plan over Medicare Advantage Plans. The comprehensive benefits provided by a Medigap, as known as Supplement Plans can limit or eliminate out of pocket costs. Individuals covered by a Medigap Plan avoid network restrictions and have coverage worldwide. Most importantly, Medicare Supplement Plans allow the insured to budget the cost of their coverage and reduce unexpected expenses.

Medicare Part A

For 2018, the Medicare Part A deductible is $1340, then the plan pays 100% of hospital expenses for that benefit period. The benefit period lasts 60 days from the start of the hospital visit. If your hospital stay lasts longer than 60 days, you will incur a per day coinsurance.
The Medicare Beneficiary is responsible for that daily coinsurance. After 60 days, or in the event of an unrelated condition, if the Medicare Beneficiary is admitted to the hospital, a new benefit period starts, and the $1340 deductible is applicable, again. This can continue throughout the policy year.

Medicare Part B

Medicare Part B covers preventive services and medically necessary services such as doctor visits, durable medical equipment, diabetic supplies, and drugs administered in a doctor’s office.
The Medicare Part B deductible is $183 for the 2018 year, after the deductible is satisfied, Medicare pays 80%.

Gaps in Coverage

As you can tell, Original Medicare leaves gaps in coverage. There are gaps in Part A and gaps in Part B. Original Medicare does not have any out of pocket maximums or provide any caps to minimize the loss incurred by the Medicare Beneficiary. Your exposure to loss is undefined; there is nothing to protect the Insured person from financial losses.

Take into account that it cost about $5,000 to go to the emergency room. That’s without being admitted and without a gamut of tests. The gaps in coverage left by Original Medicare can be filled quickly and affordably by enrolling in a plan offered by any reputable insurance provider.

Medigap Plans Protect

Medigap plans do have a premium that is in addition to your Medicare Part A and Part B. The premium amount for your Medigap Plan is paid by the Medicare Beneficiary directly to the Insurance Company.

With a Medigap plan, you choose the amount of risk you are willing to take, the premium is reflected in the amount of benefits you elect. Regardless of the underwriting company (the name on the card you carry), the benefits are the same and are differentiated by letters.

Most people choose Plan G. Medigap Plan G, covers everything not covered by Medicare except for the $183 Part B deductible. The Plan F, provides the most protection to the Medicare Beneficiary, and minimizes the medical costs that could be incurred.

Of course, you can save on premium dollars if you are willing to consider some of the other plans. This is where your licensed insurance agent can help, by shedding some light on the various options that will provide the most coverage and still keep the premium within your budget.

Medigap Offers Freedom

You’re free to choose your doctors and hospitals. These plans allow Medicare Beneficiaries to select doctor’s based on their personal preference, in addition to choosing the hospitals they utilize. The only requirement, is that the provider accept Medicare.

The freedom offered by being insured can be liberating. Just ask someone who has been limited to a list of doctor’s or had a claim from a specialty hospital denied. Treatment of medical conditions/ diseases can be determined by the patient and doctor.

The Disadvantages of a Medicare Advantage Plan

Medicare Advantage Plans require the Medicare Beneficiary to use network doctors and hospitals. With most advantage plans, going out of network isn’t an option as there are no out of network benefits. Most have network restrictions and seeing a specialist will require a visit to your primary doctor to obtain a referral.

There are only specific periods during the year when you can enroll or switch to another Medicare Advantage Plan. Otherwise, you can’t change your Plans during the year.
The premium on a Medicare Advantage Plan can be low or even zero. However, the Medicare Beneficiary will incur expenses over the course of the policy year, including deductibles, copayments and coinsurance. Typically, Medicare Advantage Plans have an out of pocket maximum of at least $6,000.

You Get What You Pay For

Medigap Policies are the best choice for securing the most comprehensive coverage. You keep your Original Medicare Parts A and B. Then choose the Medigap Plan that best fits your needs and fills the gaps in coverage left by Medicare. A qualified licensed insurance agent can help you compare the costs and benefits of your options. When comparing your choices, it will become apparent which option will best suit your needs and budget.

Medicare Beneficiaries choose supplement plans for several reasons. Most people buy a Supplement Plan because they want to protect their assets. After more than 40 years in the workforce, it’s prudent to protect that which you have worked so hard to earn.
Others select a Medigap Plan for the freedom to choose their caregivers, hospital and doctors.

Medigap Policies provide coverage at any doctor or facility that accepts Medicare. In addition, these Supplement Plans provide coverage when you travel outside the United States.

When choosing a plan to fill the gaps left by Medicare, Medicare Beneficiaries are electing to purchase one of the Medigap Plan options. These plans offer a set monthly premium amount that Medicare Beneficiaries can work into their fixed income.

A set monthly premium works best for Medicare Beneficiaries as the unexpected out of pocket costs associated with a Medicare Advantage Plans leaves the insured person financially vulnerable.

There are several options available and the best way to shop around for the plan that meets your needs is to contact a qualified licensed agent. Your agent will ask you some questions to better understand your concerns and budget.

Once your agent understands your specific needs, he/ she will be able to check with the carriers in your region to advise which companies offer the best premium amounts for the coverage you’ve elected.

Enrollment into a supplement plan is best when you are first eligible for Medicare Part B. However, if you have delayed enrolling in Part B, because of coverage through your (or your spouse’s) group health insurance plan with an employer, you may be able to enroll in Part B and your Medigap Plan when that coverage ends. You will want to take action prior to the group plans termination day. It’s a good idea to contact your insurance agent as soon as you suspect any changes to your coverage.

Difference between Medigap Plans and Medicare Advantage

Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage

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Guide to Choosing a Part D Prescription Drug Plan
Prescription Programs

Guide to Choosing a Part D Prescription Drug Plan

by Garrett Ball
written by Garrett Ball

With the arrival of the Medicare annual election period, now is the time to compare your Part D plan to make sure you have the best “deal” for 2018. Guide to Choosing a Part D Prescription Drug Plan
First of all, it is important to understand that, each year, the Medicare Part D prescription drug plans have the ability to change their benefit structures, including premiums, deductibles, co-pays, networks and formularies. This means that keeping the “status quo” from year-to-year carries with it some definite risk. It is advisable to re-evaluate your Part D selection annually to ensure you have the plan that most closely fits your needs. Guide to Choosing a Part D Prescription Drug Plan

What is Part D?

Part D is the part of Medicare that covers prescription drugs. It is, technically, a “part” of Medicare; however, Part D plans are sold through private insurance companies. CMS, the Centers for Medicare and Medicaid Services, has oversight over Part D plans and approves them on an annual basis.
Each Part D provider decides how they are going to structure their plans. They may choose to have a higher premium and lower co-pays or vice versa, for example. They must meet Medicare’s minimum standards for what drugs they cover, but within those standards, they have flexibility in designing a formulary (list of covered drugs) and co-pay structure.
In early October of each year, the Part D plans for the following year are released. Around that same time, you should receive a notice in the mail from your current Part D provider, showing how the plan’s coverage and premium is changing for the next calendar year. This is the time that you should compare Part D plans. Guide to Choosing a Part D Prescription Drug Plan

How to Compare Part D Plans

Comparing Part D plans is actually relatively easy to do if you have some computer savvy. It can all be done on Medicare’s website, www.Medicare.gov. To compare the plans, you can use the “Medicare Plan Finder”. It can be a little difficult to use if you have not used it before – this step-by-step guide to comparing Part D plans on Medicare.gov may be helpful.
Another alternative to comparing the Part D plans on Medicare.gov is asking your local pharmacy, or pharmacist, for help. Many pharmacies now offer this service to their customers. They already have a list of your medications, so they can plug those in to the “Medicare Plan Finder” and make a recommendation that way.
The way the plan finder works is that it ranks the plans in order of lowest overall annual cost to you. It takes into account the drug plan premium, the deductible and the co-pays on each plan. This way, the results are customized to your specific medications and situation, and you can make an informed choice. Guide to Choosing a Part D Prescription Drug Plan

How to Change Your Part D Plan

Once you have done the Part D comparison, you may find that you should just stay with the same plan. If this is the case, you do not need to take any action, as the plans renew automatically if you make not changes.
If, however, you see that you should choose a different plan that would cover your medications more thoroughly or give you a lower overall annual cost, you can do so easily.
One option for changing your Part D plan is to do it directly on Medicare’s website. Changes can be made between October 15 and December 7 of each calendar year.
The other alternative for changing your Part D plan is to contact the new plan directly, either online or by phone, and enroll in the plan of your choice.
Any time you change Part D plans, Medicare automatically takes you out of the old plan when they approve your enrollment into the new plan. In other words, you do not have to proactively cancel the old plan – it happens automatically when you are enrolled into the new plan. All plan changes take effect on January 1, as the plans run with the calendar year.
Overall, comparing Part D plans annually is a crucial part of a sound financial plan for someone on Medicare. You should take the time to compare and make any needed changes for next year during this annual election period. Guide to Choosing a Part D Prescription Drug Plan

Guide to Choosing a Part D Prescription Drug Plan

Guide to Choosing a Part D Prescription Drug Plan Guide to Choosing a Part D Prescription Drug Plan Guide to Choosing a Part D Prescription Drug Plan

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Understanding Medicare through Supplemental Insurance
Medicare Plans

Understanding Medicare through Supplemental Insurance

by Jeff Dailey
written by Jeff Dailey

Americans don’t celebrate it as a holiday, but July 30 is an important historical date in the United States. It was on this day in 1965 that President Lyndon Johnson signed Medicare into law, introducing a national health insurance program for citizens aged 65 and older. Understanding Medicare through Supplemental Insurance
In its first year of availability, more than 19 million Americans enrolled in the program. Medicare has since expanded to include individuals who are permanently disabled and those who suffer from kidney failure. This year the number of enrollees is expected to reach 57 million, according to the Centers for Medicare and Medicaid Services (CMS). As the Baby Boomer generation continues to leave the workforce, that number will continue to increase. In fact, Becker’s Hospital Review projects that 19.1 million more people will enroll in the program over the next 11 years. Understanding Medicare through Supplemental Insurance
That’s why it’s important for people approaching retirement to consider Medicare Supplement insurance. A Medicare Supplement policy can help patients cover some of the costs related to medical treatment that aren’t paid by Medicare. Understanding Medicare through Supplemental Insurance
But, before investing in Medicare Supplement insurance, consumers have to do their homework. They should review the 2016 Medicare and You guide published by CMS to find the latest updates to the Medicare program, and also research insurance companies. Not all companies are the same, and there are five things that people should consider before they decide which company to go with:

Insurance Company Ranking

There are many insurance companies that sell Medicare Supplement insurance in the United States today. Fortunately, there are third party organizations like Standard & Poor’s and A.M. Best that rate these insurance organizations for financial strength. These ratings are important to consider when choosing your coverage, as they rate an insurance company’s credit worthiness and its ability to pay its claims.

Experienced agents Understanding Medicare through Supplemental Insurance

When buying Medicare Supplement insurance, be sure to work with an agent who is knowledgeable and experienced in selling the ten standardized Medicare supplement plans.
Medicare is a complicated topic and consumers have so many other issues to think about after retiring from a lifetime of work that working with an agent has its advantages.
The majority of insurance companies will educate and provide training to their agents to ensure that they know the product and insurance laws before they allow them to sell. These insurance companies make sure that their agents stay updated on the annual changes the government makes to the Medicare program, which helps them to work with customers to find the insurance policy(ies) that is right for them.

Pre-existing conditions

Not all Medicare Supplemental insurance programs cover pre-existing conditions. Before reading through a policy, a number of seniors sign up for insurance, only to realize later that they aren’t covered for a second heart attack, or for hospital stays due to recurring back problems during the preexisting condition limitation period.
All companies that sell Medicare Supplement policies cover all pre-existing conditions during an insured’s open enrollment period, which is six months from their Medicare Part B effective date—so start researching your options right away and be sure to connect with a knowledgeable sales person well within those first 180 days. But, some will issue the policy beyond the open enrollment period with a pre-existing condition clause attached. If you are like most consumers, and don’t want to worry about what might not be covered at the time of a claim due to a pre-existing condition, then it is important to choose a company that does not issue policies with pre-existing clauses.

Multiple plan options

Medicare Supplement insurance isn’t a one-size-fits-all solution. There are four parts to Medicare:
Understanding Medicare through Supplemental Insurance
• Part A, covering in-hospital care
• Part B covering medical services and preventative care
• Part C, Medicare Advantage which is a combination of the first two
• Part D, medical prescriptions
There are 10 standardized Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N). Find a provider that can talk with you about what plans they offer in your state, and who can talk you through what will work best for your specific situation.

Customer’s Choice Understanding Medicare through Supplemental

Technology has changed the way the business of insurance is done. Today’s seniors are more tech savvy than previous generations, with Pew Research data showing that 61 percent of people over the age of 65 go online. Seniors expect and want to buy insurance the way they want to buy it – whether it’s purchasing online, over the phone, or face-to-face. When researching insurance companies, find one that will work with you the way you want. Understanding Medicare through Supplemental Insurance
Millions of Americans are helped by the Medicare program each year, but supplemental insurance plays a critical role in helping policyholders to cover expenses they would otherwise have to pay. You worked your whole life to be in a position to enjoy your retirement. Don’t let the exorbitant medical expenses from an unexpected injury or illness prevents you from doing that. Research how supplemental insurance can help you, and find an informed agent who can help you select coverage that is right for you. Understanding Medicare through Supplemental Insurance
By Kevin Murray and John Fauzey, Combined Insurance
Kevin Murray is Vice President, Combined Affinity Markets and John Fauzey is VP, Director of Senior Sales at Combined Insurance. Understanding Medicare through Supplemental Insurance
 

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