Medicare Supplements, Filling Gaps Left Behind By Original Medicare
As you near your 65th birthday, you may notice information flooding your email and your mailbox regarding Medicare coverages. While understanding your options can be tricky, it’s important to understand your options and take some things into consideration before you miss your enrollment window.
In addition to your Medicare Part A and part B coverages, there are ten standardized Medicare Supplement plans. These plans may be available in most states and are offered by private insurance. Also known as Medigap plans, they are designed to work in conjunction with Medicare Part A and part B by covering out-of-pocket expenses for hospital and medical services.
Medicare Part A and Part B may sound the same as supplement insurance plans, but it’s important to remember that they are not the same as Medigap Plan A, Plan B, etc.
Each Medicare Supplement insurance plan provides a different level of basic benefits, but each lettered plan must include the same standardized basic benefits no matter which insurance company you choose and where you live. For example, Medicare Supplement Plan G in Florida offers the same basic benefits as Plan G in North Dakota. However, those that live in Massachusetts, Minnesota, or Wisconsin, have Medicare Supplement insurance plan options specific to those states and differ from the rest of the country.
Medicare Supplement insurance plans must include at least a portion of the following basic benefits:
• Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits are depleted
• Medicare Part A hospice care copayments or coinsurance
• Medicare Part B copayments or coinsurance
• First three pints of blood used in a medical procedure
• Some supplemental plans like Medicare Supplement F, the most comprehensive standardized Medigap insurance plan, carries the following additional benefits:
• Medicare Part A deductible
• Medicare Part B deductible
• Part B excess charges
• Part B preventive care coinsurance
• Skilled Nursing Facility (SNF) care coinsurance
• Foreign travel emergency care (80% of Medicare-approved costs, up to plan limits)
• Other plans may include some additional benefits.
Costs Associated Medicare Supplement Insurance
While private insurance companies have to offer the same basic benefits for each lettered plan, they do have the ability to charge different rates. It’s best to shop around for Medicare Supplement insurance quotes to find a plan that fits your medical needs and financial budget. Insurance companies may rate their plan premiums in any of the following ways:
Community no-age-rated: These types of Medicare Supplement insurance plans have pricing that is the same across the board, regardless of age.
Issue-age-rated: These plan rates are based on your age when you first enrolled in the policy. Meaning the younger you are when you enroll in this type of plan; the lower your premium will be.
Attained-age-rated: Similar to issue-age-rated, these plans base their premiums on the age you were when the policy was purchased, but unlike issue-age-rated, premiums increase as you get older.
Keep in mind, no matter what rating method an insurance company uses, premiums could go up over time for reasons other than age, such as inflation.
Enrollment and Eligibility for Medicare Supplement Insurance Plan
Eligibility for enrollment in a Medicare Supplement insurance plan requires you to be enrolled in both Medicare Part A and Part B. The ideal time to enroll in a plan is usually during the Medigap Open Enrollment Period. This window begins the first day of the month that you are both age 65 or older and enrolled in Part B and lasts for six months. It’s during this period you have a guaranteed issue right to join any Medicare Supplement insurance plan available where you live. This means you may not be denied basic benefits by an insurance company based on any pre-existing conditions during this enrollment period (a waiting period may apply). If you miss enrollment during this window or try to enroll at a later date, you may be denied basic benefits or charged a higher premium based on your medical history. Some states may allow you to enroll in a Medigap plan before the age of 65.
What Medicare Insurance Doesn’t Cover
While there are supplemental plans that offer comprehensive coverages, there are things that aren’t covered, and it’s essential that you know what those things are going into it. Medicare supplement policies often don’t include things like long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Insurance Plans that aren’t Medicare Supplements
Please keep in mind that all plans outside of Original Medicare are not supplemental plans. Some types of insurance aren’t Medigap plans, they include:
• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• Veterans’ benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plan
Deciding to Drop Your Medigap policy (not just the drug coverage)
You may decide that you want completely different Medigap policy (not only your old Medigap policy without the prescription drug coverage). Or, you might choose to switch to a Medicare Advantage Plan that offers prescription drug coverage. If you do decide to drop your entire Medigap policy, you must be careful about the timing. When you sign up for a new Medicare drug plan, you could pay a late enrollment penalty if either one of these situations applies:
• You drop your entire Medigap policy, and the drug coverage wasn’t creditable prescription drug coverage.
• You go 63 days or more in a row before your new Medicare drug coverage begins.
Blake Insurance Group offers a wide range of policies and services for residents living in Tucson. We believe in providing you with the best coverage possible. Understanding all the intricacies of Medicare Supplement plans can be tricky. We will be here every step of the way to help you understand your coverages and select the best plan for your situation. If you are interested in learning more about Medicare Supplement plans, call Blake Insurance Group today, 520-326-8945.