Do You Need Supplemental Insurance with Medicare?

What does Medicare cover?

Medicare, administered by The Centers for Medicare & Medicaid Services (CMS), is the largest health insurance program in the U.S. Created as a result of the Social Security Act in 1965, its enrollees account for about 40 million people.  Original Medicare does not pay for everything. Even if you are covered by Medicare Parts A and B, there will be some out-of-pocket expenses you may have to incur, i.e. copayments, coinsurance and deductibles, as well as travel outside the U.S. Original Medicare pays for 80% of your Part B medical expenses; the remaining 20% (of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment) is your responsibility. That 20% gap could place a significant financial burden on you, resulting in very high out-of-pocket expenses.  There are no limits to the Part B 20% copays.  That is the reason why it is necessary to have a Medicare supplemental insurance plan in place.  This insurance is commonly referred to as a Medigap policy, its name implying its purpose to fill in the gaps where Medsenior staying healthyicare coverage does not exist.

There is usually no premium to pay for Part A of Medicare upon turning age 65, if you or your spouse paid Medicare taxes while working.  That is why this is often called premium-free Part A.  Important! To qualify for Medicare Part A and/or Part B, you must be a U.S. citizen or be lawfully present in the U.S. (be a legal resident of the U.S. for the last five years).

Part A covers the following:

  • inpatient hospital stays, including a semi-private room, meals, general nursing, drugs as part of your inpatient treatment and other hospital services and supplies.
  • physician’s fees
  • home health care – it covers medically necessary part time or intermittent skilled nursing care and/or physical therapy, speech language pathology services, and the need for continuing occupational therapy.  Your care must be ordered by a physician and it must be provided by a Medicare-certified home health agency
  • skilled nursing facilities,
  • hospice care – to qualify either a hospice doctor or your doctor must certify that you are terminally ill (life expectancy of 6 months or less).  After 6 months, you must be re-certified if you are still there.  Coverage includes pain management modalities, medical, nursing and social services, drugs, certain durable equipment, aide and homemaker services.  Hospice does not cover spiritual or grief counseling; stay in a facility (room & board) unless the hospice medical team deems it necessary for pain and symptom management; and the stay must be in a Medicare-approved facility.
  • critical access hospitals (small rural facilities)
  • inpatient care in a religious nonmedical health care institution.
  • blood – no charge except in cases where the hospital must buy the blood for you.  In that case, you must either pay the hospital for the first three units of blood you receive during the calendar year; or have blood donated by you or someone else.

Part B of Medicare is the medical insurance part.  It covers medically necessary physician’s services, i.e. x-rays, laboratory and diagnostic tests, flu and pneumonia vaccinations, blood transfusions, some ambulance transportation, and chemotherapy. In addition, outpatient care, physical and occupational therapy and some home health are also covered services.

Covered services also include the following:paying for medicare part b

  • Preventive screenings such as bone density tests, breast cancer screenings (mammograms), cardiovascular disease screenings and cervical and vaginal cancer screenings;
  • Clinical research studies
  • Mental health services
  • Surgical second opinions
  • Durable medical equipment (canes, walkers, wheelchairs, etc.), prosthetic and orthotics, surgical dressings, and therapeutic shoes and inserts.

According to the CMS website, coverage is equal to 80 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, less any unmet deductible. The beneficiary is responsible for 20 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, plus any unmet deductible.

What is not covered by Parts A and B of Medicare?

Medicare does not cover the cost of:

  • Routine dental care
  • Eyeglasses
  • Hearing aids and exams for fitting them
  • Acupuncture
  • Cosmetic surgery
  • Any type of custodial care for those who are unable to live independently.  That is provided you do not have an acute illness that would necessitate skilled nursing services.  For example, Medicare would not cover the medical expenses of someone in a nursing home who has Alzheimer’s or dementia, unless they suffered an acute illness, i.e. heart attack or pneumonia.
  • Long-term services
  • Concierge care (retainer-based medicine, boutique medicine, platinum practice or direct care).

In summary, supplemental insurance can help most people enrolled in Medicare pay for the things that are not covered by Medicare.  It covers the “gap” that Medicare Parts A and B do not cover.  The additional expenses can be quite substantial and become a financial burden to seniors.  Although Medigap plans have standardized benefits regulated by the Federal Government, it is very important to note that costs can vary from company to company, even though the insurance and the coverage is the same.  So, choose a plan wisely!

When Is the Medicare Open Enrollment Period?

When is the Medicare Open Enrollment Period?

The Medicare Open Enrollment period is terminology that many people often use to refer to the end of the year period during which you can change medical and prescription plans. However, there is definitely some serious confusion about this period and some misuse of the term. This is, at least in part, due to the enormous amount of marketing the insurance companies do during this time of year. So, let’s clear up the Medicare open enrollment period confusion.medicare open enrollment period

Medicare Open Enrollment: When You First Turn 65 or Start Medicare

The actual Medicare open enrollment period is when you first turn 65 or go on Medicare Part B. During this time period, you have open enrollment into a Medigap (Medicare Supplement) plan. This open enrollment period lasts for 6 months starting with the first day of the month you turn 65 (or your Part B effective date if that date is later). During this time, you cannot be made to answer any health questions or undergo any medical underwriting to be approved on a Medigap plan.

Likewise, when you turn 65 or start on Medicare Part B, you have an initial election period, during which you can select a Part D plan (prescription drug plan) without restriction or penalty. This initial election period lasts for 7 months – the month you turn 65 and three months on either side of that month. During this time, you can select any Part D plan without restriction or penalty.

If you are opting to go with a Medicare Advantage plan, you get the same initial election period as detailed above – 7 months including the month of your 65th birthday and three months on either side of that month.

So, What is the Annual Medicare Enrollment Period?

The period that occurs annually, at the end of each year, is actually the “annual election period” or AEP. This period does not apply at all to Medigap policies (Medicare Supplements). On the contrary, this period only applies to Part D and Part C (Medicare Advantage).medicare annual election period and open enrollment

The annual election period runs from October 15 to December 7. During the AEP, you can make changes to your Part D prescription drug plan or your Part C Medicare Advantage plan. Any changes that you make will take effect at the start of the following calendar year.

Many people often mistakenly think that you can also make unrestricted changes to your Medigap plan during that period; however, that is not the case. While you certainly can compare and change your Medigap plan during that period, you do still have to answer medical questions and be approved. It is not, technically, an open enrollment period for Medigap plans though. And, you can compare Medigap plans and change your plan at any time of the year.

How to Prepare for the Medicare Annual Election Period?

If you have either a Part D plan or a Medicare Advantage plan (Part C), you will receive a notice of plan changes for the following year in the mail. This usually comes in late September or early October. It is crucial not to merely disregard this mailing. Some of these plans change drastically each year, and you don’t want to get stuck in a deteriorating plan.

When you receive your notice of plan changes, you should look over it carefully. It should show a side-by-side comparison with the previous year’s benefits. See what changes have been made and decide, based on the plan changes, your satisfaction with your plan, and any changes to your health or finances, whether you want to “shop” for a new plan.

If you do want to shop for a new Part D or Advantage plan, keep in mind that you can only do so during the annual election period, which runs from October 15 to December 7.

Secure Medicare Solutions is a leading, independent Medicare insurance agency. We work with the companies that do Medicare Supplement plans so that you can compare all options in a centralized, unbiased place. We also provide Medigap quotes online by email and can answer any questions that you have. You can reach us at 877.506.3378 or online.

Medigap Rates Online – Can You Get Them and How?

A common question is whether you can get Medigap rates online. Many people are surprised to learn that it is not as easy as you think it should be. In general, you can get some Medigap rates online; however, you don’t always get complete or accurate information. This article explains why and gives you options for obtaining a Medigap comparison.

First of all, as a preface, while you may not get complete or accurate Medigap rates online, you certainly can easily get a complete, unbiased Medigap comparison by email. As far as getting a listing on a website of all plans available to you, with rates customized to your age, gender, zip code, situation, etc., it’s not that easy.

There are three main factors that make it difficult to get Medigap rates online. First, some companies do not allow their rates to be published online by agents. This greatly inhibits your ability to get an accurate picture of the plans available in your area. Second, some Medigap companies only deal with “captive” agents that only represent/sell plans for that one company. “Captive” agents wouldn’t be able to give you rates for other companies besides their company, while independent brokers wouldn’t have rates for “captive”-agent companies. Lastly, companies have different rates for each zip code and age and are changing rates all the time, making Medigap rates online possibly unreliable/out of date.

So, with the unavailability and unreliability of Medigap rates online, what are the other options? The good news for the Medigap consumer is that you don’t have to have a pushy agent come to your house or spend hours on the phone with companies or insurance agents. The easiest way to get Medigap rates online is via email. You can easily get rates delivered directly to your inbox that are both customized to your age, gender, zip code, situation, as well as accurate, reliable and prompt.

Secure Medicare Solutions can provide that service – Medigap rates by email. The important thing here is to make sure you are requesting the information from an independent broker/agent. This way, you can compare all options in a centralized place. There are likely other companies that will provide similar information as well, but most or all require a phone number and address as well in order to contact you with phone calls, mail, etc. Particularly if you are someone turning 65 or ‘shopping’ for a Medigap plan, the last thing you want to do is give someone ELSE permission to call you endlessly. Getting Medigap rates by email solves that problem – gather the information, read at your leisure, compare plans and make a sound, unbiased decision.

If you have questions about this process or want to speak with someone directly, you can contact us using the form here or by phone at 877.506.3378.

Senate Passes Medicare Doc Fix Bill, Sends to President Obama

There is big Medicare-related news out of Washington today, as the Senate passed medicare doc fix
the so-called “Medicare doc fix” bill late last night by a resounding 92-8 majority. This bill was recently labeled as the MICRA – Medicare and CHIP Reauthorization Act. President Obama has already said he will sign the bill when it reaches his desk. So, what exactly does this mean for you, the Medicare beneficiary?

Let’s start from the beginning. First and foremost, this bill is in response to the April 1 expiration of the sustainable growth rate for physician payments. When this expired, a 21% cut went into effect for doctor reimbursement rates for Medicare patients. CMS – the government organization that administers Medicare – announced that it would essentially “hold” claims for 14 days until this bill could be passed and signed. Medicare patients should see no effects from this – or really, even know that it is going on behind the scenes – but it is interesting to know nonetheless.

Even more interesting and important is what is actually in the bill itself. Here is a bullet-point summary of what the bill entails (bolded sections of particular importance to Medigap policyholders):

  • The bill repeals the sustainable growth rate of physician payments that had been in effect since 1997 – this is the so-called Medicare doc fix.
  • It replaces that with a .5% increase for physician payments each year for the next five years.
  • The bill created financial incentives for doctors to bill for quality care (“quality care” not defined at this point but will likely follow recent CMS directives).
  • The bill provides 7.2 million over two years for Community Health Centers.
  • It extends funding for nearly two dozen other programs – including federal abstinence programs and extra payments for rural hospitals.
  • The Children’s Health Insurance Program (CHIP) will receive $5 billion for two years.
  • It increases the Medicare Part B and Part D income-related adjustments for premiums for high-earners.
  • In 2020, it requires Medicare Supplement policyholders to pay for the Medicare Part B deductible (currently $147/year) themselves. This eliminates “first dollar coverage”. And, this also means that the Medicare Supplement plan offerings (Medigap coverage chart) would also have to be revamped at some point to account for these changes. Plans F and C would likely be eliminated for new policyholders starting in 2020. If the past is any indication, current Medigap policyholders will be “grandfathered in” and allowed to keep their plans even if it includes first-dollar coverage. However, at that point (2020) or maybe before, there would likely be a considerable amount of rate pressure on people in first-dollar coverage plans, as there would be no “new” policyholders coming into those plans.
  • The overall cost of the bill is approximately $210 billion, with two-thirds of that being added to the Federal deficit and the remaining $70 billion in cost being split between Medicare recipients and providers.
  • Lastly, a previously scheduled hospital payment increase of 3.2 percent – scheduled for 2018 – will be delayed and spread over 6 years.

So, how will this, particularly the change in Medigap design, impact you? In 2010, the Medigap plans were revamped to include several new plans and remove several duplicate plan designs. When that happened, policyholders that had one of the “old” plans were allowed to keep their plan. It is very likely this would be the case with this plan design change as well; however, that will be something to keep an eye on. Obviously, the 2020 start date of this requirement gives plenty of time – even at Government pace – to revamp the coverage chart and implement the changes.

Also, the “doc fix”, which “permanently” replaces the sustainable growth rate should provide some stability to providers who accept Medicare patients and payments. This elimination of payment amount uncertainty is always, ultimately, a good thing for Medicare recipients. It is expected the President Obama will sign the bill into law within the next couple of days.

Garrett Ball is the owner of Secure Medicare Solutions, an independent Medicare insurance brokerage. If you have any questions about this or want additional information about current Medigap plans, please contact SMS at 877.506.3378 or online.

Medicare Supplement Enrollment Continues to Grow

Medicare supplement enrollment continues to grow,
according to marketplacemedicare supplement enrollment data released in 2014 by Mark Farrah Associates. The study found an increase in number of Medicare supplement policies from 10.2 million to 10.5 from 2012 to 2013,  an overall increase of 3.8%. These figures also represent a notable growth in new policies. This entails policies that are issued in the last three years, and this growth is measured at 1.3% from 2012 to 2013.

Most project these study results are a result of two distinct trends in the Medicare marketplace. One, they represent the increasing numbers of Medicare eligible individuals as Baby Boomers turn 65 at a clip of 11,000 per day. Secondly, most suspect these numbers reflect a move away from other coverage types, both by choice and necessity, as there are fewer Medicare advantage plan options and more employers are reducing or eliminating coverage for retirees. Overall, the last five years have seen an overall growth in the Medicare market of over 11% in number of issued policies.

The study also found that Plan F was purchased by 52% of people purchasing Medigap plans, a large number when you consider that plan F is not always the best “deal”. These numbers, I believe, also are affected by the fact that several of the larger Medigap insurers “push” plan F as their primary option. Plan G and Plan N did also grow, according to the study, in number of Medigap enrollees. Early evidence suggests that, once 2014 data is available, we will see a leveling off of Plan F enrollments and an uptick in enrollments in Plans G and N.

So, how does all this information affect you? One, it is important to know what the marketplace looks like if you are a participant in the marketplace (i.e. a Medigap policyholder). Also, it gives you an idea of how your choices compare to what the market as a whole is doing.

If you have questions at any time about your plan, your options, or anything else regarding Medicare, please do not hesitate to contact me at 877. 506. 3378 or on our website.

Best Medicare Supplement Plan – The Right Plan For You

The best Medicare Supplement plan is the one that is right for you. There is certainly a lot of information available regarding Medicare and Medicare Supplement plans. And, a great deal of it comes to your mailbox when you are turning 65 or going on Medicare. You may hear a company or a friend or family member tout one plan as the “best one”. While getting feedback from others can be useful, it is a good idea to be cautious when it comes to choosing a Medigap plan that is being advertised or touted as the best Medicare supplement plan.

Since Medicare Supplement plans are standardized, coverage is the same on all Medigap plans. Additionally, all plan pay claims the same way – through the Medicare “crossover” system. And lastly, you can use any Medicare Supplement plan at any doctor/hospital that takes Medicare – there are no networks. Because these three aspects of the plans are standardized, comparing the plans is a function primarily of the premium rates and the company rating/reputation.

The best Medicare supplement plan is, you could say, the one that has the lowest rates for your age, gender and zip code that is sold in your state. There are typically 30-40 companies that sell Medicare Supplement plans in each state. Not all of the companies that sell the plans offer all 10 of the standardized plans. Some only offer 3-4 of the plans. And, rates can vary widely, so it is crucial to find the best Medicare supplement plan for you by comparing the rates.

Some of the “big name” companies that sell plans in this market are: AARP (United Healthcare), Blue Cross Blue Shield, Mutual of Omaha, Aetna, CIGNA, Central States Indemnity, Stonebridge, and Forethought. While not all of these companies offer plans in every state and not all of them are competitively priced in every state, they are all ‘A’ rated or higher (by AM Best) and are generally good options when it comes to finding the best Medicare Supplement plan for you.

The only way to get an unbiased and complete look at the Medigap rates for your area is to use an independent agent (broker), who can provide this information for you so that you can compare in a centralized and unbiased place. If you have any questions about this information or wish to get a comparison to find the best Medicare Supplement plan for you, you can contact us at 877.506.3378 or online at: Send me information on the best Medicare supplement plans for me.

 

Guardian Healthcare Medicare Advantage Bankruptcy – What To Do About It?

Recently, the Medicare Advantage company, Guardian Healthcare, filed for bankruptcy. Because Guardian is, as of 2010, one of the top three Medicare Advantage plans in SC, this filing affects many individuals in the state who have this Guardian Medicare Advantage plan, as well as providers and agents who are owed money by the company.

Regarding the Guardian Healthcare members, the most important thing to note is that the Centers for Medicare and Medicaid Services (CMS) has declared a special election period for many affected members of this health plan in most counties in the state. For those people who have been granted this “SEP”, they will be (or have recently been), notified by a letter from Medicare. Make sure you hold on to this letter. This “SEP” allows those who have Guardian Healthcare’s plan the opportunity to chose either an actual Medicare Supplement plan (also called Medigap) or another plan.

Although health care reform and other changes have greatly affected the number and quality of Advantage plans that are available, there are still a few Medicare Advantage plan options in the state (3 companies that are operating Advantage plans in the whole state). However, as an independent agency, our recommendation would be to use this one-time special enrollment period to choose a Medigap plan. The advantages of a Medigap plan (vs. an Advantage plan) are listed below:

  • First of all, Medicare Supplement plans don’t change each year, like Advantage plans do. The plans are Federally-standardized, so each company offers the same outline of coverage for their plans – the only variation is price and company reputation.
  • Secondly, Medigap plans, unlike all Advantage plans (as of 1/1/2011), do NOT have networks. Someone who has a Medigap plan can go to any doctor or hospital nationwide that takes Medicare.
  • Lastly, Medicare Supplement plans offer a “Guaranteed Issue” into a Medicare Supplement when you are involuntarily losing your Medicare Advantage plan (i.e. Guardian Healthcare). If you have any pending health issues or history of medications or health problems, you have this one-time opportunity to qualify for a Medicare Supplement without medical underwriting or pre-existing condition restrictions.

Overall, the bankruptcy of Guardian Healthcare has been, and will continue to be, a problem for many affected members, providers, and other affected groups. However, for members, because Medicare has granted this SEP, which allows you to choose a new plan without penalty or underwriting, you can take advantage of this one-time opportunity to either select the more comprehensive coverage of a Medicare Supplement plan or find a new Advantage plan.

To get more information about either, please visit South Carolina Medicare Supplements or call us at 877.506.3378.

Frequently Asked Question of the Month – What are the Enrollment Periods Associated with Medicare?

Answering questions is a big part of my job. Many people on Medicare have the same general questions. In this section, I answer a question that I’ve recently been asked, for everyone’s benefit:

What are the enrollment periods for the various types of Medicare plans?

This is a very common question that can be easily answered; however, there is a lot of misinformation out about this (through other agents) and just through misconceptions. The easiest way to look at it is to break it down by type of plan:


Medicare Supplement (Medigap): There are NO set enrollment periods. You can enroll/disenroll at any time, as long as you have Medicare A & B.


Medicare Advantage:
Medicare Advantage has a set enrollment period of Nov. 15-Dec. 31 each year. Then, you can also make some changes between Jan. 1-Mar. 31 (some restrictions apply – each case is different).


Part D: Part D is the same as Medicare Advantage. The annual enrollment period is Nov. 15-Dec. 31 then there is an additional enrollment period Jan 1-Mar. 31. During that additional period, you can neither drop or add coverage, only switch Part D plans.

Medicare Supplement Insurance Plans – When Can You Sign Up

Medicare Supplement insurance plans have certain enrollment periods, during which you can sign up for a plan with no medical underwriting. What this means is that you do not have to answer any medical questions or have the possibility of having any pre-existing conditions excluded. However, even outside of these enrollment periods, you can still sign up for a plan at any time. The enrollment periods that allow you to sign up without having to answer the medical questions are: Open Enrollment and Guaranteed Issue. This article will elaborate on both of those periods.

Open Enrollment occurs when you first turn 65 or first enroll in Medicare Part B. This period lasts for six months from your 65th birthday or your Part B effective date. It is possible to have two open enrollment periods – one when you go on Medicare Part B (for disability) and a later one when you turn 65. However, you must have both Medicare Parts A and B.

Guaranteed Issue, on the other hand, is more complex. There are several Guaranteed Issue situations that can occur. To name a few, leaving/losing employer coverage, losing a Medicare Advantage plan, moving to a new state out of an Advantage plan service area, and many more. When these situations occur, you typically have 63 days from the qualifying event to sign up for the Medigap plan. It is very important to do so during this period, while you can still qualify under the Guaranteed Issue stipulations.

The advantages to signing up for a plan during one of these Open Enrollment or Guaranteed Issue periods speaks for itself. It is essential to do this if you are in one of these periods to avoid having to go through medical underwriting, which can cause problems if you have some pre-existing conditions.

If you have any questions about Medicare Supplement insurance plans or the eligibility or enrollment periods, you can find information on http://www.medicare.gov or by calling us toll-free at 877.506.3378. You can also contact us on our Medicare Supplement quotes page by entering whatever questions you have in the comments box.

Medicare Supplement Insurance – Five Things 90% of Seniors Going on Medicare Don’t Know

Medicare Supplement insurance is something that everyone that goes on Medicare has to understand. Even if you have employer insurance or are electing to have only Medicare, you still must understand these supplements and the ramifications of having/not having one in order to make an informed decision on whether to get one, and if you are getting one, exactly which one to get. When looking at these supplemental plans, there are a few things to keep in mind that, from our thousands of conversations with individuals going on Medicare, we’ve realized that many seniors going on Medicare simply do not know. For your reference, we’ve listed a few of those things below:

  1. Medicare Supplement plans do not cover prescription drugs.
    Prescription drugs are covered under Medicare Part D NOT Medicare Supplement plans. Since supplemental plans are standardized (see #4 below), NO plans can offer drug coverage as a benefit to their supplemental plan.
  2. Medicare Advantage plans are NOT Medicare Supplement plans. The two are completely different.
    Many seniors make the small terminology mistake of calling Advantage plans “supplement” plans. This is simply not true. Advantage plans do not supplement Medicare; on the contrary, they replace Medicare and ALL benefits are provided through the private company. With a true supplement plan, you still have Medicare A & B, you just have a supplement to fill in some, or all, of the ‘gaps’ in Medicare.
  3. Medicare Part D (Rx coverage) has a “donut hole”. This applies to all plans and there is no way to avoid it completely.
    The Medicare Part D “donut hole” is one of the most troublesome (to many people) parts of Medicare, and unfortunately, there are no ways to avoid it completely. The best way to reduce your prescription drug costs are to ensure that you are on a Part D plan that most thoroughly covers your medications and re-evaluate this on an annual or bi-annual basis.
  4. Medicare Supplements are Federally-standardized and they are portable across state lines.
    All companies must offer the exact same standardized Medicare Supplement plans. There is no variation among these plans. A Plan ‘F’ with one company is the exact same as a Plan F with another. Also, all Medicare Supplements can be used anywhere in the U.S. – there are no restrictions or networks. As long as a doctor/hospital takes your primary coverage (Medicare), they will take your supplemental coverage.
  5. Medicare Supplement rates change over time. All plans go up in rate and there is no way to avoid that entirely.
    Regardless of what a company or agent may tell you, all Medicare Supplement plans do go up over time. There is simply no way to avoid this. They may go up at different time periods or using different methodology for increases, but overall, all companies are going to go up. And the best counsel is to have a plan that is the lowest cost possible when signing up (since plans are standardized).

Secure Medicare Solutions is a leading, independent brokerage that works exclusively with Medicare insurance. You can get a Medicare Supplement quote by visiting Medigap Quotes or Medicare Supplement Quotes. You can also reach us by phone, if you prefer, at 877.506.3378.