1. There Are 10 Standard Medigap Policies

By law, companies can only offer 10 standardized Medigap policies known as … [Continue Reading]

important

6. Your Medigap Policy Is Guaranteed Renewable

Any standardized Medigap policy is guaranteed renewable, even if you have … [Continue Reading]

Medigap 300

21. Are Medigap Plans Different From Insurer To Insurer?

Medigap plans are identical no matter which insurance provider you choose. … [Continue Reading]

medigap cost

22. Is There Any Difference Between Medigap Plans Offered In Different States?

In short, the answer is no. Buying a Texas Medicare supplement is going to … [Continue Reading]

Medicare-chart

23. What Is a Medigap Policy?

A Medigap, also known as Medicare supplemental insurance, is a policy that … [Continue Reading]

Medigap 300

1. There Are 10 Standard Medigap Policies

importantBy law, companies can only offer 10 standardized Medigap policies known as A-N. The plans are A, B, C, D, F, G, K, L, M, and N. The plans previously labeled E, H, I, and J are no longer sold. An insurance company does not have to carry all ten plans. Some may only carry a few, while others may offer all ten.

You only need one policy. Each policy builds on the previous one. Plan D includes all the coverage options offered by A, B, and C, plus additional options under Plan D. Plan E, provides everything Plan D does, plus additional coverage, and so on. It is illegal for an insurance company to sell you more than one plan.

2. Medigaps Are Not Part Of Medicare

helping-seniorsMedicare Supplements are not part of Medicare or any other federal insurance program. They are policies sold by private insurance companies. It is illegal for an insurance agent to make such claims.

3. It is Illegal For An Insurance Company To Sell A Medicare Advantage Participant A Medigap

medigap signingIf you are in a Medicare Advantage plan, it is illegal for an insurance company to sell you a Medigap unless the coverage on the Medicare Advantage plan will run out before the coverage on the Medigap will begin.

4. Does A Medigap Replace Original Medicare?

medicare question2No. A Medigap supplements your Original Medicare coverage. Medicare pays its normal share of healthcare costs, and then the Medigap coverage kicks in and pays its share.

5. Is There A Medigap That Covers Prescription Drugs?

question manSome Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Part D plan.

6. Your Medigap Policy Is Guaranteed Renewable

Medigap 300Any standardized Medigap policy is guaranteed renewable, even if you have health problems. This means the insurance company cannot cancel your Medigap policy as long as you pay the premium.

7. Hospice Care Is Not Covered By Medicare Advantage

hospice-careHospice care is not covered by Medicare Advantage. Original Medicare Part A pays for hospice care even when you get your benefits through a private Medicare Advantage plan.

Also, not all of the same prescription drugs that might be covered under a standalone prescription drug plan will be covered by Medicare Advantage.

8. What is a Service Area?

medicare-questionEvery Medicare Advantage plan has a service area. This is a geographic area where the plan is available and offers coverage. A service area is usually a county, state or region. You must live in a plan’s service area in order to join it.

9. Is Financial Assistance Available For Medicare Costs?

medigap costYes. If you have limited income and assets, you may qualify for assistance with medical costs you receive under Medicare. You should contact Social Security at 1-800-772-1213 to see if you qualify.

Some programs you may qualify for include:

  • Medicaid helps pay costs not covered by Original Medicare (Part A and Part B). It may also include some added benefits that Original Medicare doesn’t cover, including prescription drugs, eye care or long-term care.
  • The Medicare Savings Program helps you pay your Original Medicare premiums, deductibles and coinsurance.
  • Programs of All-Inclusive Care for the Elderly (PACE) combines medical, social and long-term care services for people over the age of 55 who meet the qualifications to receive nursing home care, but live and get their services in the community. This program is not available in all states.
  • Prescription drug premium assistance programs help pay some or all Medicare Part D premiums, deductibles, copays and coinsurance.
  • Other programs may be available in your state.

10. Are There Penalties For Missing My Initial Enrollment Period?

question manYes. Missing your Enrollment Period can be costly.

Medicare Part A is premium free if you or your spouse worked and paid taxes for at least ten years. If you do need to pay a premium, the penalty is 10% of the Part A premium for signing up outside of your Enrollment Period. You will have to pay that penalty for twice the number of years you delay enrollment. In other words, if you wait for 4 years to enroll, the 10% premium penalty will need to be paid for 8 years.

If you do not sign up for Medicare Part B when you are first eligible, you will have to pay a 10% premium penalty for every 12 months you delay your enrollment. For example, if your Initial Enrollment Period ended September 30, 2010 and you signed up for Part B during the General Enrollment Period in March 2012, then your Part B premium penalty would be 20%. You waited a total of 30 months to sign up, but that included only two full 12-month periods.

In most cases, the Part B penalty will be attached to your premium for as long as you have Part B coverage.

You enroll in Medicare Part D by buying a standalone prescription drug plan or enrolling in a Medicare Advantage plan that includes drug coverage. This penalty is set by Medicare. For each month you delay, you may pay an additional 1% of the average premium per month. You will pay that penalty for as long as you’re enrolled in a Medicare Part D plan.

11. Medicare Supplement Open Enrollment Period

importantThe Medicare Supplement Open Enrollment Period begins on the first day of the month that you are enrolled in Medicare Part B. It lasts for 6 months. In order to join a Medicare supplement insurance plan you must be enrolled in Medicare Part A and Part B.

There is no health screening during this period, so you cannot be denied coverage if you enroll during this time. You can still apply for a supplement plan after this time, but based on your current health condition and risks, you may be denied coverage or charged a higher premium.

In other words, an individual with a pre-existing health condition who enrolls in a supplement plan during this Open Enrollment Period, will be paying the same premiums as a perfectly healthy individual.

12. What Changes Can I Make To My Medicare Coverage During Open Enrollment?

medicare question2During the Open Enrollment Period you can make changes to your Medicare coverage. Here are your options:

  • Change from Original Medicare to a Medicare Advantage plan.
  • Change from a Medicare Advantage plan back to Original Medicare.
  • Switch from one Medicare Advantage plan to a different Medicare Advantage plan.
  • Switch from a Medicare Advantage plan that doesn’t offer drug coverage to one that does.
  • Switch from a Medicare Advantage plan that offers drug coverage to one that doesn’t.
  • Join a Medicare prescription drug plan.
  • Switch from one Medicare prescription drug plan to a different Medicare prescription drug plan.
  • Drop your Medicare prescription drug coverage completely.

13. General Enrollment Period

march 31stThe General Enrollment Period is an period of time where those who did not elect to enroll into Medicare during their Initial Enrollment Period can enroll. It runs every year from January 1st through March 31st.

14. Special Enrollment Period

special-enrollment-periodThere are a few situations in which you may be able to enroll into Medicare outside of the Initial Enrollment Period or the Open Enrollment Period. These include major changes in your life such as:

You retire and leave a health care plan that you had enrolled in through your employer or a union.

You relocate outside of the service area of your current health plan.

15. Initial Enrollment Period

Health benefit election formThe Initial Enrollment Period is your first opportunity to enroll into Medicare. It is the three months before your 65th birthday, the month of your birthday, and the three months following your birthday.

If you enroll before your 65th birthday, your coverage begins on the first day of your birth month.

For example, if your birthday is July 27th, and you enroll into Medicare for the first time in the May preceding your 65th birthday, your coverage will go into effect on July 1st.

If you enroll in the month where your birthday falls or later, your coverage will begin the first day of the following month.

For example, if your birthday is July 27th, and you enroll into Medicare for the first time on July 17th, your coverage will go into effect on August 1st.

16. When Can I Make Changes To My Medicare Coverage?

seniorwomanOnce you are enrolled into Medicare, you can make changes to your existing coverage once per year during the Open Enrollment Period. Open Enrollment starts on October 15th and extends through December 7th each year. Your changes will then take effect on January 1st the following year.

17. Make Sure Your Doctor Is In The Network For A Medicare Advantage Plan.

doctor-physicianIf you elect to go with a Medicare Advantage plan, make sure your current physician is in the network for that plan. Most Medicare Advantage plans are either PPO or HMO plans, so unless you want to switch doctors, you are going to want to make sure your current physician is part of their network.

18. Can My Medigap Policy Cover My Spouse As Well?

medicare-question

No. A Medicare Supplemental policy only provides coverage for you. It does not cover anyone else in your family. If your spouse wishes to have the same or similar coverage, they will need to obtain their own Medigap policy.

19. Can I Get Long-Term Care Coverage Through A Medigap?

medicare-questionUnfortunately, no. Medigap policies generally do not cover long-term care. They also lack coverage for vision care, dental care, hearing aids, glasses, and private-duty nursing.

20. When Is The Medicare Open Enrollment Period?

open enrollmentMedicare Open Enrollment starts on October 15th each year and runs through December 7th. Your enrollment or any changes you make to your plan then take effect on January 1st of the following year.

For example, if you enroll in Medicare on December 1st, 2013, your coverage begins on January 1st, 2014.

21. Are Medigap Plans Different From Insurer To Insurer?

medigap costMedigap plans are identical no matter which insurance provider you choose. Purchasing Medicare Supplement Plan F from United Health Care is going to give you the exact same coverage as purchasing Medicare Supplement Plan F from Mutual of Omaha.

The difference between carriers is going to be in cost and the customer service they provide. Your coverage will not vary.

22. Is There Any Difference Between Medigap Plans Offered In Different States?

Medicare-chartIn short, the answer is no. Buying a Texas Medicare supplement is going to provide you the same coverage as a Florida Medicare supplement. That is to say that Medigap A in Texas is the same as Medigap A in Florida. Medigap B in Florida is the same as Medigap B in Texas, Arkansas, Oklahoma, Pennsylvania, etc.

There is one caveat to that. There are a few differences if you live in the states of Massachusetts, Minnesota, or Wisconsin. Medicare supplements in these three states offer slightly different coverage than the plans implemented in the other 47 states. Consult a Medicare supplement insurance provider for details if you reside in one of those states.

23. What Is a Medigap Policy?

Medigap 300A Medigap, also known as Medicare supplemental insurance, is a policy that a beneficiary purchases from a private insurance company that, as the name suggests, are designed to cover the gaps in healthcare costs left by Medicare coverage alone.

24. Medicare Part D Coverage

medicare-part-dPrescription drug coverage is provided under Medicare Part D. It is issued by private insurers and is a policy you purchase separately. Plans will vary from insurer to insurer. Some have deductibles. Some do not. Once your deductible is met, the plan pays for some or all of your prescription drug costs up until an annual cost of $2,970. At that point you have reached the Medicare Donut Hole up until an annual cost of $4,750.

Previously, beneficiaries paid 100% of their costs inside the Donut Hole before Part D coverage kicked back in. Under Obamacare, participants now pay 52.5 percent of the cost for brand name drugs and 79 percent of the cost for generic drugs.

 

25. Medicare Part C Coverage

medicare-part-cMedicare Part C is also known as Medicare Advantage. These are private plans that are run through Medicare. Medicare requires that they be “equivalent” to Part A and Part B coverage. That equivalency does not mean they are identical in coverage to Part A and Part B. A Medicare Advantage plan may cover less of one thing but more of something else than what is covered under either Part A or B.

Some Medicare Advantage plans will provide you with significantly more coverage than anything provided by Part A and B, often including prescription drug coverage. In that way, they are similar to a Medicare Supplemental or Medigap plan. The difference between them though is that they are administered by Medicare rather than private insurance companies.

26. Medicare Part B Coverage

medicare-part-bDoctor visits, some outpatient costs like physical therap, and some medical equipment are covered by Medicare Part B. In addition, some preventative healthcare costs such as colon and prostrate screenings are covered, as well as diabetes testing.

27. Medicare Part A Coverage

medicare-part-aMedicare Part A covers you if you should find yourself hospitalized. If you have paid into the Social Security pool for at least 10 years, the coverage requires no premiums to be paid.  There are a few gaps in Part A that you can close with a Medicare supplement plan G or plan F policy.

28. Be Careful Not To Purchase Too Much Coverage

obamacareUnder the Affordable Care Act (Obamacare), beneficiaries are already entitled to annual exams and recommended preventative healthcare screenings without co-pays or deductibles. The drug coverage Medicare Donut Hole is also shrinking.

29. The Medicare Donut Hole

medicare drug coverageThe Medicare Donut Hole refers to out of pocket costs for beneficiaries on prescription drug coverage. Until 2010, beneficiaries were required to pay 100 percent of their annual drug costs between $2,700 and $4,350 each year. After $4350, their prescription coverage would kick in again. With Obamacare going into effect, in 2013 participants pay 52.5 percent of brand name medications and 79 percent of the cost of generic drugs. The donut hole now is between $2,970 and $4750.

30. If You Own A Medicare Advantage Plan, You Cannot Also Own A Medigap Policy

medicare advantageThe Medicare Advantage plan combines traditional Medicare and Medigap coverages. While providing the same coverage as traditional Medicare, a Medicare Advantage plan usually adds in drug coverage and other benefits such as hearing aids or medical equipment like diabetes test kits.

Shop For A Medigap Online