Medicare Insurance Blog

Medigap Chart

It can be overwhelming to review all the Medigap options that exist in today’s marketplace.  If you’re looking for a reference guide that will help you determine the best options that suit your needs, we’ve got the right info for you.

Using the Medigap Benefit Chart, you’ll be review exactly what coverage exists for something specific like skilled nursing care.  While all policies must follow Federal and State laws, they all may vary in terms of additional benefits they offer.  Check with the provider to see if they have coverages that go beyond the standard benefits.

Use the chart below to review the best options for you.

Medigap Benefits Medigap Plans
A B C D F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Part B deductible No No Yes No Yes No No No No No
Part B excess charge No No No No Yes Yes No No No No
Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $5,560 in 2019

 

($5,880 in 2020)

$2,780 in 2019

 

($2,940 in 2020)

N/A N/A

If the plan states “Yes,” this means that there is coverage for 100%

If “No,” there is no coverage for that benefit under this specific policy

If there is a “%” this indicates the amount of the plan that covers this benefit

There are a number of ways that insurance companies organize their rates.  The most common is called “Community-rated” premiums.  These are also referred to as “no-age-rated” premiums because they are consistent for everyone across the board.  These do not differ from policy to policy based on age alone.  A separate Medigap premium structure is referred to as “Issue-Age Rated” policies.  These can also be referred to as “entry-rage-rated.” There is a benefit to these rated policies as the sooner that you enroll, the less you’re going to pay.  Unfortunately, as your age increases, these types of plans become more and more costly as time goes on.  The third option is an “Attained-Age Rated” premium.  These premiums are based off of the age that you are currently.  As you celebrate each birthday, the rate will increase accordingly.  There are a number of factors that impact the policy cost for you or your spouse.  When comparing options, seek professional feedback on the best plan for you.

 

Changes with Plan F Medicare Coverage in 2020

Medicare Plan F benefits have been popular in the past and for good reason.   This comprehensive plan covers holes in the other plans that leave room for out-of-pocket expenses.   It’s no wonder as to why Plan F has been well favored by individuals that are enrolled in Medicare.   It also has rarely been discontinued by an enrollee.   This plan has guaranteed renewal and can never be cancelled based on your medical history or the incidents covered under this plan.

The important thing to know is that there are big changes coming with Plan F.   The long-awaited mandate has finally carried through and what is happening now is that new enrollees are no longer able to purchase a Plan F Medicare plan.   Based on the changes, anyone who is currently enrolled is able to maintain their coverage or purchase from a separate provider of their choosing.   Essentially, if you’re in already, you can stay in.   If you have not yet purchased this coverage and were looking to, take some consolation in the other plans that are available to you.

Plan G, which is Plan F’s closest neighbor, offers similar coverage for those who are not eligible to purchase the Plan F Option.   The difference with Plan G is that the deductible must first be met before the insurance coverage begins to pay out.   While the deductible is less than $200, it’s important to note that costs associated with this crème dela crème plan will likely be increasing the premium cost as the number of subscribers is likely to skyrocket.

Plan F isn’t obsolete so if you were already receiving the benefits from this coverage, you will still be able to maintain the same coverages.   As a precaution, like Plan G, prices are not expected to remain the same.   Plan F covers a great deal of cost and insurance providers will likely be taking that into consideration as they begin underwriting for the future.

While all is not lost, the remainder of the plans are not likely to skyrocket.   Whether or not you already had Plan F or you were looking for a new policy, the truth is that there’s always an alternative.   Speak with a professional about the coverage that makes the most sense for you so that you don’t end up paying more for premiums or co-pays than you need to.   Finding a tailored package with Medicare that is specific to your needs is the key component to having a well rounded amount of coverage without the ridiculous price tag that nearly breaks the bank.

The New High Deductible Plan G

Out with the old and in with the new.   The changes to the Medicare Plans in 2020 can be difficult to understand.   Allow us to explain easily for you so that you have a better understanding of your personal options so you can know exactly how to select coverages for yourself.   Plan F is making a small exit as of 2020.   With that change, new enrollees will not have access to determine that they would like Plan F as their benefit any longer.   However, Plan G has come in to save the day.   Plan G can be a similar or copy-cat coverage and provides benefits just like Plan F.

If you were already on Plan F and plan to stay on Plan F, this is not necessarily for you.   As a new enrollee, you are looking for the best bang for your buck.   Plan G offers a wide array of coverages, just like Plan F, but at a much higher deductible.   Like all insurance, the higher the deductible, the lower the premium.   Keeping that in mind, paying a lower amount monthly may be the trade off for paying the $2340 that will be due for your benefits up until the time that is meant.

With this plan, Medicare pays 80% of the cost, you continue to pay the remaining balance.   After that $2340 is satisfied, the plan essentially becomes Plan G with no out-of-pocket costs.   You are still receiving great benefits that were included in Plan F.    Once Medicare benefits have been exhausted, these coverages will be paid for without the stress associated with the cost of care during a difficult time.

The one difference mainly between Plan G and Plan F is that the High Deductible Plan G does not cover the deductible for the Part B coverages.   Unlike Plan F, it excludes the deductible for Part B.   While the coverages on your plan may not seem terribly important now, when the circumstances arise, the cost and care become dramatically more important.   It’s critical to anticipate what the best scenario for you and your health will be when that time arises.

Finding the best coverages can be tricky and confusing.   With changes to Plan F and C, Plan G is offering a Higher Deductible so that the more individuals are able to afford a more expansive coverage with a lower monthly premium.   Whether this meets your needs or not, contact an individual with The Health Exchange Agency in order to find the best coverage for you or your spouse in today’s market.   Our services allow us to better understand your circumstances so that we can determine the best course of action to protect your health and your wallet.

What is Medicare Plan F?

Medicare Plan F is one of gold medal of Medicare supplement plans.   While it can be an expensive supplement, it takes care of costs and deductibles extensively which could save you thousands.   This comprehensive plan does not replace your existing Medicare Part A and Plan B plans but works with them to create a well-rounded profile of coverages for you or your spouse.   With the coverages combined, it’s nearly impossible for you to end up paying out of pocket for medical expenses during an upcoming procedure or doctor’s visit.

The benefits are very expansive and include a great deal of coverage in addition to what’s currently offered through Medicare Part A or B.   With those coverages in line, Plan F pays the tab for blood work, deductibles (for Parts A & B), and even the excess charges for Part B.   There’s a reason that this plan has been the top pick for those already enrolled in Medicare.   It essentially covers the out of pocket cost that you were likely to pay under your Medicare Part B plan.   Instead of paying your deductible, you generally walk out of the doctor’s office with nothing paid at all.   Sounds too good? It may be now.

As of January 1, 2020, the Plan F is no longer available for new candidates.   Those who have been enrolled do have access to Plan F through their existing carrier and still maintain the option to change providers should they decide to do so.   If you already have an existing Plan F, there is no threat to your existing coverages outside of the regular parameters that stop insurance coverage due to non-payment or requested cancellation.   Your options to elect for a new carrier for your Plan F policy is still within your ability.

With the changes being made it can be disappointing as the Plan F was so popular amid the community.   For those who will maintain their coverage, they still have the existing benefits that have been provided in the past.   These include their ability to self-refer and choose whichever physician they prefer.   With those things in mind, it may continue to be the perfect plan for you.

While you may be nervous to change providers for your Plan F coverage, there’s no need to be concerned with the changes to your plan.   All Plan F policies cover the same benefits and will allow you eligibility as long as you keep your existing Plan F policy in tact until the new one is created.   The benefits through this plan if you are already enlisted can be discussed directly with an agent at The Health Exchange Agency.   Speaking with a professional about the benefits for you or your spouse will allow you to find the best plan for you.

Medicare Eligibility

You may be interested in signing up for Medicare or finding out alternatives to your existing coverage.   Understandably, insurance can be a difficult topic to try to grasp and the complications are compounded by so many separate options.   With Medicare, the important thing to get you started is your eligibility.   Finding out if you’re a candidate for Medicare is important and you’ll find that there’s only a few criteria you’ll need to review.   The Health Exchange Agency is skilled at determining eligibility and answering questions for you if you do have a unique situation.

When it comes to the Annual Election Period or “AEP,” being on schedule is very important. For 2020 coverage the timeline began on October 15th and ran through December 7th. For those interested in taking on the coverage for Medicare Advantage, the enrollment time-frame is available from January 1st to March 31st, 2020. This is the Medicare Advantage Open Enrollment, otherwise known as “MA OEP.” It’s important to remember that this is available to those already enrolled in Medicare Advantage plans. This is also the timeframe in which one can adjust from Medicare Advantage to the Original Medicare plan. In addition, there is the option for those are near the inception of their Medicare eligibility who can take advantage of the Initial Coverage Election Period, or “ICEP.” This time is designated for those who are newly eligible for Medicare to begin enrolling in the Medicare Advantage Plan for the first time. This happens at a different time of year than the Medicare Advantage Open Enrollment (MA OEP). It’s important to identify when the right time is for you to enroll as there are very few exceptions that fall into the Special Election Period. These exceptions, are limited to specific life events such as marriage or losing other health coverage elsewhere.

The principal criteria for determining eligibility with Medicare is age.   In order to qualify you must be 65 years of age.   If you are not yet 65 there are some specific conditions that would make you eligible like Lou Gehrig’s disease or End-Stage Renal Disease (ESRD).   If you have one of these conditions or have additional questions about your eligibility, contact The Health Exchange Agency directly to discuss your specific options.   Specified conditions are important to disclose in order to properly qualify an individual for coverage during an ongoing health concern.   Qualifying may be easier than you imagine.

After you’ve checked off the “65 years” bucket, you’ll need to evaluate a few other things.   It’s important that you’ve had Medicare-covered Employment for a minimum of 10 years leading up to your enrollment.   This means having at least 40 quarters of employment that has paid out Medicare taxes.   If you (or your spouse) did not pay these Medicare taxes, you still may be eligible.   There is additional criteria that would be the determining factor for your qualification.

In addition to the aforementioned criteria, another important qualifier is the citizenship or permanent residency status that you currently have.   You must have either the US Citizenship or Permanent Residency for a minimum of 5 years in order to move forward in your enrollment process.   If this sounds like you, you’re ready to enroll.   Taking the next step and signing up for Medicare may lead you to some new questions, be sure to gain clarity on questions you may have surrounding the process.

While Medicare has three major criteria for the enrollment of it’s clientele, it’s important to note that the individual circumstances of each person can make a difference in eligibility.   If you’re unsure based on your current status, we have answers to your questions.   While you may still be working part-time or full-time or carry insurance privately, Medicare still may be an important option for you to consider.   The benefits of having a supplementary plan assist in ensuring that you don’t end up paying out of pocket for costs that could otherwise be covered.   The Health Exchange Agency specializes in assisting men and women like you each day with their Medicare enrollment, you don’t have to do this alone.   We’re here to help and know that with the right personalization of the process, you’ll get the exact coverage you want and need.

How to Sign up for Medicare

Getting older can be a challenging experience.  The healthcare options available to you may seem confusing or unnecessary.  The inexperience you have in this new chapter coupled by ongoing health concerns create a recipe for disaster.  The best way to combat these fears is to know what your options are and how to sign up for them.   With age comes wisdom, and knowing how to navigate the system will demonstrate your wisdom all the more.  Getting the coverage and protection that you need is much easier than it seems.  Here are 3 important parts of enrolling in Medicare that will help guide you through the process.

Timing- The biggest mistake seniors make when enrolling in Medicare is timing.  There is a small window in which enrollment is open.  This window is limited to the three months leading up to your 65th birthday, the month of your birthday, and the three months following your birthday.  Failure to enroll in the specified timeframe can lead to penalties.  To avoid those fees, being proactive with the enrollment is the best way to get started.  This time is called the “First Enrollment Period,” which is self-explanatory.  Getting ahead of the enrollment period allows plenty of time to ensure that you feel comfortable with your coverages prior to utilizing them.

Knowledge- Many seniors end up making a mistake because they feel vulnerable and don’t want to be taken advantage of.  The best way to combat this is through educating yourself on your options.  There are two parts to the enrollment.  The first part is Part A which is for long term care, hospice, and hospital stays.  The second part is Part B is for specific doctor’s appointments, outpatient visits, and medical supplies.  The two parts work together to keep you covered for the spectrum of situations.  There is a Part C which is an elective portion that supplements both A and B.  Think of Part C as the component that expands your options.  With Part A and Part B, you may find yourself limited in terms of physicians that accept Medicare.  Part C is through a separate private company that offers more options and a more thorough coverage portfolio.  Part B is a paid coverage meaning that you can decide you do not want that coverage but it does cause you to lose out on the benefits. Considering the benefit of having additional coverage in the event of an onset illness or accident is something to do by consulting with a reputable Medicare Part C affiliate. They can educate you on the benefit of having the additional protection that can ensure that your out of pocket expenses will be minimal when the time comes. There’s more that can be done than just crossing your fingers and hoping for the best. Keeping in mind the value that comes by having a small monthly premium to improve the quality and accessibility of care when needed will be impactful later on.

Enrollment- Enrollment options vary but regardless, there’s an option for everyone.  The easiest way is attempting to enroll online.  If you have access to the internet on your phone, desktop, or laptop, you will be able to access the website to enroll in care.  On medicare.gov the process is outlined and the application can be filled out there.  The system on the government website is very user friendly and allows for a guided question and answer completion.  You can even check the status of your application after its been submitted through the website.  This avenue does help prevent unnecessary trips to the Social Security office and you can make corrections to the application online.  To ensure that it is completed, you can also track the status of your application for Medicare to verify what stage it is at and if there are any processing issues. This allows you the opportunity to often get ahead of anything that may come up should they require additional information or documentation from you.  If you do prefer to avoid the Social Security office but don’t feel confident about applying through their website, you can also apply by phone.  The Medicare Registration can be reached at 1-800-772-1213.  The office has hours of 7am to 7pm and service they provide will walk you through an application process.  Of course, you can take the old-fashioned way and head to the Social Security office and wait in line.  These processes all vary in the amount of time they can consume but the fastest process is generally over the phone or website.

Preparation is key.  Now that you have a good understanding on the options you will need to select from, you will want to weigh these decisions out.  There are pros and cons to the coverage choices and realistically you want to pick out the one that fits best for you.  However, something to consider is that with age, comes additional health risks.  Rejecting valuable coverage can leave someone in financial ruin without insurance to pay the difference in cost.  By utilizing your knowledge of your needs, and with being proactive in your approach, you will be able to feel confident and empowered in your decisions.  Seeing your friends or family members impacted by a terminal condition or an ongoing health issue may have already led you to see this.  It is all the more important for you to consider your options.  Another benefit of Medicare is that each year you can adjust the coverages from those you have selected the year prior.  Regardless of this opportunity, be careful to say “maybe next year I’ll add Part C,” as the year passes, emergencies can arise. At this important juncture in your life, it is important that you feel poised to handle your own Medicare benefits without the fear of being taken advantage of.  The more you know, the better you can protect yourself.  Knowledge is power, and with age comes wisdom, so you’re likely to make the right decision with all that you’ve learned.

Medicare Open Enrollment Dates

Each year there is a specific time that Medicare allows for Open Enrollment. You may be asking yourself what exactly that term means. You may have seen it when you were employed at a company where it essentially meant there was a time of year (generally less than a month) where you could make changes to your health benefits. If you needed to include a new coverage or decline one, that was the time to do it. Medicare operates similarly. There is an Open Enrollment period that allows for those enrolled in Medicare to elect separate coverages to ensure they have the protection that they want and need. This time is an established duration set by the government to benefit those who may have new concerns about the future of their health and wish to protect themselves further.

Medicare’s Open Enrollment period runs a little longer than your employer’s may have. Think about how many individuals are enrolling and making changes in the Medicare system, there is time to allow for everyone to choose what is right for them. The annual enrollment period for Medicare is set from October 15th to December 7th each year. During this time, you can decide that you may want to switch to a Medicare Advantage plan from the Original Medicare plan you were enrolled in previously. This is Part “C” of Medicare. The Medicare Advantage is an elective coverage that can range in cost of premium for individuals who would like more flexibility and coverage than what Medicare Part A and Part B Cover. This means for you that if you had Medicare Original that with adjusting to the Medicare Advantage, you can work with a private insurer to acquire coverages that you may not have had in your standard plan. This sometimes includes coverage for vision, hearing, dental, and health and wellness programs.

During Open Enrollment over 34% of beneficiaries from Medicare enroll in a Medicare Advantage Plan. These dates are specifically important to write down so that the preparation of the plan goes into place. There’s another option to enroll in Medicare Part D which covers the cost of prescription drug coverage. Something to keep in mind is that if you didn’t not enroll in this when you were initially eligible, a fee may be assessed.

What if you are already enrolled in the coverages that you like and you don’t want to change or remove any coverages or parts that you have in your plan? Your concern may be whether or not there’s anything you have to do on your own. If you do not want to make a change, you do not have to make a change. Your annual plan should automatically renew and continue moving into the following year. Something to be conscious of is paying the premium due. If the premium is not paid, the policy will cancel for non-payment. As long as it is continuing to be paid, the status of the policy will remain in good standing and it will be one less thing that you need to worry about. Although the policy renews automatically, it is important to read your renewal documentation and review the coverage choices on your plan. The plans can still evolve year over year and have differences from the coverages you had in the past. You can still change your coverage if you identify this later on, however, you don’t want it to get too far later on before do anything about it.

If you are a little late to the game and identify after the cut off of December 7th that your coverages aren’t quite what they were the year before, you do have the option with Medicare Advantage to change them once more at the beginning of the year. From January 1st to March 31st, the first quarter, you are permitted to make one change from Medicare Advantage carriers to a different company. You can also change from Medicare Advantage to the Original Plan during this time as well. During the annual Open Enrollment period, you are able to change your mind on your coverages as many times as you would like. During the first quarter, because this is a “second chance,” so to say, you only will have one opportunity to change the coverage to the correct designation of your choosing. After this is selected, unless you qualify for a special enrollment qualification, this is the coverage that will see you through to the end of the year.

If this is your first time being eligible for Medicare, the options are a little bit different. You do not need to wait until the Open Enrollment dates. You instead, must sign up and enroll within a 7-month period. The period is outlined as the first 3 months leading up to your 65th birthday, the month of your 65th birthday, and the 3 months following your 65th birthday. This time is very important to enroll during if you are just turning 65 and meeting the criteria for eligibility. If you miss this time frame because you were too busy celebrating this big milestone, you can still sign up during Open Enrollment. They won’t let you away without a slap on the wrist though. Keep in mind that if you miss the required enrollment dates at the initial eligibility, you will be assessed a fine for late enrollment.

These dates may feel overwhelming initially to remember. However, this can be kept pretty simple. When you initially are eligible, do not wait. Enroll immediately to avoid any fees that will end up costing you more than you would normally just pay with your premium. If you are already enrolled, remember around Halloween, you should be checking those coverages to make sure you’ve got what you need. If everything looks good, there’s no need to worry. If you realize then, essentially you have until March 31st to make a final call before you are committed to the coverages for the rest of the year. This will be easier to remember as the years go on and your insurance provide with Medicare Advantage will be prompt in sending you out your renewal documentation, just make sure not to file it in the trash can. Take a look over your coverages and take advantage of Open Enrollment. Your coverages matter and while we’d like to be able to change our coverages after a life-threatening event, we are never able to. Being proactive and being aware of the coverages is the best way to stay prepared and protected.

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