Helping Seniors Navigate the Medicare Maze!

More individuals than ever before are turning 65 and becoming eligible for Medicare.  By 2030, 80 million people in the United States will turn 65 years old.  If you are approaching 65, you are probably being inundated with calls and mail, which can make it difficult to figure out which path to take.  Finding an agent who can help you navigate the Medicare maze should be a priority. 

I am about to provide you with some valuable advice.  You may even want to save it for future reference.  

If you are coming off a group plan and transitioning to Original Medicare, there is a possibility you will be eligible for Guaranteed Issue Medicare Rights (Medigap protections).  If you would like more information, please click here.

Navigating the Medicare maze

Discussing Part A, B, C or D, Medigap, Medicare Supplements, initial enrollment period, or Original Medicare can be confusing.  At MWG Senior Services, helping seniors navigate the Medicare maze is our specialty.  So, let’s get started.

Original Medicare is health insurance coverage managed by the federal government.  The two main parts are Part A (Hospital Insurance) and Part B (Medical Insurance).  Part A covers care in a skilled nursing facility, inpatient hospital stays, hospice care, and some home health care.  A rather large number of US citizens will not be required to pay for their Part A monthly premium.

Premium-free qualifications for Part A at 65 years of age:

  1. If you or your spouse has worked 40 or more quarters paying Medicare taxes.
  2. If you receive retirement benefits from Social Security or the Railroad Retirement Board.
  3. If you are eligible to get Social Security or Railroad benefits, but haven’t filed for them yet.

If you OR your spouse had Medicare-covered government employment.

Premium-free qualifications for Part A if you are UNDER 65 years of age:

  1. If you received Social Security or Railroad Retirement Board disability benefits for 24 months.
  2. If you have End-Stage Renal Disease (ESRD) and meet certain requirements.

Part A Premiums

According to Medicare.gov, if you paid Medicare taxes for less than 30 quarters (7 ½ years), the standard Part A premium is $413 in 2017. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $227.  But in most cases, if you choose to buy Part A, you must also purchase Medicare Part B (Medicare Insurance).  You will be required to pay monthly premiums for both.

Part B Premiums

Historically, Part B premiums have increased every year.  In 2017, the Part B premium is $134 (or higher depending on your income).  If you are currently receiving Social Security benefits, you could have a decreased Part B premium. 

In Original Medicare, Part B will cover certain doctor services, outpatient care, medical supplies, and preventive services. 

Two types of services Part B can cover:

  1. Medically necessary:  Services or supplies needed to diagnose or treat your medical condition which meet accepted standards of medical practice.
  2. Preventive:  Services which provide healthcare to prevent illness (like the flu), or detect it at an early stage when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a healthcare provider who accepts assignment.

What Original Medicare (Part A & Part B) doesn’t cover

It’s no secret that Original Medicare doesn’t cover everything, nor does it pay in full.  You could be stuck paying out-of-pocket for the portion not covered by Medicare, unless you have other insurance (Medicare Supplement or Medigap policy), or you’re in a Medicare health plan (like Medicare Advantage Plans).  With Original Medicare, you could be responsible for your deductible, coinsurance, or copay.  Purchasing a Medicare supplement or Medigap policy can help pay some of the healthcare costs that Original Medicare doesn’t cover.

Also, when you purchase a Medicare Supplement, such as a Medigap policy, it could cover up to 20%.  This could help you have less out-of-pocket expenses when your personal health isn’t at its best.  For instance, a Plan F Medicare Supplement would insure maximum coverage. 

You can purchase a Medicare Supplement at any time during the year, unlike Medicare Advantage plans (Part C).  All Medicare Supplements are standardized, so a Plan F with one carrier has the same coverage as a Plan F with any other carrier. 

Plan G is also very popular because the only difference between a Plan F and a Plan G is the Medicare Part B deductible cost.  With Plan F, you pay nothing, but with Plan G, you pay a one-time cost of $183 (current cost as of 2017) for Part B services.  This deductible typically changes and starts over on January 1st of each year. 

These plans are considered portable because you can use your insurance in any state in the US, as long as the doctor accepts Medicare.  Medicare Supplements typically don’t cover long-term care, vision, dental, hearing aids, eyeglasses, private-duty nursing, or Prescription Drug Plans (Part D).  You can purchase these as stand-alone policies if it fits your needs.

To compare prices of different Medicare Supplement plans and carriers located in your area, click here.MWGSSMedicareMazeVideo2

 

Part D (Prescription Drug Plans)
Prescription Drug Plans are important and you will need to make sure the plan you choose is considered creditableprescriptiondrug coverage.  If you don’t have creditable prescription drug coverage, you could pay a late enrollment penalty.  This means, you will be required to pay a higher monthly premium and that penalty continues each year.   We suggest, if you are currently not taking any drugs, you will still need a low-cost premium plan to prevent having to pay high or late enrollment penalties later in life.   Medicare multiplies 1% of the national base beneficiary premium by the number of full, uncovered months you didn’t have Part D or creditable coverage.  That amount is added to every monthly premium for the remainder of the service. This can be an issue for those on a strict budget, therefore, we want to help prevent you from being penalized.

Medicare Advantage (Part C) plans administer Original Medicare (Part A & B).  Most Medicare Advantage plans offer prescription drug coverage.  With Part C plans, you must have a primary care physician and you may have to be referred before you can see a specialist.  You must also choose a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service Plan, Special Needs Plan, and Medicare Medical Savings Account Plan.  These plans are not typically considered portable because of the network stipulations and regulations.  

Initial Enrollment Period

If you are new to Medicare, turning 65, and ready to hop on the Medicare bandwagon, you can sign up for a Medicare Advantage or Part D (Prescription Drug Plan) during your Initial Enrollment Period.  Your Initial Enrollment Period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.  

Open Enrollment Period

Medicare Supplement (Medigap policy) plans have a different time period that you can sign up with no health questions.  When you first enroll in Part B, you can enroll in a Medicare Supplement with no medical underwriting starting 6 months before your Part B effective date until 6 months after your Part B effective date.

There are definitely different ways you can obtain creditable coverage and navigate the Medicare maze.  Everyone’s situation is different and there isn’t one option made to fit all.  We advise you to look at a several different avenues to see which option best fits your needs. I hope the information you take from our blog will leave you more knowledgeable and happy!  Life is too short to worry about which road to take when navigating the Medicare maze.  Give us a call at (877) 759-5760 or send us an email at seniorservices@morganwhite.com.  Be sure to mention that you heard about us through our blog.  Have a great day!

Source:  Medicare.gov

Medicare Supplement

Medicare Supplement Insurance is secondary insurance to Original Medicare. These plans are sold by private insurance companies to fill in the gaps of Original Medicare that you are required to pay.  These plans are regulated federally but can also have state regulations that govern how insurance companies can sell the plan in their state. An example would be the state of Texas not allowing Texas Medicare Supplement Insurance to price their plans by “Gender”.  This means a male and female pay the same rate.

Medicare Supplement Insurance Benefits

  1. Guaranteed Renewable – the insurance companies can not drop your policy.  These plans will be there as long as you pay your premium.
  2. Standardized – benefits are the same between companies so it makes Medicare Supplement comparison much easier than a traditional health insurance policy.
  3. Electronic Claims – you do not have to file claims, they are filed electronically.
  4. Open Enrollment Period – the open enrollment period for Medigap plans allows you to join a policy with no health questions for 6 months.  This is a huge benefit for someone with health problems.

Medicare Supplement Rates

If you have realized that Medicare Supplement plans are standardized you probably realize that they only difference between plans is their rate and financial stability!  Comparing rates is important because there is no need to pay more than necessary for the policy.

In Mississippi, the lowest plan F is about $105 per month and the highest plan F is about $180 per month.  There is no difference in benefits yet there is a $75 per month or $900 per year difference.  Make sure you compare plans before signing up.  To compare plans online go to out MEDICARE QUOTE ENGINE!  To speak with someone on the phone call 1-877-936-2991!

Medicare Supplement Outline of Coverage

Medicare Supplement Outline of Coverage

For more information on Medicare Supplement insurance contact our accredited advisors at 1-877-936-2991.

High Deductible Plan F

If you are in the market for a Medicare Supplement with lower premiums, you should consider the high deductible Plan F or the Plan N Medicare Supplement.  Both of these plans allow you to go to any doctor or hospital that accepts Medicare, they both limit your out of pocket maximum, and they are standardized plans that are regulated both federally and on a state level.

High Deductible Plan F Benefits

The high deductible Plan F has the same benefits as the Plan F; however, the difference is the $2,110 deductible that is applied before coverage begins.  This should lower your premium drastically usually by 70%.  In the state of New York, we have seen policies go from $300+ a month to around $110 per month with companies like Humana when choosing the high deductible plan F.

Things to consider when applying for medigap insurance

Something to consider would be choosing the Plan N Medicare Supplement over the High Deductible Plan F. Since the premiums are comparable and there are less out of pocket costs with the Plan N it makes it a little easier on the budget when health issues arise.  The Plan N covers the Part A deductible and 20% co-insurance where the Plan F High Deductible gives you a deductible that is for both parts of Original Medicare.

The Plan N only has a deductible of $147 and a $20 co-pay when you visit the doctor.   So in a nutshell, your deductible is reduced by roughly $2,000 dollars and you are only responsible for a $20 co-pay when you see the doctor.  This is less drastic than a $2,100 deductible.  However, the premiums will be roughly $20 – $30 higher per month for this plan ($360 a year on a high guesstimate).

High Deductible Plan F vs. Plan N Example

Here are two examples of Medicare Supplement Rates and the differences between a High Deductible Plan F and a Plan N.

Mississippi Medicare Supplement Rates – Example April 2013

Plan N Medicare Supplement – 65 Female is $73.73 per month

Plan F (High Deductible) – 65 Female is $43.40 per month

California Medicare Supplement Rates – Example

Plan N Medicare Supplement – 65 Female is $90 per month

Plan F (High Deductible) – 65 Female is $46 per month 

High Deductible Plan F

The Plan F and the High Deductible Plan are two very well known Medicare Supplement Plans.