Medicare Supplement Insurance is often called Medigap so that is how i will refer to it here , if only because it is short and simple and that is our goal going forward to help make Medicare and Medigap easy to understand.
We look forward to discussing you and your needs , answering questions you have and we will explain Medicare coverage , and the importance of having a Medigap plan along with additional coverage that you may want to consider going forward.
Medicare has evolved over the years like everything does . It is much easier to discuss and explain the nuts and bolts when we talk , but i will give a short explanation below on Medicare Part A and Part B.There are many more details on each but we can explain and answer questions anytime just call us.
Medicare Part A is your hospital coverage , you get in-patient care in a semi private room with a bed and regular meals , skilled nursing , immediate or acute care of an injury or illness.
Medicare Part A covers some home health care services received in the hospital or immediately following an inpatient stay. This includes skilled nursing care, medical social services, and physical therapy. Home health aid services are generally only covered where skilled nursing is required.
Note outpatient surgery is sometimes handled under Part A and other times under Part B , that can make you scratch your head. The best way to figure out if it will be considered Part A or B is to call your Medicare Insurance carrier , give them the procedure code and they will clarify.
Medicare Part B is for your out-patient medical services which covers preventive care including mammograms , colonoscopies, flu shots , even prostate specific antigen (PSA) blood tests and much more. It covers ordinary outpatient things like doctor’s visits, lab testing, home health care, and some chiropractic care.
Medicare Part B also covers radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, osteoporosis injections, infused drugs, antigens, and insulin used with an insulin pump.There are some outpatient drugs which are handled under Medicare Part D.
Medicare Part C is often referred to as Medicare Advantage . Medicare Advantage must cover everything that is covered by Medicare A & B , but the out of pocket costs can be higher compared to Parts A & B when combined with a Medigap policy. Most Medicare Advantage plans also include Part D prescription drug coverage . You may also get coverage for additional benefits such as dental, hearing, vision, and wellness programs.
The many different Medicare Advantage Plans are all with private carriers who contract through Medicare , and are managed as one of the following Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
There are pros and cons to Medicare Advantage , some Advantage plans offer zero premiums which could be considered a pro.These plans can have unexpected high out of pocket expenses in the way of copays and co-insurance.The coverage is 80% on the Insurance carrier and 20% your responsibility which is made up as copays and co-insurance. There is a maximum out of pocket of $ 6700 for in network and $ 10,000 out of network per year.Most plans require you to go to their network of doctors and health providers. An example of problems with Advantage is if you are having skilled care for rehabilitation for a broken hip and after a few sessions a utilization reviewer with your Advantage plan decides the care is no longer ” medically necessary ” any further sessions will be on you . Coverage while traveling is questionable and better safe than sorry if you will be traveling out of state, contact your Medicare Advantage plan for more information on coverage while out of your plan’s service area.
Part D is the prescription drug plan. If you are eligible for Medicare coverage, you are also eligible for the Part D Medicare drug benefit , you must be enrolled in Medicare Part A and or Part B to enroll in Part D.
Medicare Part D covers most drugs commonly prescribed for folks on Medicare , there is a list with specific brand names and generic prescription names that are currently covered as determined by federal standards. Medicare Part D is specific in what drugs are not covered as drugs not covered under Part A or Part B , drugs not on the plans drug list , and any drugs excluded by medicare. All that being said it would be in your best interest to check with your plan’s carrier for clarity , but suffice to say the majority of the most common drugs are covered.
Medicare Supplement Insurance is often referred to as Medigap .There are many reasons why Medigap is your best option if you want better coverage , your choice of doctor , with no networks , no referrals needed , no pre-authorization required , and no problems on traveling in the continental USA if you use a Doctor that accepts Medicare which 9 out of 10 still do. In a nutshell , for predictable out of pocket expenses choose a Medigap plan.
Medigap is a supplemental insurance to your Medicare coverage , it is extra insurance you buy to cover the gaps. It is designed to provide more coverage for routine services that Medicare covers and in some cases all or part of the expenses that Medicare does not cover. Medigap plans A thru N are all thru private carriers , Plans E , H , I , and J are no longer available to new subscribers. The plans A thru N are available thru many Insurance companies or carriers , though not all carriers offer all plans or offer the plans in all states. The interesting part here is that the premiums will vary among the carrier on each plan but in that plan the benefits are always the same , except in Massachusetts , Minnesota and Wisconsin , in all other states each plan type is identified by a letter and has different standardized basic benefits. This means that no matter which insurer you buy from, the basic benefits of each plan type of the same letter will be the same.
Sort of reminds me of 32 flavors of ice cream , but with Medigap the options are easier to understand since there are only 10 and each offers different benefits , technically there are still 10 BUT As of 2020, both Plan F and Plan C are no longer available except for folks eligible for Medicare Part A prior to 2020 and they will continue to have options to enroll in Plans C and F .
The best time to buy a Medigap plan is during the open enrollment period which is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B or within six months of signing up for Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays. If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage and if you do get covered, your rates will likely be higher.
The differences in the plans benefits are in the co-payments , co-insurance, deductibles , foreign emergency travel coverage and pints of blood when needed.
We look forward to speaking to you , discussing your needs and seeing what will be your best plan going forward.It is much easier to talk about the differences than to write a novel here trying to explain all the details of each plan.