Do I Need Supplemental Insurance With Medicare Advantage
- Asked April 15, 2013 in
Contact J Scott Burke Contact J Scott Burke by filling out the form below
J Scott BurkePROPresident, Newbury Inc., Evansville, IndianaNo you do not need supplemental insurance when you are on Medicare Part C aka:Medicare Advantage. In fact if you keep your Medicare Supplement while you are on Medicare Advantage it will not pay anything. Medicare Supplements only pay the gaps after Medicare A& B pay their part. When you are on Medicare Advantage, A& B do not pay at all.Answered on April 16, 2013+1
Contact Ted Ratliff Contact Ted Ratliff by filling out the form below
Ted RatliffPROOwner, SFS Associates, You do not need and it is actually unethical and against Medicare guidelines to sell you a Medicare Supplement with a Medicare Advantage Plan. There are some policies that will help pay some of the out of pocket costs of a Medicare Advantage and in some cases they may be a good option. These are not Medicare Supplements. If however the premium gets too high you are better off in a Medicare Supplement plan rather than a Medicare Advantage rather than pay a premium for the supplemental hospital coverage, Make sure you have a good agent who can help you decide your best options based on your individual situation.Answered on April 16, 2013+0
The Cares Act Of 2020
On March 27, 2020, President Trump signed a $2 trillion coronavirus emergency stimulus package, called the CARES Act, into law. It expanded Medicare’s ability to cover treatment and services for those affected by COVID-19. The CARES Act also:
- Increased flexibility for Medicare to cover telehealth services.
- Increased Medicare payments for COVID-19-related hospital stays and durable medical equipment.
For Medicaid, the CARES Act clarified that non-expansion states can use the Medicaid program to cover COVID-19-related services for uninsured adults who would have qualified for Medicaid if the state had chosen to expand. Other populations with limited Medicaid coverage are also eligible for coverage under this state option.
Do not pay a Medicare broker directly for their assistance. They are paid by the insurance company to sell their insurance. If you suspect Medicare Advantage fraud, please call the Medicare Drug Integrity Contractor at 1-877-772-3379.
Original Medicare Doesnt Include An Out
Under Original Medicare, there is no out-of-pocket spending limit. That means you could potentially face Medicare costs that continue to pile up. A Medigap plan may help alleviate that concern.
Additionally, two Medigap plans Plan K and Plan L include an annual out-of-pocket spending limit. Once you reach this limit in a calendar year, the plan then pays for 100% of all covered out-of-pocket costs for the remainder of the year.
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A Great Idea For Some But Not For Others
Supplemental insurance is extra or additional insurance that you can purchase to help you pay for services and out-of-pocket expenses that your regular insurance doesn’t cover.
Some supplemental insurance plans will pay for the out-of-pocket cost-sharing that goes along with your health insurance plan , or for medical services that your health plan doesn’t cover at all, such as dental and vision costs.
Other supplemental plans may provide you with a cash benefit paid out over a period of time or given to you in one lump sum. The cash can be used for:
- Covering lost wages
- Transportation related to your health condition
- Food, medication, and other unexpected expenses you have due to an illness or injury
Are Medicare Advantage Plans Worth It
Part C is also known as an Advantage plan. These plans include the same benefits as Original Medicare and often provide prescription drug coverage and other perks, including dental, vision, and hearing.Advantage plans can work well for some individuals.
If you have an Advantage plan, it acts as a substitute for Original Medicare, meaning you wont need Medigap. However, youll want to make sure your preferred doctors are in your network.
Also, keep in mind that youll likely need a referral from your Advantage plan to see a specialist. So, these plans are better suited to healthier individuals who dont need to see many doctors.
If youre choosing between Medigap and Advantage plans, make sure to keep your future health and budget needs in mind as well as your current circumstances.
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Medigap Plans Cover Some Of The 20% Gap In Orginal Medicare
There are 10 lettered Medicare supplement plans . Each lettered plan represents a standardized insurance policy and covers the nine gaps in Medicare. These gaps include:
Medicare Part A is your hospital inpatient coverageMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care…. and Medicare Part B is your medical coverage. Without additional coverage, you are responsible for the shared costs listed above. This surprises many people getting their Medicare benefits for the first time. And thats why its so important to understand one basic fact.
What Does Medicare Supplement Insurance Cost
The primary goal of a Medicare Supplement insurance plan is to help cover some of the out-of-pocket costs of Original Medicare . As a general rule, the more comprehensive the coverage, the higher the premium, however, premiums will also vary by insurance company, and premium amounts can change yearly.
Do I Really Need Supplemental Insurance With Medicare
In the matter of your health care, its better to have extra protection. Having only Medicare may not be enough to protect you from large medical bills. Medicare covers only a portion of your medical costs.
Thus, leaving you with the remaining portion of the bill, in addition to any unmet deductibles or copayments. The best option would be to get an additional plan that can cover your medical costs.
Is Medicare Part D Worth It
If youre going with a Medigap plan rather than Advantage, prescription drugs wont be covered. Therefore, its advised that you enroll in a Part D plan. If you delay enrollment, you could face a penalty for the life of your policy.
If you dont take any medications, you might wonder why you would enroll in such a plan today. In reality, it can easily be worth it, considering the money you could save on future penalties.
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Who Is Eligible For Supplemental Insurance
Anyone who has Medicare Part A and Part B is eligible to apply for a Medicare supplement plan. However, you need to qualify for coverage with the private insurance company. When you first turn 65 and sign up for Medicare Part B, you have a Medigap open enrollment period that lasts six months. During this time, you could sign up for any Medigap plan in your area and the insurer must accept your application, even if you have preexisting health conditions.
After the open enrollment period, you can still try signing up for a policy, but the insurance company could ask you questions about your health for underwriting. If you have preexisting conditions, they could increase the premium or even deny giving you a policy.
How Do I Enroll
You can buy a Medigap policy from any insurer that is licensed to sell them in your state. But, an insurer cannot sell you a Medigap policy if you have Medicare Advantage unless you are in the process of switching back to Original Medicare.
Also, not all insurers offer all plans in all states. You can find what ones are available in your state on the Medicare website.
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How To Find Out If A Medicare Supplement Is Worth It For You
It is better to have some protection when it comes to your healthcare than it is to have no protection. Enrolling in a plan will help give you peace of mind and financial security. Medicare Supplement plans are worth it doctor freedom, low out of pocket costs, and when Medicare pays the claim, your supplemental Medicare plan will pay the rest.
Our team of experts is ready to answer your questions are share the most popular Medigap plans in your area. Call us today to find out if Medicare Supplements are worth it for you!
Medicare Provides Affordable Health Insurance To Approximately 626 Million People Read This Article For A Complete Overview Of The Medicare Program And The Procedure To Sign Up For Medicare
Medicare, a federal social insurance program, was established in 1965. Its goal is to provide health insurance to the elderly and disabled. Unlike Medicaid, Medicare is not restricted to people with low incomes or those living in poverty. However, a sizable number of people meet the eligibility requirements for both programs.
In 2020, 62.6 million people were enrolled in Medicare, accounting for 18.4% of all people in the United States. Around 54 million of them received benefits due to their age, while the remainder received benefits due to various disabilities. Maine and West Virginia had the highest percentages of Medicare beneficiaries in their populations, with 24 and more percent of the population enrolled. California had the highest number of Medicare beneficiaries, with over 6.2 million.
Medicare has proven to be beneficial to many Americans, but the question remains: how does one sign up for Medicare? Read on for a comprehensive guide to Medicares eligibility criteria and how to sign up for medicare.
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Medicare Sign Up: What You Cant Do
The annual Medicare open enrollment period does not apply to Medigap plans, which are only guaranteed issues in most states during a beneficiarys initial enrollment period and for a limited time during special enrollment periods.
If you did not enroll in Medicare when you first became eligible, you will be unable to sign up during the fall open enrollment period. Instead, youll take advantage of the Medicare general enrollment period, which runs from January 1 to March 31.
The general enrollment period for Medicare is for people who did not sign up for Medicare Part B when they first became eligible and do not have access to a Medicare Part B special enrollment period. It is also for people who have to pay a premium for Medicare Part A but did not enroll when they first became eligible. If you sign up during the open enrollment period, your coverage will begin on July 1.
Costs Without A Supplement Plan
Without a Medigap Plan, youll be responsible for deductibles and coinsurance. These out of pocket costs can stack up, so you need to be aware of potential costs.
Medicare Part A
In 2021, the deductible for Medicare Part A is $1484. As a reminder, your deductible is the amount that you must meet out of pocket before your insurance kicks in. This is not a once yearly deductible. It is applied to each hospital stay. So, if you have to visit the hospital for an overnight stay more than once in a given year, you will be responsible for meeting that deductible each time .
For the first 60 days in the hospital, you will not be charged . After that you will be charged coinsurance based on your length of stay. Honestly, its very unlikely that you would be held in the hospital for such an extended period of time. You would most likely be transferred to some type of skilled nursing facility and for that, there can be charges.
Medicare Part B
Medicare Part B also has a deductible and coinsurance to be aware of. In 2021, the deductible for Medicare Part B is $203. Unlike Part A, this is a once annual deductible, so its really not that big of a deal. You really need to be aware of Medicare Part B coinsurance.
Finally, be aware that with Original Medicare, there is no out of pocket maximum.
What Is The Cost Of Supplemental Health Insurance For Seniors
The average cost of supplemental health insurance for seniors will depend on where you live, the health insurance company, type of plan, and benefit level you select. While these amounts will vary greatly, we can still give you an idea what you may spend. These average monthly premium price can range from $150 to $200.1
Who Is Eligible For Medicare Supplement Insurance
If you are age 65 or older and enrolled in Original Medicare Part B, you may be eligible to enroll for Medicare Supplement Insurance. You can apply for a Medicare Supplement plan at any time throughout the calendar year, but during your 6-month open enrollment period, you can buy any policy offered in your state and you are guaranteed coverage even if you have pre-existing health conditions.
- If you are retiring at 65 and applying for Medicare Part B, your open enrollment period lasts for 6 months starting the first day your Part B coverage begins.
- If you are not retiring until later and still getting medical coverage under your employers insurance, then your open enrollment starts when you do retire and sign up for Part B coverage.
Medicare Supplement plans are also available to you if youre younger than age 65 and eligible for Medicare due to disability.
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Are There Alternative Insurance Programs
Besides Medigap, you could also cover your retirement health insurance costs through a Medicare Advantage plan. Medicare Advantage is private health insurance. Through this program, you would leave traditional Medicare and instead have the private insurer pay for your health care bills. The government also sets up regulations so the Medicare Advantage coverage must be similar to Medicare.
Medicare Advantage policies typically have a bit more flexibility than Medigap and can include extra benefits such as dental, vision and prescription drugs. They may also charge a lower monthly premium than Medicare supplement plans.
The downside of Medicare Advantage is that you would need to renew your policy each year during an annual enrollment period. The insurance company can change your benefits or even cancel the plan altogether during this time, so you may need to find a new one in such an event. The co-payments and deductibles can also be higher for Medicare Advantage than for Medigap.
Medigap & Medicare Advantage Plans
Medigap policies can’t work with Medicare Advantage Plans. If you have a Medigap policy and join a
, you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.
If you want to cancel your Medigap policy, contact your insurance company. If you leave the Medicare Advantage Plan, you might not be able to get the same, or in some cases, any Medigap policy back unless you have a “trial right.“
If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to
. Contact your State Insurance Department if this happens to you.
If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you’re able to disenroll.
If you join a Medicare Advantage Plan for the first time, and you arent happy with the plan, youll have special rights under federal law to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining.
|If you dont drop your Medicare Advantage Plan and return to Original Medicare within 12 months of joining, generally, you must keep your Medicare Advantage Plan for the rest of the year. You can disenroll or change plans during the Open Enrollment Period or if you qualify for a Special Enrollment Period. Depending on the type of Special Enrollment Period, you may or may not have the right to buy a Medigap policy.|
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Im Retired Do I Need A Medicare Supplement Insurance Plan
Are you retired, or thinking about retirement, and wondering if you need a Medicare Supplement insurance plan? The answer involves a look at your personal circumstances and a little educated guesswork into the future. It might seem scary, trying to figure out what kind of Medicare and related insurance you need when you retire but you can generally make a plan based on your past and present health-care needs and costs, and your budget.
Before you can get a Medicare Supplement insurance plan, you need to be enrolled in Original Medicare, Part A and Part B. So, if:
- Youre eligible for Medicare but youre not yet retired, and
- You havent enrolled in Medicare Part B because youre still on your employers plan
- Or, whether retired or not, youre not enrolled in Medicare Part A and Part B
then youre not yet eligible for a Medicare Supplement insurance plan, as you must be enrolled in both Medicare Part A and Part B.
But lets suppose you are enrolled in both Medicare Part A and Part B. That coverage typically pays a portion of many health-care expenses, leaving you responsible for deductibles, copayments, coinsurance and sometimes other health-care costs. In other words, you pay the out-of-pocket expensesout of your pocket.