Tuesday, August 2, 2022

Do You Really Need Supplemental Insurance With Medicare

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Things To Consider Before You Buy A Plan

Medicare Supplemental Insurance – Medigap: Do You Really Need It? Part 3
  • You must have Medicare Part A and Part B .
  • If you have a Medicare Advantage plan, you can apply for a Medigap policy, but make sure you leave the MA plan before your Medigap plan starts.
  • You pay the private insurance company a monthly premium for your Medigap plan in addition to the monthly Part B premium you pay to Medicare.
  • A Medigap plan only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  • You can buy a Medigap plan from any insurance company that’s licensed in your state to sell one.
  • Any standardized Medigap plan is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap plan as long as you pay the premium.

Are Medigap Plans Worth The Cost In All States

The federal government regulates the benefits of all the plans, but it doesnt have any influence on their costs. The plan rates vary in different insurance companies and states. For example, Medigap costs are different in Louisiana than they are in South Dakota.

The insured should consider comparing different companies to avoid overpaying for what they need. Comparing prices includes checking how insurance companies price their policies as well as the features that would contribute to increased rates.

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Remember that the cost also varies from one letter plan to another So, if you find a Plan G cheaper than a Plan F, you should see what both companies are offering the Plan G and Plan F for, then you can make the best decision.

Are Medicare Advantage Plans Worth It

Medicare 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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How Much Does A Medicare Supplement Plan Cost

The estimated average monthly premium for a Medicare Supplement plan can range from $150 to around $200, depending on the state you live in and your insurer.

Just like Medicare Advantage plans, its good to shop around65-year-olds stand to save an average of $840 a year with Medicare Supplement Plan G or $648 a year with Plan N if they enroll in the lowest-cost option available in their areas, according to a price comparison analysis by eHealth, Inc.

We continue looking at how private plans and Medicare can be more efficient, effective and equitable for people, says Jacobson. The good story here is in the data. Weve seen pretty consistently that inequities are much smaller in Medicare than any other source of coverage.

Medicare Advantage vs. Medicare Supplement: Which Is Right For You?
Medicare Advantage Medicare Supplement
  • $0 deductible for many plans, no copay for a primary doctor, low copays for a specialist
  • Restricted choice of providers, hospitals and suppliers
  • One-stop-shop coverage, but must also be enrolled in Medicare Parts A and B
  • Most policies include Part D prescription drug coverage, as well as some vision, hearing, dental and fitness benefits
  • Some plans offer extra benefits
  • Some plans offer out-of-network provider coverage
  • Predictable monthly payments
  • Plans K and L offer annual out-of-pocket limits
  • Small percentage of plans offer nontraditional benefits like hearing, dental and vision
  • International travel coverage

Is Supplemental Insurance Worth It

Don

It depends. Most seniors do supplement Medicare in some way. Those that dont have access to group health coverage will often invest in a Medigap policy to supplement Original Medicare or Medicare Advantage plan in lieu of Original Medicare. The right choice between these two really hinges on what you need. Medicare Advantage has lower premiums, which can keep costs down for healthy seniors. Medigap has higher premiums than Medicare Advantage plans. But those higher premiums may be worth it when:

  • You have health issues that require frequent doctor visits.
  • You travel frequently out of your home state or out of the country.
  • You prefer to choose your own doctors and specialists, rather than seeing only the healthcare providers that are in your plans network.

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How Does Medigap Serve Or Help Me

Medicare coverage lasts for the rest of your life. As you age, doctor visits and hospitalizations may increase. But, it is impossible to project your future healthcare needs.

Medigap policies work hand-in-hand with Original Medicare to limit your exposure to unexpected out-of-pocket medical costs. You decide how much you want to be covered and what premium you want to pay.

What Are The Parts Of Medicare

There are four parts to Medicare that ensure that individuals will be taken care of in all departments. Part A and B , also called original Medicare, supply inpatient/hospital coverage and outpatient/medical coverage . Part C also called the Medicare Advantage plan, allows an alternative way to receive your Medicare benefits. Lastly, Part D provides prescription drug coverage. Considering the different options of Medicare programs, you may ask yourself, Why would I need supplemental insurance?

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Do I Really Need A Medicare Supplement

David Belk, a doctor and anti-supplement activist says, If you have Medicare and buy a supplemental policy with your own money, you are effectively giving an insurance company your money so that they can keep it.

Wow. This statement is moving. For those who have had a Medicare Supplement Policy for years, it slaps you in the face with regret.

And for those who may not be on Medicare and have yet to purchase Medicare Supplement Insurance, it frees you. It justifies a decision that will save you money on premium month to month.

However, it is not entirely true. He has a point, butultimatelyit represents a fundamental misunderstanding of what insurance is.

How Long Do You Have To Sign Up For Medicare Part B

Do I Need a Medicare Supplement Plan? The Truth About Medigap Plans….

You are able to sign up for Part B anytime you have current employer health coverage. Once employment ends, you will have eight months to sign up for Medicare Part B without having to pay a penalty. If you are enrolled in Medicare and another health plan, one of your insurers is the primary payer. The other is the secondary payer.

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Open Enrollment Vs Annual Election Periods

Dont confuse your Medicare Supplement Open Enrollment with the Annual Election Period in the fall. The period that runs from October 15th December 7th every year is for changing your Part D drug plan or Advantage plan.

Heres what its NOT:

It is NOT a time when you can apply for any Medigap plan and get approved without having to answer health questions. No annual period for that exists. Your only period to do that in most states is the one-time 6-month window that I mentioned above.

In a couple of states of like California and Oregon, there is an annual 30-day period when you can enroll in a Medigap plan without health questions, but ONLY if you already have a Medigap plan and are switching to an equal or lesser plan. It does NOT apply to people who want to switch from no coverage or Medicare Advantage coverage over to Medigap coverage. That kind of switch generally requires you to complete a full application with health questions.

Coverage Gaps In Original Medicare

People can receive Medicare benefits in one of two ways: Original Medicare or Medicare Advantage.

Original Medicare, also known as traditional Medicare, consists of Part A and Part B. At age 65, you can automatically be enrolled or manually enroll in Original Medicare.

Original Medicare has several out-of-pocket costs, including monthly premiums, annual deductibles and copayments for doctor services.

Unlike Medicare Advantage, there is no yearly out-of-pocket maximum in Original Medicare.

These gaps in Original Medicare insurance can quickly add up, especially if youre in poor health or on a fixed budget.

2022 Original Medicare Out-of-Pocket Costs at a Glance

  • 20 percent of all Part B services, including doctor visits, durable medical equipment and outpatient therapy
  • $1,556 Part A hospital deductible for each benefit period
  • $233 Part B deductible
  • $170.10 monthly Part B premium

Most people dont pay a monthly premium for Medicare Part A. But if you didnt work enough before turning 65, you may face this extra fee, which can cost up to an additional $499 a month.

There are also several coverage gaps in Original Medicare. For example, vision, dental and hearing are not covered unless deemed medically necessary.

Medigap, also known as Medicare supplement insurance, can help pay some of the remaining health care costs Original Medicare doesnt cover.

Don’t Leave Your Health to Chance

Medigap policies are sold by private insurance companies.

Medigap Plan Coverage Highlights

Also Check: What Preventive Care Does Medicare Cover

The Medicare Supplement With The Most Coverage

Plan F pays 100% of all out-of-pocket expenses. If you are looking for a comprehensive plan that will pay for everything, this one is it.

Here are a few of the benefits that a Medigap plan can help pay for:

  • Medicare Part A coinsurance hospital costs after initial Medicare coverage is exhausted
  • Medicare Part B copayment
  • Part B excess charges
  • Preventive care coinsurance

I should note that Plan G and Plan N are also very popular sellers at our agency. These plans offer lower premiums than Plan F, and you do a little bit of cost-sharing on the back end of your policy.

Many people dont mind paying the Part B deductible out of pocket in return for the lower premiums that Plan G and Plan N can give them. For a closer look at the comparison between Medicare Plan F and Plan G, visit this post I wrote for Forbes.

It is important to note that Plan F was phased out at the end of 2019. If you were eligible for Medicare prior to 2020, you are grandfathered in and able to get Plan F beyond 2020.

Thats one strategy, but looking at Plan G is a good idea. You can save on premiums and have the confidence that your plan is not being discontinued anytime soon.

How Much Does Medicare Advantage Cost

Do I really need Medicare supplement insurance?

Many Medicare Advantage plans have a $0 premium, so be sure to explore your options. Baethke explains it like this: If you enroll in a plan that does charge a premium, you must pay this fee every month in addition to your Medicare Part B premium, which is around $149 .

Medicare Part Bs coinsurance and the deductible is $203, according to Medicare.gov, and once they are met, your copay under Medicare Advantage is typically 20% of the Medicare-approved amount for most services and products, such as durable medical equipment like glucometers, walkers, hospital beds and more.

What gets many people into financial trouble is not following the rules of their plan, such as using an out-of-network provider or facility or getting products or services from a supplier not approved by Medicare.

Sometimes, patients urgently need this medical equipment and arent thinking about reading the fine print, says Baethke. This is why its so important to understand Medicares DME requirements from the beginning.

Nebulizers, for instance, are DME commonly used to treat conditions that cause difficulty breathing, such as asthma and COVID-19. If your doctor recommends one, Medicare requires you to get the machine through a Medicare-approved supplier. Not doing so will mean a denied claim from your Medicare Advantage insurerand a sizable surprise bill.

To learn more about your costs in specific Medicare Advantage plans, contact the plan or visit Medicare.gov/plan-compare.

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When Original Medicare Might Be Sufficient

For many low-income Medicare beneficiaries, theres no need for private supplemental coverage. Almost one in five Medicare beneficiaries are dual eligible for both Medicare and Medicaid.

This includes Medicare enrollees who are eligible for full Medicaid as well as those who qualify for Medicare Savings Programs that help low-income seniors pay premiums and cost-sharing under Original Medicare.

For dual-eligible enrollees who qualify for full Medicaid, that coverage picks up where Medicare leaves off, covering coinsurance and deductibles, as well as services not covered at all by Medicare . For Medicare beneficiaries who qualify for Medicare Savings Programs but not full Medicaid, there are varying levels of assistance available depending on the enrollees income.

Those who receive the least assistance might find a Medigap plan to be beneficial, but most Medicare Savings Program enrollees do not have additional coverage under a Medigap plan.

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.

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Who Needs Medigap Insurance

If you have Medicare, you should consider a Medigap plan. A Medicare supplement plan can provide you with peace of mind during a major health event.

Those that have a lot of doctors should consider a Medigap policy, since Medigap allows you to see any doctor that takes original Medicare, you have a plethora of options.

Beneficiaries with chronic health conditions, a strict budget, lower risk tolerance, and those that travel need to sign up for Medigap.

If one of those applies to you, talk to a Medicare advisor to find out which option is going to provide you with the most value.

What Medigap Plans Do

Medicare Supplemental Insurance – Medigap: Do You Really Need It? Part 1

Medigap policies, also known as Medicare Supplement Insurance, can help pay some of the healthcare costs that original Medicare doesn’t cover. These expenses include copayments, coinsurance, and deductibles under Medicare. Private companies sell Medigap policies, and typically, they’ll step in to pay whatever share of your overall costs the policies call for after Medicare pays its approved amount for the services you need.

In order to get a Medigap policy, you must have Medicare coverage under Parts A and B of the program. The Medigap policy comes with an additional monthly premium that you pay on top of your regular Part B premium amount.

It’s important to understand that even Medigap policies don’t fill in all of the gaps in Medicare coverage. For instance, they generally don’t cover long-term care, vision or dental services, hearing aids, eyeglasses, or private-duty nursing services.

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What Does Supplemental Insurance Cover

We’ll start with what they cover. Supplemental insurance is sold to cover “what Medicare doesn’t.” Remember I said that wasn’t quite true. Unless a supplemental policy specifically states otherwise, the most it will cover are the Medicare deductibles and the 20 percent co-insurance. Supplemental policies do not usually cover any medical services Medicare won’t cover. What’s more, Medicare supplemental insurance will only pay health care providers what you would pay if you didn’t have the supplemental policy. Providers aren’t paid any more for taking care of you if you have one of these policies.

What About Cancer Chemotherapy How Much Will That Cost You

The cost of cancer chemotherapy is probably one of the most expensive treatments a Medicare recipient could face. This is, in part, because medical oncologists are paid more if they give more expensive chemotherapy agents. Oncologists in the US get an average 6% commission on the price of any medications they administer in their office. This commission creates a major conflict of interest for these doctors that has dramatically increased cancer chemotherapy costs in recent years.

Still, Medicare Part B covers IV therapy, including cancer chemotherapy, when administered either in a nursing home or an infusion center. If you receive chemotherapy during a hospitalization, then the cost of your chemotherapy is covered by your Part A deductible.

How much will the chemotherapy cost you? As with everything else in health care, the cost of cancer chemotherapy varies dramatically depending on the treatment. Most of the basic chemotherapeutic drugs have been around for decades so they arent very expensive. Heres a statement showing Medicares approved fee for a basic chemotherapy infusion:

Figure 4: Chemotherapy bill

This patient received IV carboplatin and gemcitabine and fosaprepitant for nausea. For this, medicare was billed over $7,700. It doesnt show how much Medicare approved for this treatment but, her 20% portion of the approved fee was $269.97. That means that Medicare approved a total of $1350 for this treatment or about 17% of what was billed.

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