Tag: Medicare Advantage

Does Medicare Cover Hearing Aids?

Does Medicare Cover Hearing Aids?

Does Medicare Cover Hearing Aids?

One questions we hear a lot at Medicare Life Health is “Does Medicare Cover Hearing Aids?

  • The simple answer is NO.
  • However, some Medicare Advantage Plans will. Let’s look at both.

Original Medicare Will Not Cover Hearing Aids.

Original Medicare – Parts A & B run and administered by the Federal Government – does not pay for hearing aids. In addition, it does not cover exams or fittings needed for hearing aids.

As an exception, Medicare will cover any hearing exams ordered by your doctor for medical treatment. Here is the direct quote from the Medicare and You Guidebook. (Please see our Medicare and You User Guide for more information.)

Hearing and balance exams – Medicare covers these exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.”

Medicare and You 2020 Guidebook

What about Medigap (Supplement) Plans?

No, Medicare Supplement Plans (also called Medigap) do not cover hearing exams or hearing aids. These supplements cover the costs of covered services that Medicare leaves for beneficiaries to pay. (For example, coinsurances, co-pays and deductibles.)

They are not structured to pay for extra services like hearing, dental, vision, wellness or long-term care.

Do Medicare Advantage Plans Cover Hearing Aids?

All Medicare Advantage Plans are designed differently, but most of them offer benefits for exams and hearing aids. Depending on the plan, you may find covered, or partially covered, hearing exams. In addition, many plans will have co-pays or coinsurance on hearing aids.

As an example, one MA plan might offer 0% co-pay on a hearing exam and a co-payment on a hearing aid. They might have two kinds of hearing aids with different amounts you pay as your portion for either a standard hearing aid or a more advanced one.

Also, some Medicare Advantage Plans will contract with specific hearing aid companies to offer discounted or even fully covered hearing aids if you use these providers.

Summary & Action Steps

In summary, if you are in need of hearing aids, Original Medicare and Medigap Plans will not cover them. However, a Medicare Advantage plan often will.

With hearing aids often costing thousands of dollars, it can make sense to consider a Medicare Advantage plan where you can get discounted hearing benefits and hearing aids.

Finally, to learn more about Medicare Advantage Plans – how they work and what they cover – please click here.

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Medicare and You 2020

Medicare and You 2020

Medicare and You 2020 Guidebook – Read This First

Your Introduction to the Medicare and You 2020 Book, and where to get a copy.

The Medicare and You 2020 Guidebook details what you need to know about Medicare benefits for the current year. In it you will find the basics of Medicare, how to get it, and what changes the program is implementing in the calendar year.

However, it is 120 pages long and very detailed. It is also very dry and technical.

So, if you are trying to learn more about Medicare – without falling asleep in the process – we have on-topic website article suggestions for you here that follow the elements of the Medicare and You 2020 Guide.

Where to find the guide

What is included in the Medicare and You 2020 Guidebook?

Here we will outline the sections of the guidebook and give you relevant articles that discuss the various Medicare elements and benefits.

What are the Parts of Medicare?

Intro Section (page 5)

The Medicare and You book starts out with summarizing parts A, B, and D and what they include.

Medicare Part C is discussed in the next section.

Related Article: For an illustrated overview of the four parts of Medicare, visit our medicare parts infographic and article “Medicare Parts A B C D.”

What are my Medicare options?

Intro Section on Original vs Medicare Advantage (pages 6-8)

Many online comparisons are between Medicare Supplements and Medicare Advantage plans as those are the additions that are in your hands to choose.

However, all these comparisons are in their simplest form between having Original Medicare vs Medicare Advantage. This section does a side-by-side comparison of the two (with or without a supplement).

Related Article: For a more in-depth discussion to help you decide what Medicare options are right for you, please read the “Medicare Advantage vs Medicare Supplements” article here.

How do I get Medicare?

“Section 1: Signing up for Medicare” (pages 15-24)

People get Medicare in different ways. Some are signed-up for it automatically if you are already receiving Social Security or Railroad Retirement. Some people must sign up for it when they turn 65 (or delay it if they are not ready at 65).

This section gives you people to call (Social Security at 1-800-772-1213) and places to visit (online at ssa.gov/benefits/medicare) if you need to sign yourself up.

Other topics covered include, when to sign-up, what to sign-up for, and what does each part cost?

Related Articles:

Hey, Medicare and You 2020, Will Medicare Cover My…?

“Section 2: Find out if Medicare covers your test, service or item” (pages 25-50)

This section lists all Medicare Benefits you will receive if you are signed-up for both Medicare Parts A and B. These benefits are universal, meaning they are the standards of care you will receive whether you are receiving Medicare from the federal government or through a private carrier with a Medicare Advantage Plan.

If you are looking to see if a specific benefit is included in Medicare, this is the section to search for it.

This section also reminds you of what is not included in Medicare, such as Long-Term Care insurance. In addition, Original Medicare does NOT include many services that ARE covered by Medicare Advantage Plans. These include dental care, eye exams, hearing benefits, and fitness programs.

2020 New Offering Alert: One interesting change noted in the Medicare and You 2020 book is that many Medicare Advantage programs are now offering “telehealth” benefits where you can see a provider at home instead of at their facility. The guidebook notes that this is typically beyond what Original Medicare can offer.

Related Article: To see the basics of what Medicare Covers, please see our article “Medicare Parts A B C D.”

What exactly is Original Medicare?

“Section 3: Original Medicare” (pages 51-54)

The Original Medicare section explains how our Federal Health Insurance for Seniors works. If you have Original Medicare, with or without a supplement, you are a beneficiary of a nationalized health care system and the government is the primary payer of your health benefits.

Read this section to learn how that works and how to use your benefits once you are on Medicare.

Related Article: Read “What is Medicare?

What is Medicare Advantage?

“Section 4: Medicare Advantage Plans & other options”

medicare and you 2020 guidebook and how to read it
Every year the government puts out a new Medicare Guide. Here is how to read it.

The other option than being on Original Medicare is to be on a Medicare Advantage Plan. In this case, a private insurance company becomes your primary payer and main contact. Medicare Advantage (MA/MAPD) Plans are called “bundled plans” because they combine parts A, B and D to form one “Plan C.”

They often have reduced costs for premium payments, with some of them even offering “$0” monthly premiums. In addition, they often include extra benefits, not included by government Medicare, such as dental, hearing and eye care. “Silver Sneakers” and similar fitness/wellness programs are also often an included benefit.

Related Articles:

What is a Medicare Supplement / Medigap Plan?

“Section 5: Medicare Supplement Insurance (Medigap) policies” (pages 69-72)

Medigap Policy Chart
CLICK HERE to see more about the various Medigap plans and what they offer.

When you opt for keeping Original Medicare (instead of a Medicare Advantage Plan) you will most likely want to pair that with not just a stand-alone drug plan, but also with a Medigap Plan. These plans are also called Medicare Supplement Plans.

They are supplemental insurance plans that pick up paying where Original Medicare leaves off – such as with the 20% coinsurance, co-pays and deductibles.

The government sets the requirements for each supplement plan and then the private insurance companies decide what price they can offer for each plan in each market they are in. These plans are labeled with letters, and offer the exact same benefits no matter what private insurance company you choose.

Related Article: For more information, please read this article on Medicare Supplement Insurance.

What is Part D?

“Section 6: Medicare Prescription Drug Coverage (Part D)” (pages 73-82)

Read this section to learn how Medicare Drug Plans work, where to get one, and when you can get one / switch them.

Remember, that if you opt for a Medicare Advantage Plan, you will most likely have your drug plan included (which is called a MAPD plan).

Related Articles:

Can I get help paying for medical costs?

“Section 7: Get help paying your health & prescription drug costs” (pages 83-88)

The government has set up several ways for Medicare Beneficiaries to get help in paying for their health insurance. Read this section to see if you qualify for the various tiers of assistance.

How can I protect myself?

“Section 8: Know your rights & protect yourself from fraud” (pages 89-100)

The U.S. government understands that health insurance can be confusing, and there are people out there that will try to take advantage of this confusion. Read this section to know how to protect yourself from health care and insurance fraud.

In addition, Section 8 also explains your rights under Medicare and how to make an appeal if you decide your rights have been violated. The Medicare and You 2020 book defines an appeal as “…the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan.”

How do I get my questions answered?

“Section 9: Get more information” (pages 101-112)

Next, if you have questions related to Original Medicare, the handbook offers you the following numbers to call:

1-800-MEDICARE (1-800-633-4227)
TTY users call 1-877-486-2048
Get information 24 hours a day, including weekends

Medicare and You 2020

Additionally, for questions regarding insurance plans like Supplement (Medigap) or Medicare Advantage (MA/MAPD) then we suggested talking to a licensed insurance professional.

If you are lucky enough to live in our headquarters of Nebraska or our neighboring state of Iowa, you can give Carly a call/text or email.

Related Article: Please see our Frequently Asked Questions page, and if you have a question, please leave it in the comments section or email us. Thanks!

What does this word mean?

“Section 10: Definitions” (pages 113-116)

Do you just live to read a good glossary? Well, here you go. You will find here definitions to all the health care and insurance lingo you need to know to navigate your health care effectively.

Related Article: Feel free to look through all our Medicare Articles. They are all listed on this page.

Medicare and You 2020 Handbook Review

We hope our review of the 2020 Medicare and You Book has been helpful.

Our one hope for next year is that the book might be more helpful in pointing beneficiaries towards ways to find LICENSED independent insurance professionals that can help them in making decisions. These agents are the only ones required to stay licensed, tested and up to date on the plans that are out there. Moreover, this applies especially for the Medicare Advantage approved agents as they have to be re-tested every year on changes.

Finally, we are MedicareLifeHealth.com just don’t understand how people can be offering advice on plans – that change yearly – they have not be certified to explain.

Our advice? Find yourself a good agent, and make them work for you.

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Biggest Medicare Mistakes

Biggest Medicare Mistakes

The 5 Biggest Medicare Mistakes and How to Avoid Them

No one wants to make a mistake that will cost them hundreds (or thousands) of dollars down the road if they can help it! However, Medicare can be very confusing, and even very knowledgeable people can miss things. Here are the five biggest Medicare mistakes people make, and how you can avoid them!

#1 in Our Biggest Medicare Mistakes: Missing Enrollment Deadlines

Although the government gives us all a little wiggle room around each Medicare Milestone we pass, there are certain deadlines you must mind to avoid late penalties and inconveniences.

Original Medicare Coverage Deadlines

five biggest medicare mistakes and how to avoid them

You will need to sign-up for Medicare when you turn 65 if you are not already getting Social Security. You will be automatically signed-up for Medicare if you are getting Social Security. In addition, you will need to tell the government if you are delaying Medicare because of other credible coverage (such as an employers coverage).

You will have three months before your birthday to sign-up, the month of you birthday, and then three months after to sign-up. However, what some people do not understand, is that if you enroll after you turn 65, your coverage will not start until the first of the month after you enroll. This could lead to a gap in your health care coverage.

A NOTE ON CREDIBLE COVERAGE: Some people will delay Medicare coverage if they have a good health plan from their employer. This is usually okay, but there is an exception for small business employers to be aware of: If your employer has less than 20 employees, you will need to enroll in Medicare right away when you turn 65.

This is because when you work for a small business, their insurance will become secondary insurance and Medicare will be your primary payer. If this is the case, you will need to enroll right away in Medicare to avoid a penalty. (Also note that Cobra is not credible coverage.)

Medigap Guaranteed Enrollment Deadlines

The last Medicare Enrollment Mistake people make is missing their Guaranteed Enrollment period for a Medigap Plan. You will have six months, from the beginning of the month you first turn 65, to enroll in a Medigap plan with a guarantee to be issued a policy. If you apply after this window, you will have to go through medical underwriting. This means that companies have the right to deny issuing you a policy based on your medical history after your open enrollment is over.

It is important to remember that Medicare Advantage Plans have a different enrollment process than Medigap. The Medicare Advantage Annual Election Period is not for Medigap Plans. Which lead us right into Mistake #2…

Medicare Mistake #2: Not Understanding Medigap Plans vs. Medicare Advantage Plans

There are two main ways you can set up your Medicare Health Care Plan: Medicare Advantage (Part C) and Original Medicare with a Medigap Plan. You either have one or the other, not both. Both can be good ways to set up your health care, but not understanding how they work can lead to making on of our biggest Medicare mistakes.

We have a whole article on Medicare Advantage vs. Medigap Plans here. I suggest reading it if you are unfamiliar with the two plan types. Considerations with these plans include how you get your Prescription Drugs and how you want to budget your money. Cash flow can be different plan to plan with premium payments and out of pocket expenses to consider when making a decision. Your lifestyle needs and travel patterns also need to be considered when making a choice between MA and Medigap.

Mistake #3: Assuming Your Doctors and Drugs are Covered

We all know what assuming can lead to… mistakes! It is very important to make sure that your doctors are covered with the Medicare option you choose. The carrier will be able to help you confirm that you will be able to continue with your current doctor if you so desire. If you are working with an Insurance Agent, they will have the ability to do this for you as well.

Checking your drug options with a plan is also an important part of finding coverage. The government does make sure that at least two kinds of drugs are available per category of treatment. Moreover, carriers will have a process for you to make an exception for a drug not on its list (called a formulary). However, it makes for a smoother transition to check ahead of time to see what is covered for your specific needs.

Biggest Medicare Mistake #4: Assuming Medicare Covers Long-Term Care

It is a common mistake to assume that your Medicare coverage includes long term care – it does not. Skilled nursing facilities for recovery from a certain event are covered (and come with different co-insurances based on different plans). However, long term stays in assisted living and nursing homes are not covered. You will need to have a plan in place to cover these needs. Your planning may include, long term care insurance, IUL policies with long term care (or critical illness) riders, or self-insurance (paying cash).

Another option, for those that do not have a lot of resources saved up for retirement, is to “spend down” your assets to qualify for Medicaid to help you in paying for your care. However, I would not suggest this option for those that have the means to plan ahead for the level of care they desire or those that want to pass money on when they pass.

Biggest Medicare Mistake #5: Enrolling Directly with a Carrier

Ok, follow me on this one. When you first turn 65, you are bombarded with advertisements for different Medicare plans. Sometimes, it feels easiest to just pick up the nearest postcard and give that insurance company a call. Or maybe you have done your research on your own (which is just fine!) and decide to enroll directly with the carrier you want to go with. Here is where you should stop and consider this as a mistake.

Here is the problem: when you enroll with an insurance company for one of their plans directly, you have to deal with them alone. On the other hand, when you enroll with that same company through an independent insurance agent, you now have an advocate and support system to help you work with that carrier.

Here is how an independent agent helps:

  • First, if something goes wrong, you can call your agent for help! You are not on your own, and this is a big deal. As we all know, everyone can make mistakes – you, your doctor’s office, your insurance company. When these mistakes happen, you can call your agent for support and they can work with you and the insurance company to make sure you are taken care of.
  • Second, rates and plans change! A good independent agent will keep on top of industry changes and plan changes for you. They can stay on top of your premium rates and what might be new or changing in your area to make sure you always have the best coverage. You will not get this level of service when you work directly with a carrier.
  • Finally, you do not pay anything extra for working with an independent agent. They are still paid as an independent agent from Whichever company you are placed with at no charge to you.

Medicare Mistakes Summary

In addition to this article, another great resource is the Medicare and You book put out by the government. Since this is a large (120 page) document, we have created a Medicare and You User’s Guide for you to read and reference here.

In summary, you can avoid the biggest Medicare mistakes with a little research and a little help.

Reach out to a professional to answer any of your market specific questions and find out more about Medicare, Medicare Advantage, Medicare Supplements, and their differences here on MedicareLifeHealth.com.

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Using an Independent Medicare Insurance Agent

Using an Independent Medicare Insurance Agent

Should I Use an Independent Medicare Insurance Agent?

5 reasons to use an independent medicare insurance agent. Author is a Nebraska based independent insurance agent.

When it comes to making decisions on and signing up for Medicare health care planning, you will have a few paths to consider. First, you could take the path of figuring everything thing out on your own and signing-up independently. Your second option is to talk to a captive agent that works for one insurance company. Finally, you can use an Independent Medicare Insurance Agent to help you make Medicare decisions.

FULL DISCLOSURE: If you have read up on your fearless author, you will know that I am an Independent Medicare Insurance Agent. Therefore, you can rightly assume that I am for using an independent agent or broker for Medicare help. However, I know there are different ways to tackle any one solution, so use this information to move you forward in the direction you for which you are most comfortable.

The Top Five Reasons to Work with an Independent Medicare Insurance Agent

1. Independent Agents Can Compare Companies

I decided on a career as an independent agent expressly because I enjoy helping people. Moreover, I feel proud to introduce seniors to our nation’s national health care system and the private insurance companies that administer both MA plans and supplements.

To compare, let’s define a captive insurance agent as an agent that works for just one insurance company. That agent can sign you up only for the plans that are offered by their employer. If one of their plans do not fit your needs, you will need to find another agent to help you. On the other hand, using an independent insurance agent for Medicare allows you to compare the multiple carriers they represent and the various plans they offer.

As an example, let’s say you are comparing Medicare Supplement Plans available in your area. Your independent agent might be contracted to sell multiple carriers and can look up the prices and find the best rate for you. Remember that Medigap (supplement) letter plan benefits are set by the government and often the only main difference will be price. In this instance, the more choices, the merrier (for your wallet)!

2. You Do Not Pay Medicare Insurance Agents

My clients do not pay me, and the government does not pay me. As an independent agent, I get paid by private insurance carriers when I place business with them. As mentioned in reason one, since I do not belong to any one carrier, I can help my clients look at many different options available to them.

An agent’s goal is to help you make the right decision for your needs without thinking about making money. We do need to make a living, but there are rules set with compensation that all the insurance companies comply with. As a result, getting paid with one carrier versus another is not going to make a big difference to an independent agent that has her client’s best interest in mind.

3. Your Independent Agent Can Help You Communicate with Insurance Carriers

This is a big reason to work with an independent agent that often gets overlooked. Your agent can help you work with your chosen insurance (carrier) company. If you sign-up with a carrier directly, you will have to work with them directly. This is fine, but let’s say you have a question or have a dispute. Your insurance agent can “go to bat” for you in helping you get your question answered or problem solved. Perhaps even faster than you could do it yourself.

Your agent will also stay on top of news and changes coming from your carrier and can alert you to anything you need to know or actions you need to take. This includes helping you to stay up on Medicare Part D plans and changes.

4. You Can Ask Your Agent Questions

Yes, yes you can. Call, email, text your insurance agent and they are there to help with your health insurance needs. Often times your agent will also be an expert in other kinds of insurance such as life, dental/vision/hearing, annuities, etc.

5. Your Agent Can Shop Rates/Plans for You in the Future

Much like car insurance these days, your premium rates might change over time, and you might have more options that become available in your area.

For supplement insurance, it is a good idea to shop your policy every once and a while to make sure you are not paying to much. Medical Underwriting becomes necessary for supplement switching when you are not in a guaranteed time of eligibility. As a result, you will want to work your agent hard while you are perhaps younger and hopefully healthier to keep on top of your supplement rates.

As for Medicare Advantage Plans, your agent can help you keep on top of the market to help you in deciding if you ever need to switch plans or companies.

Your Other Options

There may be reasons that you choose to not use an independent agent. You may end up using a captive agent, or you may end up doing everything by yourself, and this is just fine. If you want to go the solo route, or even just to get an overview of the market in your area, I suggest you visit the Medicare Government Website Plan Overview Page. Visiting this page before you visit with an agent is also a good idea so you can ask knowledgeable questions.

Conclusions

In conclusion, you might appreciate using an Independent Medicare Insurance Agent if you…

  • Like to compare rates/plans
  • Enjoy complimentary help
  • Appreciate a company lesion
  • Have occasional health care plan questions
  • Like to keep up-to-date on market changes
Carly Cummings, Medicare and Medigap Expert, Independent Medicare Insurance Agent
Medicare Expert ,Carly Cummings

If you are living “The Good Life” in my home state of Nebraska, I would ask that you give me a shot at being your Nebraska Independent Medicare Agent. Click here for my contact info.

If you are in any of our other fine 49 states, you can always reach out to ask me questions, but I can’t represent any companies or plans to you, but I encourage you to find an agent in your area. Word of mouth is always a good way to find an agent, so start by asking your friends and family who they use. Alternatively, you can always Google, “independent Medicare insurance agents near me.”

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What is AEP?

What is AEP?

What is AEP? Medicare’s Annual Enrollment Period

Do you love a good acronym? How about a very large amount of them? The health and insurance industries are nothing if not full of confusing acronyms. Moreover, “industry people” will just assume you know them all. AEP is no exception, so let’s discuss what actually is the Medicare Annual Enrollment Period.

The Definition of AEP

Medicare Annual Enrollment Period (AEP)

AEP stands for Annual Enrollment Period. It is defines the period of time each year eligible seniors can enroll in both Medicare Advantage Insurance Plans (Part C) and Prescription Drug Plans (Part D). In addition, you will not be required to go through medical underwriting to join these plans. (ESRD is an exception.)

Outside of a SEP (Special Enrollment Period) or your IEP (Initial Enrollment Period), this is the only time that you can join a Part D or Part C plan. Yes, I know, more acronyms!

In addition, AEP is one of the two times you can switch plans, if you are already in one. (The US government just added the Medicare Advantage Open Enrollment Period. This is a second period of time – Jan. 1 – March 31 – where you can switch plans once if you are already in a plan. )

When is AEP?

The Medicare Annual Enrollment Period is October 15th – December 7th. The changes you make during this period of time will take place for the following year on January 1st.

Possible Changes During the Medicare Annual Enrollment Period (AEP)

Does AEP apply to Medigap (Medicare Supplement) Plans?

No, AEP does not apply to Medigap (supplements). You can switch a supplement plan at any time. However, you will be subject to medical underwriting. This means that you are not guaranteed to be accepted into the Medigap plan.

How do I Switch Plans / Join a Plan During AEP?

You can start researching and learning about the plans available to you the next year, starting October 1st. However, you will not be able to complete an enrollment application until October 15th.

When switching/joining a MA/MAPD or Drug Plan, I highly suggest using an independent insurance agent. There are many considerations when choosing a plan, and she/he will help you in making sure you pick the right plan for you. (If you live in Nebraska, please give me a email/call/text, and I will be happy to help.)

That said, you can also research plans and see their ratings at https://www.medicare.gov/find-a-plan.

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Medicare FAQ’s

Medicare FAQ’s

The Most Frequently Asked Medicare Questions & Answers

Once you are familiar with the basics of Medicare, these are the Medicare questions we hear the most often that you might have too.

If you are starting from the beginning and do not have a basic understanding of Medicare, we recommend checking out our pages that detail out the basics on:

Can I have both Medicare Advantage and a Medicare Supplement?

No, you have one or the other. Not both, they do not work together and it is illegal for anyone to sell you both.

What are the Medicare Supplement Plan Changes for 2020?

Starting in 2020, the government has stated the no one newly aging into Medicare will be able to buy a supplement that includes coverage of the Part B.

In 2019, this deductible was $185. The only difference between two of the most popular Medicare Supplement (Medigap) Plans – Plan F and Plan G – is the inclusion or exclusion of the Part B Deductible.

Insurance companies often offer Plan G’s at less expensive prices than their Plan F’s. Even after adding back in the Part B deductible, and for that reason, they are often a good choice.

In addition, if you already have a Plan F, it is a good idea to see if you could save money by switching to a Plan G. However, know that you will have to pass medical underwriting to switch your plan.

What is Medicare’s Annual Enrollment Period (AEP)?

I wrote a whole article to answer this question for you – click here to read it.

Where Should I go for Government Medicare Information?

  • In addition, the government publishes a Guidebook to every year called Medicare and You. You can find our review and User’s Manual to this 120-page book here: Medicare and You 2020.

Who should I talk to if I have more Medicare Questions or if I want Medigap or Medicare Advantage?

You can compare Supplement and MA plans online, but I suggest you talk to a professional, independent insurance broker. They can help you compare plans. Moreover, it won’t cost you any more money to use a professional. Both Medigap and Medicare Advantage Plans can be overwhelming when you are trying to pick one, especially if there are many offered in your area.

Remember, independent agents work for you (not the carriers). In addition, having an actual person to help you in communicating to insurance carriers and keeping you updated each year is very valuable. This is something you don’t get if you sign-up directly with a company online.

Carly Cummings, Medicare and Medigap Expert
Medicare Expert -Carly Cummings

If you are in the states of Nebraska or Iowa and you are looking for an agent to help you in any area of Medicare, Health or Life Insurance, please get in touch with me here.

FAQs - Frequently Asked Medicare Questions - Medicare Life Health Pin
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Medicare Advantage vs Medicare Supplement

Medicare Advantage vs Medicare Supplement

Medicare Advantage vs Medicare Supplement (Medigap): What Medicare Plan is Best for Me?

I am a firm believer that there is a good Medicare health plan out there for everyone. Moreover, there might even be more than one good choice out there for your situation. If there is more than one good choice available to you, you might be weighing your options right now – Medicare Advantage vs Medicare Supplement.

First, Let’s review your Medicare options:

Original Medicare (no supplement)

Certainly, stand-alone Medicare coverage is an option. You would still want to get Part D Prescription coverage. (There are penalties down the road if you do not get Part D or have credible coverage already and then want to get it later.) However, you would then be left paying your deductibles and 20% coinsurance out-of-pocket.

For example, with ONLY Original Medicare and NO supplement or MA plan, if you ended up having a major health event like a surgery, the 20% left that medicare doesn’t pay could still be thousands of dollars.

You would also have to go through medical underwriting with a private insurance carrier if you later want a supplement and you have missed your Guaranteed Issue time frame. You can always join a MA plan later, but only during a special enrollment period or during the Annual Enrollment Period (Oct. 15 – Dec. 7).

Original Medicare with a Supplement

With this option, you keep Original Medicare and add on a Supplement (Medigap) Policy with a private insurance company to help you in paying the pieces that Medicare does not. These costs can become large if you have a big medical event or a chronic illness. In this instance, a Supplement would protect you from “losing the shirt off your back”! You would also have a stand-alone Part D Prescription Drug Plan (or a plan that is considered “credible coverage”).

Medicare Advantage (MA/MAPD)

Finally, with a MA/MAPD plan you would replace Original Medicare with a bundled plan offered by a private insurance company. These often include a Prescription Drug Plan. (These are called MAPD plans, which are most the common plans). You still “have Medicare” with these plans. However, they are run by private companies who put together networks of providers and health facilities.

One question we hear a lot is, “can I have both Medicare Advantage and a Medicare Supplement?” No, you have one or the other. Not both, they do not work together and it is illegal for anyone to sell you both.

What are the Differences Between having a Supplement (Medigap) and having Medicare Advantage (MA/MAPD)?

Now, let’s do a breakdown of Medicare Advantage vs. Medicare Supplements. First, let’s look at the difference in care and the differences in cost. We are assuming you either have Medicare Advantage or Original Medicare with a Supplement (aka Medigap Plans).

Medicare w/Medigap Medicare Advantage
Care OptionsYou can go to any doctor that accepts Medicare already. Specialist referrals are not needed.You typically must visit doctors that are in the plan’s network if you do not want to pay extra. Specialist visits sometimes need a referral, depending on your plan. Click here to read more about plan structures (HMO, PPO, etc.)
ExtrasNASome plans include extra benefits such as hearing, dental, vision and fitness/wellness programs.
Monthly
Costs
Medicare Part A – usually premium free
Part B – Monthly Premium (based on income level)
Part D – Monthly Prescription Premium
Supplement – Premium dependent on which company & plan letter you choose
MAPD plans with Drug Coverage Included pays a monthly premium to the insurance company for all services. Some plans include the Part B Premium and some plans do not. Some plans have a $0 monthly premium option.
Out of Pocket CostsCosts can be very minimal depending on that Medigap plan you choose. There are high deductible options, and starting in 2020, the Part B deductible will have to be paid by everyone who is just aging into Medicare. Some plans have lower out-of-pocket costs than Original Medicare and all have a yearly limit on out-of-pocket expenses that are covered by Medicare.
Domestic TravelEmergency and urgent care are always covered in the US. You can use any doctor that takes Medicare in the US for routine visits. If you spend long periods of time traveling and need to see a doctor for routine visits whole out of town, this might be your best option. Emergency and urgent care are always covered in the US. You will have to use doctors in network for routine visits for them to be covered. Some insurance companies have large networks that can span several states, so make sure to inquire about how large the network is before you rule out a MA plan if you travel a lot.
Foreign TravelSome supplement plans cover part of the emergency medical fees you may use in other countries. Plans C, D, F, G, M & N have 80% foreign travel exchange limits. Plans do not typically have any over seas coverage.

Making Your Choice between Medicare Advantage vs Medicare Supplement

Now that you understand the basics of Medicare Advantage Plans and Original Medicare plus a Medigap (Supplement) Plan and know the significant differences between the two, it’s decision time.

First, I always recommend speaking with a licensed, independent agent that can help you in assessing all the various plan types available in your area. Every county has different options for MA/MAPD plans, and insurance carriers have different prices on the supplement plans you may be considering.

Second, it’s good to have an idea of what is important to you. You should be thinking specifically in regards to money and lifestyle when choosing a path.

Consider these questions when choosing between Medigap and MA Plans:

Do you plan on living in another place for a significant period of time during the year?

If you are a “snowbird” or are planning a longer vacation where a routine doctor visit may be necessary when away from your primary residence, then a supplement may be your best choice. Remember though, emergency / urgent care visits are covered with both types of plans.

However, if your travel happens to be international, Both Original Medicare and MA plans do not cover foreign travel, but some supplement plans (plans C, D, F, G, M & N) have 80% foreign travel exchange limits that will help off-set some costs.

What is (or will be) your cash flow situation in retirement?

Some retirees have pensions, social security and other payments (like annuities) that come to them automatically each month. Other retirees have less of these automatic infusions or smaller required distributions and prefer to leave as much of their cash in investments as possible. Finally, some retirees are on a smaller, fixed income. This might require them to consider cash flow very carefully.

In each situation, you will need to review how you are paying for your health services, as each plan offers different payment options.

Cash Flow with a Supplement:

With a supplement, you will have a set amount of money (that could be a larger sum than an MA plan) come out of your bank (and/or S.S./R.R. check) each month. This can add up when you consider it includes Part B premiums, Part D Prescription premiums, and your supplement premiums. However, if you chose a plan that covers everything Original Medicare leaves out, then you would not pay any other out-of-pocket fees for Medicare covered services.

Cash Flow with a MA/MAPD Plan:

With a Medicare Advantage plan, you will most likely have a smaller amount of money coming out of your wallet each month. You will most likely have an MAPD plan that includes your drug plan, as stand alone MA plans are becoming much more rare, and some plans even include Part B premiums. So, with a MAPD plan, you would be paying a MA premium and maybe your Part B premium each month. Moreover, there are sometimes zero dollar per month ($0/month) premium MA plans available. The costs then to consider and maybe budget for with MA plans is if there are any co-pays, co-insurances and deductibles with the plans. Each plan will be set-up differently, and each plan will also have a max yearly out-of-pocket limit.

Just like in any kind of insurance, Medicare plans are set-up to allow you to choose how much out-of-pocket expenses you incur versus monthly premiums you pay.

Looking at your budget and then talking through your options with a licensed agent will allow you to make the best choice for your situation.

How interested are you in extra benefits being included?

Finally, one more consideration is the other elements that round out your health insurance plan, such as dental, vision, hearing, etc. If you have a supplement plan, you will need to decide if you need these services, and if you do, are you wanting to take on insurance plans for them. You might decide to add on a stand-alone, or a plan that includes any or all of these common services (dental, vision, hearing).

Often times, Medicare Advantage plans will include these services as a part of their plan as an additional benefit which might save you money if you were planning on getting a stand alone plan or paying cash for these services.

Moreover, many MA plans will offer fitness or wellness services that are included at no additional cost. Sometimes this means you will not have to pay for a separate gym membership. Silver Sneakers is one example of a national program that is used by many MA plans to provide fitness and wellness services.

The Next Steps for Choosing Your Medicare Plan

As you can see, developing your Medicare Health Insurance Plan can be very involved, but I am confident you can do it! Having a professional to help you through the process is important. Please reach out to an independent insurance agent to review what is available in your area. They will be able to explain plans in specifics and answer your questions about Medicare Advantage vs Medicare Supplement.

Finally, Medicare.gov is also a good tool for answering your broader questions, and we also encourage you to comment on this page or contact us directly with any questions. Thanks!

Other Topics Related to Medicare Choices:

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What is Medicare Advantage

What is Medicare Advantage

Is Medicare Advantage Best for My Situation?

In this article, we look at what is Medicare Advantage (aka Medicare Part C). As we discussed in our Medicare 101 Post, there are two different Medicare paths. You will choose one when you are setting up your health care in retirement.

  • Path One = Original Medicare, Part A and Part B, with a stand alone Prescription Drug Plan (Part D) and an optional Medigap (Medicare Supplement) Plan.
  • Path Two = Medicare Advantage (Part C) that replaces Medicare Part A and Part B and typcially includes a Part D Drug Plan. These plans are offered by private insurance companies that you work with directly.

The Basics of Medicare Advantage

Medicare Advantage “bundled” plans are offered by private insurance companies (carriers). You use them IN PLACE of Original Medicare, but they are still Medicare. Moreover, they must include all the same Medicare services covered by Part A (hospital) and Part B (medical). In addition, almost of them include Part D (prescription drugs).

You will hear/see these plans referred to as MA plans, and MAPD plans when they include prescription drugs.

What is the Advantage to Choosing a MA or MAPD plan?

Medicare Advantage

The first advantage to these plans is that many of them have lower out-of-pocket costs than Original Medicare. Secondly, they often have extra benefits such as dental, vision or hearing that is not included in Medicare.

What are the Costs of a MA / MAPD Plan?

First, remember that most people have Medicare Part A “premium free”. (See this page on the medicare.gov website if you are wondering if you are in the “most people” category.) Second, remember that most people also pay a monthly premium for Part B. However, some Medicare Advantage plans will pay all or part of your Part B premium.

There may be many (or just a few) different MA and MAPD plans available in your area. They will all be set up differently and cost different prices from carrier to carrier. We suggest finding an independent insurance agent/broker that can compare different plans, carriers (insurance companies) and prices. They will help you pick a plan that fits your lifestyle and financial needs. Please note, there are often plans out there that have low or even $0 monthly premiums.

In addition to whether or not you pay a monthly premium with a MAPD plan, each plan will have a different set up for out-of-pocket costs:

You will need to decide what plans fit well with your monthly cash flow situation in addition to how often you need medical products and services.

How do MA and MAPD Plans Work?

Insurance companies usually set-up Medicare Advantage programs as a PPO or HMO networks. You might be familiar with this style of network plan insurance if you had (have) one from an employer or even from the open marketplace.

Typically, you will need to use doctors in your MA plans network. (Unless it is an emergency, or unless you are willing to pay extra to go “out-of-network”). If you have providers you want to keep, ask them if they are part of a network you are considering. In some MA/MAPD plans, you may also need referrals to see specialists. These are all plan specific requirements. You will need to look all these requirements prior to making your MA decisions.

HMO and PPO plans have much more robust networks now than plans from the past. Most people can find a plan that is large enough/flexible enough to work with their lifestyle. This is true even if they travel frequently in retirement. I recommend talking to a licensed agent to make sure you understand how the plans work.

When Can You Sign-up for a Medicare Advantage Plan?

If you are a US citizen with both Part A and Part B Medicare coverage, you can join MA plans in your area during these times:

  • During your Initial Enrollment Period (IEP): Just like joining Original Medicare, you can join a MA plan during the 7 month period (3 months before the effective date of Medicare Part A and B, including the month Medicare begins, and then 3 months after) of time that you are turning 65.
  • During the Annual Enrollment Period (AEP): October 15th to December 7th, is when you have the opportunity each year to join an MA/MAPD plan. Your new coverage will begin January 1st.

    *OEP – As of 2019, if you are already in a Medicare Advanage plan, you can also change plans during AEP, or you can switch plans once (or switch back to Original Medicare) during Open Enrollment Period – January 1st to March 31st.

Other things the US Government would like you to know about MA Plans:

  • Emergency and Urgent Care is always covered with MA plans.
  • MA plans cover all Original Medicare Services and carriers must follow all Medicare rules.
  • MA plans may have extra benefits like vision, health, dental and other fitness/wellness programs.
  • You can join a MA plan with pre-existing conditions (except for ESRD, which is a special case and has other options).

Who can Help You with a Medicare Advantage Policy?

Just like a supplement, you can compare these plans online, but I suggest you talk to a professional, independent insurance broker that can help you compare plans. It won’t cost you any more money to use a professional, and Medicare Advantage Plans can be overwhelming when you are trying to pick one, especially if there are many offered in your area.

Remember, independent agents work for you (not the carriers), and having an actual person to help you in communicating to insurance carriers and keeping you updated each year is very valuable. This is something you do not get if you sign-up directly with a company online.

If you are in the state of Nebraska and you are looking for an agent to help you in any area of Medicare, Health or Life Insurance, please get in touch with me here.

Where to go next:

Medicare Advantage Part C - Medicare Life Health Pin
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What is Medicare?

What is Medicare?

Medicare 101 – The Basics

To start, we are going to assume that you know very little about Medicare. We will break down the basics to Medicare Insurance and its various parts. In addition, we are going to assume you have better things (or at least more interesting things) to do than read about Medicare all day, so we will keep it succinct.

What is Medicare?

In 1966, the United States started the Medicare program to provide seniors, age 65 and older (and some people with disabilities), a national health insurance program. The Centers for Medicare and Medicaid Services runs these programs. It also covers people with end stage renal disease and amyotrophic lateral sclerosis. (Visit the government’s website, if you want more info on these situations).

When do I sign-up?

If you are mentioned in the above paragraph, you might be ready to sign-up. We are going to assume that you are in the senior category for simplicity’s sake. Turning 65 is the catalyst for many people to join the Medicare program, but if you are still working and covered by an employer’s program, you may opt to defer this start date. (Just remember to tell the government if you are opting to defer.)

Open enrollment starts 3 months before your 65th birthday and ends 7 months after that start (so 3 months after your 65th birthday month). If you do not have “credible coverage,” such as an employer plan, in place after this window, you could incur penalties from the government.

What am I getting with Original Medicare?

Medicare Parts A B C D Explained
Click here for our infographic on the 4 parts of Medicare.

Original Medicare, the national health care program sponsored by the US government, is going to provide you with two points of coverage: Part A Hospital Insurance and Part B Medical Insurance. In addition to these two basic parts, you have to option of adding on a Part D Prescription Drug Plan. These drug plans are not administered by the Federal government, but instead by private insurance companies, and you must sign-up for them individually.

The last part of Medicare is Part C or Medicare Advantage. This is a second route you can take to manage your health care that replaces Original Medicare with a “bundled” program that rolls your Parts A, B and D all into one plan. These plans (also called MA or MAPD plans) are provided by private insurance companies. We will discuss how this works more after we look at the basic Medicare parts.

Let’s look at each part:

Part A

First, Part A, also known as “Hospital Insurance,” helps with coverage regarding inpatient care, skill nursing facility care, hospice care, and home health care. (Visit the government’s website for more details ).

Part B

Second, there is Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, outpatient care, home health care, durable medical equipment, and any covered preventative services.

In addition, there is a third part called…

Part D

Finally, you need Part D, also known as “Prescription Drug Coverage.” Private insurance companies provide Part D coverage rather than the government.

Consequently, if you decide not to take on Part D coverage right away, you might incur a penalty if you try to join later. This is if you do not have “credible coverage” (such as with an employer or union). Therefore, please make sure you are signed-up for a drug plan, not just Parts A and B. This is important if you ever suspect you will need this benefit in the future.

The Two Paths of Medicare Coverage

You can be covered one of two ways.

  • Path One – Enroll and keep Original Medicare Part A and Part B, sign-up for a Part D or drug plan with a private insurance company, and then you can add on top of that a Supplemental Coverage Plan that picks-up the tab where Medicare leaves off. There are different kinds of Supplement plans (Medigap Policies) that cover different benefits and they all cost different prices with different insurance companies. To learn more about Medigap or Supplements click here.
  • Path Two – After your enrollment in Parts A and B, your second option is to join a Part C plan. We call these Medicare Advantage Plans, and private insurance companies run them. In fact, the government calls these “bundled plans.” Most of them wrap parts A, B and D all into one package. In addition, they often give their members extra benefits and hopefully lower out-of-pocket costs. To learn more about Medicare Advantage click here.

What are My Next Steps?

What is Medicare, Medicare 101, Learn the Basics
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