Tag: Medigap

What is Medicare Plan F?

What is Medicare Plan F?

What is Medicare Plan F?

What is Medicare Plan F - simple answers to medigap questions

You may have heard, but there have been changes with who can get what Medicare Supplement Plans (aka Medigap Plans) now. Plan F and Plan C are not available to people turning 65 on or after 2020. So, you might be wondering, what is Medicare Plan F?

In this quick article, let’s look at what are Medicare Supplements and then specifically, what is Medicare Supplement Plan F.

Medicare Supplement Plans Explained

What are Medicare Supplements_

Medicare Supplement plans are supplemental policies that people can purchase to cover the costs that Original Medicare does not pick up.

There are many different plans to choose from, and they are all labeled with a Plan Letter. In addition, there are many different insurance companies that offer these plans, but they all over the exact same services as what is listed in the letter plan benefits. The only difference from private insurance company to company is the price they can offer in each specific market (area of the country).

Here is a Chart of What Supplement Letter Covers What Services

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

Why People Like Supplements (Medigap)

what is medicare Plan F Pin medigap made easy

People like Medicare Supplement Plans because of their flexibility and their routine costs. First, these plans offer flexibility because they allow beneficiaries to see any providers that accept Medicare in the whole country. Second, Medigap Plans have the same premium charged each month, and plans like F, have no costs other than that for covered services. As a result, Medigap Plans are good for budgeting and knowing what your costs are going to be each month.

Remember, the other option for supplementing Original Medicare covered services is a Medicare Advantage Plan. That is a plan you have INSTEAD OF a supplement (Medigap) plan.

Who is Eligible for a Supplement?

Anyone with Medicare Benefits can apply for a supplement. When you first age into Medicare, you have a window of “Guaranteed Enrollment Eligibility” to get the supplement of your choosing. After that, you will either need a special enrollment option to get into another one, or go through medical underwriting to get a supplement.

You can read more about Medicare Supplements here.

Medicare Supplement Plan F Explained

Medigap Plan F (aka Medicare Supplement Plan F) covers the most amount of services out of all the supplemental plans. So, this means if you have Plan F, you pay your monthly plan premium for the supplement, and then you pay no other costs for Medicare covered services.

As a result, it has been one of the most popular plans. If you take a look at the Medigap Plan chart above, you will see that…

Plan F Covers:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used
  • Part B coinsurance or copayment
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel exchange (up to plan limits – 80%)

People like Plan F for its full coverage and it’s travel coverage both in the states and internationally.

Who Can get Medicare Plan F and Who Cannot?

A while back., the U.S. government passed MACRA bill, or “The Medicare Access and CHIP Reauthorization Act of 2015”, that made changes to who could sign-up for Medicare Supplement Policies that covered the Medicare Part B Deductible. These plans are not “going away,” but not everyone can get them as of January 1, 2020.

Here is who CAN get Plan F still:

  • You CAN get Medicare Supplement Plan F (or keep Plan F) is you turn 65 before January 1, 2020. (Same applies to Plan C.)
  • In addition, you CAN get Medicare Plan F (or C) if you turn 65 on or after January 1 2020, BUT ALSO you have a Medicare Part A Effective Date that started before the year 2020. (One example of this might be someone who was on Medicare prior to turning 65 because of a disability.)
  • You can KEEP your Plan F if you are already on one. It is not going away. However, there might be reasons for you to switch to a Plan G, or another plan that does not have the Part B Deductible covered. The main reason people switch is because the plans that can accept younger people into their pool, often have lower cost increases over time. You can read more about switching to a Plan G here.

Who CANNOT Get Plan F Now:

  • If you turn 65 on or after January 1, 2020, you cannot get Medigap Plan F or C. (Unless you fall into the Medicare Part A Effective Date Category explained above.)

Now, if you are someone who turns 65 after the cut-off, don’t fear. Plan G is the same as Plan F with only one difference: Plan G does not cover the Medicare Part B deductible.

Conclusions

In summary, Medicare Plan F is a robust, comprehensive Medicare Supplement Plan (aka Medigap Plan) that picks up all of the extra costs that Original Medicare does not cover.

Plan F is only available to people who already turned 65 before January 1, 2020. However, this plan is not going away at this time. It is still a popular plan and will continue offer full coverage and service flexibility to its beneficiaries.

Further Reading

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Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

medicare and medicaid difference guide

The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones.

The United States has two separate national health care systems: Medicare and Medicaid. The government created the two programs for two different kinds of people. However, they often overlap. Let’s look at both programs, including their similarities and difference. We will also look at who needs or qualifies for each program.

Let’s Start with Medicare vs Medicaid.

What is Medicare?

Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.

The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis.

Medicare does not cover all of the costs associated with health care. As a result, people with Medicare will also use a Medicare Supplement Insurance Plan (Medigap Plan) or a Medicare Advantage Insurance Plan to round out their care coverage.

Please read our Ultimate Guide article on “What is Medicare.

https://medicarelifehealth.com/glossary/medicare

What is Medicaid?

Medicaid is the United States National Health Care System that provides health coverage to over 64.7 Million People.

The program was created for people with low-incomes that cannot afford, or do not have access to, private healthcare insurance.

https://medicarelifehealth.com/glossary/medicaid

How are the programs similar?

Medicare vs Medicaid Pin

The programs are both National Health Care Systems. In fact, they are the only two nationalized heath care systems the United States has. Many other countries around the world have much more extensive national coverage for their citizens. The U.S. has a limited program for specific age, income, and health groups, and the rest of the country relies on private health insurance.

In addition, both programs cover specific hospital services, doctor services, and other health care related services.

Medicare has four parts. First, Medicare Part A, also known as “Hospital Insurance,” helps with coverage regarding: inpatient care, home health care, nursing facilities, and hospice.

Second, there is Medicare Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including: doctors visits, health care providers, outpatient, prevention services, and medical equipment. Medicare Beneficiaries pay for Part B.

Finally, Medicare has a Prescription Drug Program that is administered by private insurance carriers. Click here to lean more about What Medicare Covers and Medicare Parts A, B, C and D are.

How are the programs different?

One of the biggest differences between the two programs is who runs them. Medicare is run on a national level, by the Federal government. On the other hand, Medicaid is run by each state individually.

Of course, the biggest difference is the the different populations the programs serve:

  • Medicare – For Seniors over age 65, and some disabled people
  • Medicaid – For people with low income and few resources

Medicare and Medicaid Differences in Beneficiaries – Who Gets What Program?

The U.S. government created Medicare and Medicaid to take care of different “vulnerable” populations – the poor, the disabled, and the elderly. Let’s look at each program and population.

Who should get Medicare?

Anyone who is a citizen or qualified resident of the U.S. can enroll in Medicare when they turn 65 years old. There is a seven month window of time starting three months before turning 65, the month of your birthday, and then three months after your birthday month.

How do I Sign-up for Medicare?

First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).

Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.

Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Click here to read more about Medicare, including where to go to enroll.

From Our Article What is Medicare? A Guide to All Medicare Basics

Supplemental Medicare Insurance Options

Medicare picks up about 80% of the health care costs for its beneficiaries. For the other 20%, seniors turn to either Medicare Supplements (aka Medigap Plans) or Medicare Advantage Plans. Click here to read our article on Medicare Advantage vs. Medigap, or see the informational articles below.

What is Medicare Advantage?
What are Medicare Supplements_

Who should get Medicaid?

Medicaid is for people with limited income and resources. Medicaid is run on a state level, not on a federal level. As a result, in order to qualify for Medicaid, you will need to determine what your state defines as a qualifying income level.

How Do You Enroll in Medicaid?

Again, since Medicaid is run by State Governments, you will need to contact your state’s agency to start see if you qualify to enroll.

You can find a list of State Agencies here on the Medicaid.gov website.

Who Can Get Both Medicare and Medicaid?

People of any age who have certain qualified disabilities and people over 65, who are also below their states Medicaid income levels, can qualify for both Medicare and Medicaid.

For example, Henry is a 55 year-old disabled man who is also unemployed and living below the poverty level set by his state. Consequently, he would most likely qualify for both Medicaid (because of his income level) and Medicare (because of his qualified disability).

People that qualify for both programs are called “Dual Eligible.”

Who Can Help?

Navigating one (let alone both) of these systems can be confusing. But there is help available.

  • If you need help enrolling in Medicare, then you can contact CMS and Social Security in the following ways:
  • Finally, if you need help finding a Medicare Supplement or Medicare Insurance Plan, or if you are dual eligible for both Medicare and Medicaid, then please contact an Insurance Agent. An Independent Medicare Insurance Agent will help you explore your options, and help you make the right choice for your unique situation.

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Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

Is Medicare Plan F Going Away?

As a Medicare Health Insurance Agent I hear this question over and over: “Is Medicare Plan F Going Away?” The simple answer is, no, Plan F is not going away. However, not everyone can sign-up for it as of January 2020.

Who Can Still Get a Medigap Plan F?

Medicare Beneficiaries who turned 65 prior to January 2020, are eligible to purchase a Plan F Medicare Supplement. They will either have to have a special enrollment period for guaranteed acceptance, or go through Medical Underwriting to get into a plan.

Who Cannot Get a Medigap Plan F?

Beneficiaries who turn 65 after January 2020, are not eligible to purchase a Plan F Medicare Supplement.

Why Can’t Some People Purchase a Plan F?

Well, the government set a new rule that says anyone that turns 65, on January 1, 2020, or after, cannot purchase any supplement policy that covers the Medicare Part B deductible. This includes Plan F and Plan C.

2020 Part B Deductible

In 2020, the Medicare Part B Deductible is $198.

Click here to read all the 2020 Changes and Updates to Medicare Part B.

Medicare Supplement (Medigap) Plan Chart

Wondering what the difference is in Plan G vs Plan F? Here is a Medicare Supplement (Medigap) Plan Chart to remind you of what letter Plan covers what.

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

Plan G is More Competitive

Is Medicare Plan F Going Away Pin

The good news is that Plan G Medigap Plans are typically much more competitively priced than Plan F’s. Moreover, the only difference between the two plans is Plan F covers the Medicare Part B deductible, while Plan G does not.

Additionally, the Medicare Plan G Supplements are usually still less expensive than Plan F’s even after adding back in the Part B deductible.

Even if you are 65 years old before January 1, 2020, it is a good idea to see if you could save money by switching to a Plan G if you now have a Plan F.

Just know, You will have to pass medical underwriting to switch plans. Plan F’s will not have the ability to add younger (potentially healthier) beneficiaries to their pool. As a result, these plan prices will most likely rise at a faster rate than plans that can add younger people.

Plan F vs Plan G – How do They Work Differently?

Again, the only difference between Medigap Plan F and Plan G, is that Plan F pays the Medicare Part B Deductible and Plan G does not.

Part B pays for Medical Insurance. This includes:

  • Outpatient
  • Home Health
  • Doctors
  • Health Care Providers
  • Durable Medical Equipment
  • Prevention

Each year, when you use these types of services, you will pay the Part B Deductible ($198 in 2020) first. Then, you will pay no other costs as everything else will be picked up by your supplement.

With Plan G Supplements sometimes being up to $900 a year cheaper, it makes a lot of sense to see if you are eligible to switch to one or start on one.

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Click here for our infographic on the 4 parts of Medicare.
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Caring for Elderly Parents

Caring for Elderly Parents

Caring for Elderly Parents: A How To Guide

Caring for Elderly Parents - a how to guide from medicare life health co.

Welcome to the ultimate guide to caring for elderly parents and/or grandparents. Aging is a natural part of life, and everyone should have a care plan for themselves and their aging loved ones. This guide helps you make the tough decisions to keep your loved ones safe and happy.

I personally know what it is like to live with elderly loved ones and care for them. I lived with my grandparents right before their health declined enough to move them to assisted living. It was the hardest year of my life. However, it was also rewarding to care for them after all of the years they cared for me.

This guide leads you through the decisions you will need to consider to help your elderly parents.

We will cover:

  • Where can my aging parents/grandparents safely live?
  • What services and products can keep them safe and happy?
  • How can I help them with health care and insurance?
  • Who should be in charge of their finances?
  • Where can I go for support?

Where can my loved ones safely live?

Senior Living Options with Medicare Life Health Co. is part of the caring for elderly parents series.

Helping your elderly parents or grandparents decide where they should live can be very emotional. This is true for all the people involved. The options range from staying at home to full-time care, and everything in between.

Senior Living Options

  • Living at Home – Options exist for helping your seniors live at home as long as possible.
    • There are non-medical care-giving services such as Home Instead and Right at Home. They provide help around the house and companionship, but not medical care.
    • The medical alert devices listed in the services in the next section also help give seniors and you peace of mind in regards to their safety. These are good for the home environment, as well as running around town.
  • Retirement Community / Apartment or Condo – Often times seniors will want to move to a retirement community or 55+ apartment or condo building. Seniors like the social aspects of these communities. In addition, there are add conveniences and informal safety networks in place to give everyone peace of mind.
  • Assisted Living – For seniors that need a level of care below the nursing home, assisted living is a great option. However, these homes can be expensive. There are not always spots open for low income or Medicaid beneficiaries.
  • Memory Care Centers – Dementia and Alzheimer’s is a growing disease in America. As a result, we see more centers and homes dedicated to residents with memory issues.
  • Nursing Homes and Long-Term Care – The last stop on the list is the nursing home / long-term care facilities. There are both private and public options in most cities, but it takes a lot of research to make sure you are finding the best fit for your loved one.

What services / products can keep elderly loved ones safe and happy?

Especially if your loved ones are living at home, there are different products and services that can give everyone peace of mind. These include aides to help with daily activities, as well as alert / check-in services.

Products to Keep Your Loved Ones Safe & Happy

Best gifts for seniors

We love products that keep seniors happy, independent and safe. Happily, more creative and innovative options exist that ever to make life easier. We are constantly on the hunt for life-improving and safety-enhancing innovations.

Best Gifts for The Elderly in Nursing Homes

For now, you can start by looking at our senior gift lists.

We love the idea of thoughtful and helpful house warming gifts for seniors that are making a move. Especially if this move was out of necessity. A little love and thought goes a long way with these big transitions.

Services to Keep Your Elderly Parents Safe

We all worry about falls and accidents. The elderly often experience a decline in balance and strength with each passing year. There are a few options out there of companies that will monitor your loved ones and give them the help they need in case of a fall. When we look at companies to refer you to, we look for ones with good customer service, customization options and no long-term contracts.

Here are our Top Senior Monitoring Picks:

  • MobileHelp – Provides an alert system that works with a “Fall Button” that can automatically detect when a fall occurs. This company gets almost 5/5 stars in most consumer review panels. Learn more here.
  • LifeFone – Is our other top pick for Medical Alert Systems. It also is rated very highly and offers a free trial period. Spouses are also included in their standard pricing, which makes it a good choice for couples.
  • Iamfine – As a different kind of monitoring service, Iamfine is a daily call service that checks in with your loved ones by phone. If they fail to answer after a few attempts, Iamfine will alert your “care circle.” The service has a free 2 week trial period as well.

How can I help elderly parents with health care and insurance?

If your loved one is either older than 65 or disabled, they probably qualify for the Medicare program. In addition, if they are living on a very small income, they could also qualify for Medicaid.

From a high level view, your loved one will need to choose if they want their Medicare coverage to be bundled with a Medicare Advantage Plan or to be put together with Original Medicare, a Supplement and a Drug Plan. These are the two paths to choose from.

Let’s back up now, and break down the parts of Medicare. We want you, the caregiver, to feel as comfortable and knowledgeable as possible when helping your seniors make their decisions.

Helpful Medicare Articles for Caregivers

MedicareLifeHealth.com is a great resource for learning about Medicare. We have articles to show you how to set-up your loved one’s health care. We understand it is so important to make sure they get the coverage and care they need.

Here is where to go for more information:

Who can I call or email for help with Medicare/Medicaid/Health Care Insurance?

MedicareLifeHealth is a national community, but health care questions and registrations are often different state to state. So, we have a couple different resources for you to work with.

Carly Cummings, Medicare and Medigap Expert

If you live in Nebraska or Iowa: Your fearless leader of Medicare Life Health Co. (Carly Cummings – that’s me!) is a licensed life/health agent in NE and IA. I would be glad to help you with your questions and enrollment needs.


Please contact me here.

If you live in all other 48 States: We are building our directory of national insurance agents. Find one now:

Insurance Agents Near Me

Who should be in charge of caring for elderly parents’ finances?

There might come a time when you realize your seniors need help with their finances. As a result, you will discover two phases of caring for your elderly parents’ or grandparents’ finances:

  1. Assisting with their decisions.
  2. Taking over the decisions.

This same process translates to Medical decisions, so we will include information on both.

Durable Power of Attorney

When working with seniors to help them in making financial and medical decisions, you will want to set up “Durable” Power of Attorney (POA). This is a document that will give you (or someone else they trust) power to act in their place if they become mentally incapacitated.

The “Durable” part is important. Regular power of attorney documents end when a person becomes mentally incapacitated. Durable powers of attorney contracts do not. With this document, you will be able to help your elderly parent with important decisions when they cannot.

In addition, you will want to have two separate Durable Power of Attorney Documents:

  1. One for Medical
  2. And one for Financial.

Medical Power of Attorney (POA)

Commonly called the durable power of attorney for health care, this document names the person who will be making health care decisions for your elderly parent.

The named person will be able to enroll the elderly parent in medical plans, speak to doctors on their behalf, and represent their wishes in regards to medical care.

caring for a dying parent - a how to guide from medicare life health co. by crystal bayliss

You will also want to make sure your loved ones have a living will and a regular will. Knowing your loved one’s desires for how end of life care and services will go is very important. Please see our full article on “Caring for Dying Parents” here.

Financial Power of Attorney (POA)

Your elderly family member will also need to name someone to carry out their financial wishes when they cannot. This is where a comprehensive durable financial power of attorney is important.

Note, this should be a separate document from the medical POA. The financial POA allows someone take over your elder’s retirement accounts, taxes, and bills. For this reason, it needs to be someone they trust, and should be done as soon as possible to make sure they are represented in the ways they wish.

Working Together

Finally, although these are two separate documents, you certainly can name the same person on both. In fact, having the same person do both will make life much easier and simpler. If you do have different people named on each document, you will want to ensure they communicate well and can work together effectively.

Where can I get support for caring for elderly parents?

I remember pulling over to the side of the road, one very stressful day, because I couldn’t see through my tears to drive. At the time, I was living with my grandparents and trying to care for them while their health continued to decline.

Caring for Elderly Parents Stress Management: A How to Guide Presented by Medicare Life Health Co.

I was overwhelmed by the amount of work it took to keep them safe in their own home (even with the help of a home care company). Consequently, we were reaching the tipping point of needing to move them to assisted living. However, the thoughts about and process of this change were also just sad. It was a lot for me to handle.

Luckily, I had a very strong support system and access to help. You need this too.

Find Someone to Talk to Regularly

The first step is to reach out to someone to talk to and confide in. Care-giving takes a lot out of you. As a result, you need someone to listen to you and give back to you. Whether this is a professional counselor, or just a friend, you need to make “talking it out” a priority. Better yet, make your conversations a habit or a standing date.

Seek Outside Help

The second step is to get outside help. If your parent is still at home, see what is in the budget for hiring a care service. Even if just for a few hours a week. These companies help with daily living activities for seniors wanting to still live by themselves. (This is non-medical help.)

Alternatively, you can see what social network your seniors are a part of that might want to help. My mom was excellent at getting visitors for her elderly parents from not only their friends, church member, etc. but also from her own social network. You would be amazed at how many people are willing to swing by a nursing home and say hello during the week. You just have to ask!

Set-up Self-Care

Care-giving makes you busy, tired and often plain run-down. The only way self-care happens is when you make it a priority. Moreover, you need to set it in your schedule as an important appointment.

First, create and stick to a weekly workout schedule. Then, create a routine for getting healthy meals onto your table. Finally, make sure you keep your hair appointments, massages or other healthy ways to relax and stay on top of your health.

I know it is all easier said than done, but you will be much more efficient and helpful if you are well rested and cared for first.

Action Steps for Caring for Elderly Parents

checklist for aging parents and caring for your elderly parents and grandparents

In summary, caring for elderly parents, grandparent and loved ones is a long, hard journey. However, you are not alone! In addition to all the helpful organizations, services and innovations out there, there are also real people that want to love and support you. You cannot, and should not, do this alone.

Here are a few good steps to get you started or move you forward with your loved one’s journey.

  • First, if you are considering housing options, reach out to a home care service. If a move is a necessity sooner or later, start by touring one assisted living center or nursing home.
  • Second, for seniors living at home or even in assisted living, look into a couple of medical alert systems. Falls are all too common, and you need to be prepared.
  • Third, in regards to health care, reach out to a professional to make sure your loved one has the best coverage in their area. Plans change all the time, so a review is always a good idea.
  • Fourth, legally, make sure you understand what your loved one needs and wants in regards to making financial decisions. Get together all the proper documents needed to secure current or future Power of Attorney options.
  • See in your loved one has any Long-Term Care Insurance in place. Additionally, they could have a life insurance policy with a Long-Term Care Rider or a Critical Illness Rider.
  • Finally, create a plan now for taking care of yourself and start implementing it right away. You deserve it. Thank you for taking care of your elderly parents and loved ones.
Do I need Long-Term Care Insurance?
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2020 Part B Deductible

2020 Part B Deductible

2020 Part B Deductible for Medicare

2020 Part B Deductible

The 2020 changes for Medicare were released this month. The 2020 Part B Deductible is just one of the increases you will see.

The Centers for Medicare & Medicaid Services (CMS) released their updates for the coming year in a press release – 2020 Medicare Parts A & B Premiums and Deductibles. Let’s look at what is changing.

Part B Deductible for 2020

  • In 2020, the Medicare Part B Deductible will be $198.
  • In contrast, the deductible was 185 for 2019.
  • This is an increase of $13.

Part B Premiums for 2020

  • In 2020, the Medicare Part B Monthly Premium will be $144.60.
  • In contrast, the premium was 135.50 for 2019.
  • Consequently, this is an increase of $9.10.

Why are the Part B Deductible and Premiums Increasing in 2020?

The CMS adjusts the deductibles yearly, in accordance to the Social Security Act. Moreover, the increase reflects national healthcare trends.

In addition, the CMS has stated that the rate hike is mostly due to the increased use and cost of physician- administered drugs. Part B covers Physician-administered drugs.

What Part B Covers

Medicare Parts A B C D Explained

As a reminder, Medicare Part B covers:

  • Physician and Provider Services
  • Outpatient Services
  • Home Health Services
  • Durable Medical Equipment
  • Other non-hospital health services

To learn even more about the parts of Medicare and what they cover, you can see our infographic and discussion here.

Who Pays the Part B Deductible?

  • If you have Original Medicare only, you will pay the Part B Deductible.
  • In addition, if you have a Medicare Supplement that does not cover the Part B Deductible, you will pay it.
  • Some Medicare Advantage Plans have you cover the Part B deductible. This will be stated in your Summary of Benefits. However, 2020 plans have already been released, so deductibles are already set for the new year and will not be affected by this increase.

As of 2020, new beneficiaries to Medicare will not be able to choose a Medicare Supplement Letter Plan that covers the Part B Deductible. For example, Plan F covers the deductible, so seniors new to Medicare in 2020 and beyond will not be able to pick Plan F. Seniors that are already on these letter plans can keep them. Read more about this topic here.

Will the Changes Affect Part C or Part D costs?

No, these deductible and premium increases will not affect Part D Drug Plans or Part C Medicare Advantage Plans. The premium costs and the deductibles have already been set for the coming year. As a result, they are not affected.

According to the CMS press release,

As previously announced, as a result of CMS actions to drive competition, on average for 2020, Medicare Advantage premiums are expected to decline by 23 percent from 2018, and will be the lowest in the last thirteen years while plan choices, benefits and enrollment continue to increase. Premiums and deductibles for Medicare Advantage and Medicare Part D Prescription Drug plans are already finalized and are unaffected by this announcement.

CMS Press Release, Nov 2019

That is extra good news for those on Medicare Advantage Plans that have their deductibles satisfied with their plan. Some Medicare Advantage plans have a zero dollar deductible for their whole plan. These plans bundle Parts A & B and have the option of including the Part B Original Medicare deductible or covering it themselves.

Income Adjustments to Part B Premiums

There are no income related adjustments to the Part B Medicare Deductible. However, there are income related adjustments to your Part B Premiums.

  • First, the standard 2020 Part B premium of $144.60 applies to those with income less than or equal to $87,000 a year ($174,000 joint income).
  • Second, if you claim income between $87,000 and $109,000 ($174k-$218k joint), you will pay $202.40 a month.
  • Third, if you claim income between $109,000 and $136,000 ($218k – $272k joint), you pay $289.20.
  • Fourth, if you claim income between $136,000 and $163,000 ($272k – $326k joint), you pay $376.00.
  • Fifth, if you claim income between $163,000 and $500,000 ($326k – $750k joint), you pay $462.70.
  • Finally, if you have income greather than or equal to $500,000 ($750k+ joint), then you pay 491.60.
  • Click here if you need to see a table for premiums for spouses that file separate returns.

Are there Changes to Part A?

Yes, there are also changes to Medicare Part A. If you have a Medicare Supplement Plan, depending on which Letter plan you have, your supplement will continue to pick up these costs.

If you have a Medicare Advantage Plan, your plans benefits will still apply to you instead of the Original Medicare benefit structure. 2020 plans have already been released, so you will not be affected by these changes.

However, if you have Original Medicare only, you will want to take a look at the Part A changes that affect you here.

Further Reading

If you would like to learn more about Medicare we Suggest the following articles:

This Tool Kit answers your questions regarding Medicare Information, Medicare Supplements, Medicare Advantage, and Prescription Drug Plans. Discover what products are right for you and how to sign-up for them. 

Medicare 101

Read about basic Medicare Information. What is Medicare Part A? Part B? Get answers to your basic Medicare questions.

Medicare Supplements

What is a Medicare Supplement and how do I choose the best one for me? 

Medicare Advantage

What is Medicare Advantage and when is it, and what plans are, best for my situation?

Prescription Drug Plans

When do I need a drug plan and what do I need to look for in a good plan?

Medicare Advantage vs Medicare Supplements

What plan type is best for my situation and what do I need to consider when choosing.

Most Asked Medicare ?s

Answers to your questions and answers to questions you should be asking.

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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.)

does medicare cover hearing aids?

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)

how to read Medicare and You 2020 guidebook

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”

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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5 Biggest Medicare Mistakes

5 Biggest Medicare Mistakes

The 5 Biggest Medicare Mistakes and How to Avoid Them

5 Biggest Medicare Mistakes

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

The 5 Biggest Medicare Mistakes and How to Avoid Them Article Pin

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

What Is Long Term Care Insurance

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:

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.

Further Reading:

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How Much Does Medicare Cost?

How Much Does Medicare Cost?

How Much Does Medicare Cost?

how much does medicare cost?

Medicare costs can be different person to person, depending on which type of plan you choose. After you have a basic understanding of Medicare and it’s basic components, you will want to know how much does Medicare cost? The answer is, it depends on how you structure it. Let’s break down what you could be paying.

Medicare Costs Broken Down & Made Simple

When you set up your Medicare, you will decide if:

Your costs will also be different if you get help in any way from any state or federal programs.

How Much Original Medicare Costs

  • Medicare Part A – For most people, there is not a cost or premium you pay for Part A. Your Part A is premium free if you worked in the US and paid Medicare taxes for at least 30 quarters. (You will pay between $252 – $458 a month depending on your work history for Part A if you do not meet the premium free requirements in 2020).
    • There is also a $1,408 yearly deductible for Part A services and coinsurance tiers on hospital stays.
  • Medicare Part B – You will pay a premium for Part B. In 2020, the standard premium is $144.60 per month. If you make more than $85,000 a year in retirement, you will pay more on an income dependent scale.
    • There is also a $198 Part B deductible and a 20% coinsurance (co-pay) for most approved services.
    • Late penalties may also apply to Part B (and less commonly, Part A) if you do not sign-up when you are first eligible.

How Much Prescription Drug Costs

Medicare Part D Prescription Drug Plans

Medicare Part D – Prescription Drug Coverage needs to be obtained from a private insurance company. Each company will price their service differently and you can shop for the best plan and price for you. In addition, you will pay more for your Part D coverage, on a sliding scale, if you make more than $85,000 a year while on Medicare.

Other costs to consider with your Part D coverage are co-pays and coinsurance, in addition to deductibles.

There are also late enrollment penalties associated with not signing up for Part D coverage when you are first eligible if you do not have “credible coverage.”

How Much Medicare Supplements or Medicare Advantage Plans Cost

On top of your Original Medicare, you will need to make a decision to either participate in a Medicare Advantage (Part C) plan or to consider having a Medigap (Medicare Supplement) Plan. If you need help deciding on which one is best for your needs, please read our article on Medicare Advantage Vs. Medicare Supplements.

  • Medicare Supplement Plan Costs – Medicare Supplements will each have a different cost depending on the Letter Plan you choose and the company you go with. The government decides what benefits are offered by each letter plan. Then, each private insurance company decides what price they can offer for each plan in each market. It is a good idea to compare multiple plans by multiple carriers (insurance companies) in your area before choosing a plan. An independent insurance agent will be able to help you do this.
  • Here are a Few Medigap Articles to tell you more:
  • Medicare Advantage (MA/MAPD) Costs – Part C, or Medicare Advantage Plans are also offered by private insurance companies and stand in place of Original Medicare. In addition, they often include Part D Prescription Drug Coverage. Some of these plans have low or zero premium plan options. A few even cover Part B premiums. All of them are required to have max out of pocket expenditures and deductibles. It is a good idea to talk to an independent insurance agent on MAPD plans in your area to help you choose your best option.

Medicare Costs Summary

In summary, Medicare will cost you something, unless you are on full benefits from Medicaid. Moreover, you have already been paying into the Medicare system during your working career with Medicare taxes. Common set-up for Medicare beneficiaries include:

  • Having Original Medicare, Part A Premium Free, Part B Premium at $135.50 /month and a stand alone Part D Premium to pay. Then, adding on a Supplement Plan to cover the expenses Original Medicare does not pay.
  • Or having a Part C Medicare Advantage Plan that includes a drug plan with a premium to pay (sometimes a $0 premium). Most commonly, you will still pay your Part B premium with Medicare Advantage.

Get More Help Understanding How Much Medicare will Cost You

One good resource for learning more about the costs of Medicare is the Medicare and You Book published by the government every year. It is a large book, so please star with our Medicare and You User’s Guide to learn what it offers and to get a copy if you need one.

In addition, finding the best Medicare options for your budget can be a lot to take on, but hopefully this breakdown is helpful. I strongly suggest talking to a professional to help you in setting up your Medicare plan. As an independent agent myself, I suggest using an independent agent. They are not tied to one company, so they work for you, not one carrier and can help you in considering many different carriers and plans.

Carly Cummings, Medicare and Medigap Expert

As always, if you live in Nebraska or Iowa, please give me a call, and I can help you out either in person or over the phone.

Carly Cummings, NE/IA Licensed Independent Insurance Agent for Life and Health.
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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:

medicare advantage vs original medicare with a supplement - Medicare Life Health Pin
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