Three Reasons the Name of Your Medigap Company Is Not Important

One of the most common thoughts, and understandably so, for many people “shopping” seniors looking at computer
for a Medigap plan is what company or companies have I heard the most about. This leads to people looking, primarily, at the companies that do the most marketing or the company that a neighbor or family member has. While this can lead to some good results – personal testimonials are often a great predictor of future performance – it can also lead to some “tunnel vision” and a lack of understanding of how the plans actually work and what factors should truly go into your decision-making process.

Put simply, the name of your company – even the rating of the company – is not ultimately very important when it comes to choosing a Medigap policy. This does not hold true with other types of insurance, where there are more variables and less standardization. But for Medigap insurance, the name of the company is virtually irrelevant. Here is why:

  1. First of all, the plans are Federally-standardized. This means that the coverage with one company is the same as the coverage with another company. For example, a Plan F with one company is the same as a Plan F with another. This means that price is, or should be, the primary differentiating comparison factor.
  2. Claim payments are paid through the Medicare “crossover” system. This is the same system used by all Medigap companies – it links your “original” Medicare Parts A and B up with your Medigap and insures that claims are paid on the same time schedule and in the same amount regardless of who your Medigap company is.
  3. You can use any doctor or hospital that takes Medicare regardless of which company you have. Different plans are not more or less widely accepted. As long as your doctor takes Medicare, he/she is required to take any of the standardized Medigap plans. Note that doctors offices, and particularly those that work in the insurance/billing offices, are not always well-versed on the different types of plans. And, some companies offer both Medigap and Medicare replacement plans like Medicare Advantage. Very often, someone in the billing department will say that they do not “accept” a certain Medigap plan, when in reality, they don’t have a choice as all claims are paid through the Medicare “crossover” (see point #2 above) and they are not filing specifically to the individual companies anyway.

It is important not to make a decision on a Medigap plan simply because you’ve heard the plan pays well or someone else is “happy with it”. Frankly, everyone is (or atleast should be) happy with their Medigap plan’s claim-paying performance because it is the very same from company to company. It is prudent to have an understanding of the above three points and compare Medigap plans on what really matters – price – before selecting a plan based on imagined or superficial differences. Otherwise, you could, like many others, end up paying “extra” every month for the exact same products that works the exact same way.

If you have questions about this or want to further discuss, you can contact me online or call 877.506.3378.

Does Medicare Cover Preventive Care?

One of the most common questions newcomers to Medicare ask is if Medicare covers preventive care. In the past (pre-2011), Medicare did not cover many of the preventive services that most people wanted or needed to pursue. However, starting 1/1/11, Medicare began to cover the majority of these preventive services, in accordance with recommendations by the U.S. Preventive Services Task Force.

Below, we’ve listed a comprehensive list of what preventive care services Medicare now covers. These services are required to be covered, regardless of whether you have “original” Medicare (Parts A & B) or coverage through a private Medicare plan, such as Medicare Advantage:

  • Diabetes screening – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Diabetes services and supplies – 80% of the Medicare-approved amount (after the Part B deductible)
  • Medical nutritional therapy – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Alcohol misuse screening and counseling – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Depression screenings – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Sexually transmitted infection screening and counseling – 100% of the Medicare-approved amount (Part B deductible does not apply) for those at risk
  • HIV screenings – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Smoking cessation – 100% of the Medicare-approved amount (Part B deductible does not apply) for those who do not have a smoking-related illness (80% for those that do)
  • Glaucoma screening – 80% of the Medicare-approved amount (after Part B deductible)
  • Blood tests for heart disease – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Bone Mass measurement – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Cardiovascular risk reduction visits – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Obesity screening and counseling – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Screening mammograms – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Pap smears, pelvic exams and clinical breast exams – covers 100% for pap lab tests, pap test collections, clinical breast exams, and pelvic exams (Part B deductible does not apply)
  • Colon cancer screening – 80% for barium enema (no Part B deductible) and 100% for fecal occult blood test, flexible sigmoidoscopy, and colonoscopy (no Part B deductible)
  • Prostate cancer screening – 100% for PSA test (Part B deductible does not apply) and 80% of the Medicare-approved amount for digital rectal exam (after Part B deductible)
  • Flu shot – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Pneumonia vaccine – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Hepatitis B vaccine – 100% of the Medicare-approved amount (Part B deductible does not apply) for people at medium or hgh risk – covered by Part D (Rx coverage) for people at low risk
  • Annual wellness visit – 100% of the Medicare-approved amount (Part B deductible does not apply)
  • Abdominal Aortic Aneurysm Screening – 100% of the Medicare-approved amount for people at an increased risk of AAA who receive a referral during their Welcome to Medicare physical (see next bullet point)
  • Welcome to Medicare preventive visit – 100% of the Medicare-approved amount (Part B deductible does not apply)

Keep in mind that doctors who accept Medicare “assignment” cannot charge you more than the Medicare-approved amount. However, if your doctor doesn’t accept assignment or orders more tests/procedures, you will  be charged for those. If you have a Medicare supplement plan, depending on which plan you have, you may have $0 or a very minimal out of pocket costs for those additional tests.

Be sure to follow the Medicare guidelines for how often you can get these various preventive tests and procedures. These guidelines can be found on Medicare.gov or in the “Medicare and You” handbook. Also, you can access Medicare’s guidebook – “Your Guide to Medicare’s Preventive Services” – for more information. If you have any other questions or if we can help in any way, please call us at 877.506.3378 or visit our website at Medicare-Supplement.US

Medicare Supplement Open Enrollment – When Is It and How Does It Work

Medicare Supplement open enrollment is the name given to the time when you are BOTH 65 or older AND enrolled in Medicare Part B. This time period, which begins on the first day of the month that you meet these criteria (65 or older and enrolled in Medicare Part B), lasts for 6 months.

During this time period, insurance companies cannot use medical underwriting. This just means that they cannot make you pay more for pre-existing conditions, deny your coverage, or restrict the coverage based on your health. Because this is the case, it is essential that if you are going on Medicare, you sign up for a plan during this time period.

At a later time period, the insurance companies use medical underwriting to determine your eligibility for coverage. This can cause you to be denied coverage or made to pay more because of your health. The individual companies set their own unique underwriting guidelines. These can vary by state and according to state-specific restrictions and variations.

The only way to avoid this uncertainty, altogether, is to sign up during this open enrollment period, when you are first eligible for Medicare.

One consideration that may affect when you sign up is if you plan to work past the age of 65. There are other enrollment rights, called “guaranteed issue” rights, which would allow you to sign up for a Medigap plan later when you retire, if you have been covered by employer insurance.

However, you may want to also consider delaying enrollment in Medicare Part B, if you plan to work past the age of 65. Since both conditions must be met in order to trigger your open enrollment period, being 65 or older AND having Part B, your open enrollment period can also be delayed until the time of your retirement. You should discuss this with your benefits person at your current employer or insurance plan, so that you can understand the implications of how their plan will work with Medicare Part A only. If their coverage is primary to Medicare, delaying Medicare Part B is likely the most advantageous choice.

During open enrollment, you can easily compare Medicare supplement plans, get Medigap quotes from an independent brokerage and make a sound decision on the plan that makes the most sense for you. When you apply, you will not be made to disclose anything about your health, answer medical questions, or take any sort of physical examination to obtain coverage. You simply fill out some general personal information, sign the application to apply, and wait for your card and policy to come in the mail.

On a regular basis, we deal with cases where someone has waited to buy a Medigap plan until after their open enrollment period is up. In many cases, waiting can cause someone to be “stuck” in a situation where they cannot get a plan, or atleast not get the plan they want.

This makes getting a plan during your open enrollment period, no matter what company or broker you get it from, of utmost importance. If we can assist in comparing the plan options, we are happy to do so. We can send quote information by email. To get this information, visit Medicare-Supplement.US or call us at 877.506.3378.