Top Five Misconceptions about Medicare and Medigap

medicare mythsMedicare can be complex – there are “parts” and “plans”, changes and updates, ins and outs that only the most experienced or devoted person could follow and understand. Moreover, there is a great deal of misinformation out there about Medicare and Medicare supplement plans, particularly this time of year as we approach the end of year annual election period. As an independent Medicare insurance and Medigap agency, we hear these misconceptions over and over. It is an uphill battle to fight against the misinformation and misunderstandings regarding Medicare and Medigap plans. But in a small way, this article may help shed some light on the top five misconceptions about Medicare.

1. “When I turn 65, I’ll get Medicare for free.”
Unfortunately, this one is not true in most cases. There is a premium associated with Medicare Part B (currently $134/month) that is typically paid as a deduction from your social security check. If you are not receiving Social Security, you can also pay this quarterly by receiving a bill. This amount can be higher or lower based on your income. Find out how much you will pay for Medicare Part B.

2. “The end of year enrollment period applies to Medicare supplement, or Medigap, plans.”This misconception is very prevalent this time of year, as we approach October 15, which is the start of the annual election period. Many people mistakenly believe that this end-of-the-year period also applies to Medicare Supplement, or Medigap, plans. However, that is not the case. The end-of-the-year period only applies to Medicare Advantage and Part D plans. You can actually change Medigap plans at any time but do have to qualify medically (in most states) when you do so.

3. “Medicare Advantage plans are a type of Medicare supplement.”Medicare Advantage plans are completely independent of and different from Medicare supplement plans. On the contrary, they take the place of Medicare A & B, whereas supplement plans (also called Medigap) “supplement” Medicare. If you opt on to a Medicare Advantage plan, which is a privatized version of Medicare, instead of Medicare itself, you can go back to having Medicare during the annual election period, but to get a Medicare supplement, you generally would have to qualify medically. You can also get supplements as maeng da from independent suppliers and still get the advantage of Medicare.

4. “Medicare does not cover any preventive care.”This one was more true in the past than it is now. Medicare does now provide coverage for a good bit of preventive care (much of this is relatively new). Here is a breakdown we did previously of some of the more common preventive care that Medicare does cover. Most importantly, Medicare does cover a “welcome to Medicare” physical when you turn 65 and also an annual wellness check-up.

5. “I need to find out if my doctor takes this Medigap plan (or the related misconception of, “I am going to ask my doctor which Medigap plans pay him faster or more”)This misconception is easily understood, when you consider that it is rooted in (for most people) years of worrying if their insurance is paying their claims in full or quickly enough. However, these concerns do not carry over to “over-65” insurance, at least if you are talking about Medicare and a Medigap plan. For Medigap plan, claims are paid through the Medicare “crossover” system. And, they are paid in the same amount on the same time schedule, regardless of which company you have for your Medigap carrier. Additionally, Medigap plans do not have networks – if a doctor takes Medicare, they are required to take the standardized Medigap plans.

While there is a lot to decipher and understand related to Medicare and Medigap plans, it is crucial to your health and financial well-being to do so. If you have any questions about this information or wish to further discuss Medicare and Medigap plans, you can contact us online or call us at 877.506.3378.

Going on Medicare Part 3 – Medigap vs. Medicare Advantage

**This is Part 4 in a 5-part series intended to assist people turning 65 or going on Medicare with understanding Medicare, Medigap and other Medicare plan options.**

This article focuses on the difference in the two types of Medicare insurance plans – Medigap plans and Medicare Advantage plans. Contrary to what many people think, these are NOT the same thing, work very differently, and there are some distinct advantages/disadvantages to the different types of plans.Medigap vs. Medicare Advantage – Two Distinct and Very Different Options

Commonly, individuals going on Medicare refer to all plans that are secondary to Medicare as Medicare Supplements. This is, obviously, incorrect. An employer group health plan, Medicare Advantage plan, etc. is NOT a Medicare Supplement.

Medicare Supplements are also called Medigap plans. These two terms are interchangeable. These Medigap plans cover the same things from company to company – plans are Federally-standardized. Below, we’ve listed some major bullet-point differences between the plans:

  • Medicare Advantage plans have networks and some (HMOs) require referrals; Medigap plans do not have networks – you can go anywhere that takes Medicare.
  • Medicare Advantage plans have co-pays and deductibles but lower premiums; with Medigap, you pay a larger premium but it is more comprehensive coverage. The Medigap fills in the ‘gaps’ in Medicare A & B so you don’t, in most cases, have any out of pocket co-pays or deductibles.
  • Medigap plans do not include drug coverage; Medicare Advantage plans sometimes include Medicare Part D prescription drug coverage, within their plan.
  • If you take a Medicare Advantage when first eligible (when leaving employer coverage or turning 65), you have to qualify medically if you ever want to return to the more comprehensive coverage of a Medigap plan. However, you can always go the “other way” – from Medigap to Medicare Advantage.

There are obviously some other factors to consider when comparing these two types of plans, but these are the primary differences in the plans. Other things you will want to consider are your own personal health, your financial means and the future of the Medicare Advantage program since the onset of health insurance reform.

What’s right for one person may not be right for another. It’s most advantageous to you to work with an independent agent who can simply provide all of the information for both types of plans, so that you can compare in one centralized place and make an educated decision.

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If you prefer to speak with someone by phone, please call me directly using the information below:J. Garrett Ball, President
Secure Medicare Solutions, Inc.Toll-Free: 877.506.3378

Medigap Rates – Who Determines Them and Why Do They Go Up?

Medigap rates change over time. That is, quite simply, a fact. Some companies will be more stable than others – some plans are more stable than others. But overall, all rates, regardless of the company, plan or where you live will change. The important thing is understanding how those rate changes work, when they occur and why they occur. This allows you to minimize the effect rate increases have on your pocketbook and know when to make changes to your plan if necessary.

First of all, rate increases are always approved by the state departments of insurance. Your state is responsible for screening both the increase itself, as well as the size and administration of that increase (i.e. when it occurs). You cannot be singled out for an increase. One of the most common questions that we receive is… “I have not been to the doctor’s office but once all year, so why is my rate going up?” Unfortunately, that is not the way insurance works. Your rate goes up based on the claims experiences of everyone who has that company in your geographical area (usually in your state). So, your rate, when it goes up (not IF, but WHEN) will go up based on a percentage. For example, if your Plan F rate is $100 and the company has a 6% increase on Plan F rates, your new rate will be $106. The company is required to give you advance notice of any rate changes – 30 days in most states.

There are many things that differentiate the increases that companies will have. Besides geographical and claims experience factors, there is also the factor of which plan you have. In other words, most companies have different size increases on different plans. In general, a plan that is not Federally-required to be offered on a “guaranteed issue” basis in certain situations will be more stable over time. The plans that are required to be offered in “guaranteed issue” situations (i.e. losing employer coverage or Advantage plan coverage) are A, B, C, F, K and L. The other four plans would be, historically speaking, more stable over time due to NOT having to be offered in “guaranteed issue” situations.

Now, when your rate is going to go up, you do have some recourse, particularly if you are in relatively good health and are getting a significant increase. There are NO enrollment periods for Medigap plans (When is the Medigap enrollment period?) so you can change plans any time that your rate goes up. It is always advisable to re-evaluate your rates against those of other plan options when your rate goes up.

If you have questions about this or would like a rate quote comparison for the plans available for your age and zip code, please call us at 877.506.3378 or contact us on our website at Medigap quotes from Medicare-Supplement.US.

The Differences in Medicare Advantage and Medigap – What You Need to Know

This time of year, there is much confusion about the two different types of Medicare plans. The purpose of this article is to differentiate between the two types of plans and elaborate on what makes them different and how they work.

On the one hand, there are Medigap plans – these plans work with the Federal Medicare program, filling in the gaps and supplementing Medicare. Then, there is the other type of plan – which is quite different – Medicare Advantage. Medicare Advantage plans are not Medicare Supplements. On the contrary, they replace Medicare A & B with a privatized version of Medicare offered exclusively through private companies that are approved annually by the Centers for Medicare and Medicaid Services (CMS).

The upcoming time of year is especially confusing for those who are on Medicare, primarily because of what many people refer to as the “Medicare Enrollment Period”. The formal name for the period is the “Annual Election Period” – during this time, you can make changes to your Medicare Advantage or Part D prescription drug plan. However, you can change Medigap plans at any time – there is no annual enrollment period that applies to these plans.

The primary differences between Medicare Advantage and Medigap are:

  • Premium
    Medicare Advantage plans will generally have a lower premium than Medigap plans in almost all instances. In some places, Medicare Advantage premiums can be as low as $0/month. Medigap plans have premiums that are based on your age, gender, zip code, and tobacco usage, and those premiums range widely depending on those factors.
  • Coverage
    Medigap plan coverage is, generally, more comprehensive than Medicare Advantage plan coverage. Essentially, you get what you pay for. In some cases, Medigap plans (particularly in the case of Plan F) will cover everything that Medicare doesn’t cover at the doctor/hospital with no out of pocket costs. Medicare Advantage plans have a complex system of co-pays and deductibles that vary for different services/procedures and for in/out of network.
  • Doctor Accessibility
    Medigap plans do not have networks – you can use any Medigap plan at any doctor, nationwide, that takes Medicare. Most Medicare Advantage, typically, have a regional network of doctors/hospitals that are contracted to participate in their plan. You can use out of network doctors in emergency situations or if you are willing to pay a higher co-pay/deductible amount.
  • Portability
    If you move to a new state, you will have to change your Medicare Advantage plans. These plans are done by county, so if you move, you will be automatically disenrolled from your current plan and have to choose a new plan. Medigap plans, on the other hand, are national. Any plan can be used anywhere nationwide that takes Medicare, and if you move, you CAN change plans but you are not required to do so.
  • Enrollment Requirements
    Medigap plans are available on an open enrollment basis when you first turn 65 or go on Medicare. During this time period, you do not have to answer health questions, take a physical, be concerned with pre-existing conditions, etc. After that period, you do have to answer health questions (in most states) if you want to get a Medigap plan. With Medicare Advantage, you can enroll in a plan during the annual enrollment period at any time without having to answer health questions. What this means is that – if you take a Medicare Advantage plan initially, and then later if your health changes, wish to move to the more comprehensive coverage, you will have to qualify medically in order to do so.

The issues surrounding Medigap and Medicare Advantage are complex. Different plans are better for different people. Health status, location and financial means all come into play – or should – when comparing these types of plans. If you have questions or wish to compare the plans that are available to you, please call us at 877.506.3378 or visit us at Compare Medicare Plans.

Comparing Medicare Part D – Why You Should and The Process for Changing Plans

Comparing Part D plans is an essential part of any sound financial strategy. Part D plans can change each year, and most do change on a regular basis. The coverage changes, the premium changes, and some plans may choose to discontinue coverage altogether. Insurance is an ever-changing industry, and this is never more true than in the case of Part D plans. Because of that, it is absolutely critical that you re-evaluate your Part D plan on an annual, or at the very least, bi-annual basis.

The biggest things that you need to look for when you are evaluating and comparing your Part D plan to other options are the premium, deductible and co-pays/coverage. While one plan may have a lower premium, note whether the deductible is higher and/or whether the co-pays are larger. Often, plans will put forth an enticing lower premium but have the plan loaded with a large deductible and high medication co-pays. This is okay for someone in good health, but if your health changes or if you are on a lot of medications, this is not going to be something that will benefit you in the long run.

Towards the end of the year, usually in September or October, you will receive a packet from your current Part D plan regarding the coverage for the following year. If you have not received this by the end of October, we recommend contacting the plan to notify them of this and obtain this packet. This will be required in order to make a careful and effective evaluation of the plan options. The packet will contain a comparative chart, showing how the plan is changing from the current plan year into the next year. It should be relatively easy to understand if the premium, deductible, or co-pay structures are changing. Also, if your medications are moving to a new “tier”, this is something that you can find out from the packet, and it will be important to know as you evaluate the plans.

Each year, you have the opportunity to change plans during the annual election period. It is my recommendation that you carefully evaluate the plan options each year, as these plans change very frequently. If you wish to make a change, you simply apply for the new plan. You cannot be enrolled in two plans at one time, so when Medicare processes your enrollment into the new plan, they also disenroll you from your old plan. The process is seamless and easy to do. It can be done online with Medicare, by calling 1-800-MEDICARE or by contacting the new plan directly.

If you have any questions about this process, Part D plans in general or Medigap plan options, please contact us on our website or call us at 877.506.3378.

This concludes our five-part series on Part D plans. Hope you have found it to be enlightening and beneficial. Part D is the most confusing, and least enjoyable, part of Medicare for most people. However, it doesn’t have to be. With a little knowledge of the Part D system, how it works and how to easily compare plans, you can save hundreds, even thousands, of dollars a year. And, that’s enjoyable for anyone!

Medigap Plan N – Who Is Choosing This Plan?

Medigap Plan N is a relatively new Medigap plan. It came out as part of the revision of the standardized plans in 2010, and it has really become one of the more popular plans. Due in large part to the incorporation of the plan into many companies offerings, many people are choosing it as a lower-cost alternative to some of the other Medigap plans. So, what is Plan N and who is choosing this plan?

First and foremost, you must understand what Plan N covers:

  • It is the same as the more expensive plans at the hospital (Medicare Part A). It still covers the Medicare Part A deductible and the 20% that Medicare doesn’t cover at the hospital, skilled nursing facility, etc. (Part A costs).
  • The differences come under Part B. Plan N doesn’t cover the Medicare Part B deductible ($140/year for 2012). Also, Plan N doesn’t cover the Medicare Part B Excess charges. These are very rare but occur when a doctor does not accept Medicare “assignment” (in other words, he/she doesn’t accept the Medicare payment schedule). The doctor can charge up to 15% over the normal Medicare payment schedule, and Plan N doesn’t cover this (What Are Part B Excess Charges?). This, incidentally, only happens in about 1% of cases nationwide. Lastly, Plan N does include some small co-pays. The co-pays are $20 for doctor’s visits and $50 for a trip to the ER. So, there are really three differences: Part B deductible, Part B excess charges, and co-pays.

With these differences in mind, you can see that, although ‘N’ is definitely a lower level of coverage than something like Plan F or Plan G, it can be a very good option and still provides comprehensive coverage, including the full coverage at the hospital that is so attractive about the Medigap plans. Moreover, because it is one of the standardized Medigap plans, it still provides the security of nationwide coverage, no networks, guaranteed renewability, etc. that all of the supplement provide – in contrast to Medicare Advantage plans which have co-pays like ‘N’ but are not national plans, all have networks and are not guaranteed renewable.

Plan N is typically about $40 less than Plan F, on average with most companies that offer it. Many companies have adopted it and now offer it as their alternative for people in good health who may not want to pay the larger cost for Plan F. It is certainly something to consider.

If you have questions about this information, want more information on Plan N, or want to get a Medigap Plan N rate for your area, please contact us on our website or call us at 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