Are you confused and overwhelmed by Medicare??
Worried about making the wrong decision and being stuck with a plan that doesn’t cover your medical and prescription needs when you need it most?
Don’t worry! You are not alone. The vast majority of seniors who are on Medicare have absolutely no idea which type of plan they have, and what it does and does not cover.
Getting quality health coverage is one of the most important parts of aging. Often times, especially when we are in good health, we neglect the importance of getting this coverage, thinking we can always get it in the future if we need it. This is critical misconception!! You need to get health insurance while you are healthy, because once your health goes, so do your options. It’s like trying to get home insurance while your house is on fire
With potential unforeseen medical expenses looming, this is a crucial time to make sure you are completely covered. Unfortunately, Medicare does not cover all of your Medical expenses at 100%. In order to get this complete coverage, you will need to add a Medicare supplement plan.
What Does Medicare Cover?
To understand Medicare supplement plans, you must first understand what Medicare does and does not cover. When you are nearing 65, you will have the opportunity to enroll in Medicare Part A, Medicare Part B, and Medicare Part D. Or, you can enroll in Medicare Part C (Medicare Advantage), but then you would not be able to enroll in a Medicare supplement plan. There are specific reasons why you should choose a Medicare supplement plan over Medicare Advantage.
It is important to note that Medicare SUPPLEMENT plans and Medicare Advantage plans are not the same thing. This is another common and important misconception. Medicare Advantage is a substitute, or replacement for Medicare. If you choose this type of plan, you will be giving up the Medicare rights and benefits you have earned by years of working hard and paying into Social Security, and you will be forfeiting them for a managed care plan (HMO/PPO) where the insurance company (not you) dictates your coverage and care.
Medicare Part A is your hospital insurance. It covers inpatient care in the hospital or skilled nursing facility. For example, if for any reason you need to go to the hospital, and the hospital admits you as an inpatient, Medicare would cover a portion of the expenses associated with the stay, after you first pay a $1,364 deductible out of your pocket.
Medicare Part B is your medical (outpatient) insurance. You would use this coverage for all doctor visits and outpatient surgeries. For example, if you need a routine exam or checkup, one that you would not need to go to the hospital for, you would be taking advantage of your Part B benefits. Part B also covers benefits such as ambulance services, durable medical equipment, and mental health services.
Medicare Part D is your prescription drug coverage. If you need prescription drugs for any condition, it is essential to have this coverage. Even if you are currently healthy, it is a good idea to pick up a low-cost Part D plan. You never know when you might need prescription medications in the future, and if you do not add a Part D drug plan when you are first eligible, Medicare will penalize you and that penalty lasts forever.
While it may seem like Medicare covers most of your expenses, you may still be left with numerous expenses that Medicare does not cover, i.e. the “gaps” in coverage. These expenses can add up quickly, leaving you with significant bills to pay for your health coverage. This is why you need a Medicare supplement plan! Depending on which type of Medicare supplement plan you choose, the plan will cover some or all of the gaps that Medicare does not cover, so you can guarantee that you will be 100% covered and enjoy the peace of mind and predictability of never having to pay any out-of-pocket medical expenses at all.
What are Medicare Supplement Plans?
Medicare supplement plans, also known as Medigap plans, fill the gaps in Original Medicare Parts A and B. These plans are private supplemental insurance plans. The government completely standardizes these plans, so they are exactly the same from company to company. This ensures that the same plans cover all the same gaps in your Medicare coverage, no matter which insurance company that you choose.
What this means is that different insurance companies in your area may charge totally different monthly premiums for the exact same plan. Sometimes there might be as much a $100 per month spread between two companies offering the same identical supplement plan, so it is very important to make sure you choose one of the insurance companies that offers your desired supplement plan for the lowest monthly premium available in your zip-code.
For example: Let’s say you have decided that you want to enroll in Medicare supplement Plan G, one of the most popular full-coverage supplement plans.
Insurance Company A’s premium rate for Plan G is $200 per month.
Insurance Company B’s premium rate for Plan G is $215 per month.
Insurance Company C’s premium rate for Plan G is $245 per month.
There is absolutely no difference between any Plan G, whether you choose Company A, B or C. Supplement Plan G is a standardized plan… every Plan G is exactly the same from one company to another. Not close, not similar, but EXACTLY the same in every which way!
One of the biggest misconceptions that folks have when comparing Medicare supplement insurance companies is thinking that by paying more for their plan they will get access to more doctors, faster service, more benefits, etc. This is not the case, as all plans of the same type are 100% identical in coverage and benefits.
With inpatient hospital expenses, Medicare will typically only pay 80% of the expenses. Certain Medicare supplement plans cover the remaining 20% that Medicare does not cover, which would normally be your responsibility. With the right Medicare supplement plan, you would eliminate your responsible for any inpatient hospital expenses, no matter how high.
Without a Medicare supplement plan, you have exposure to high deductibles and large hospital and medical bills. Having a Medicare supplement plan is vital to protect yourself in the event of a significant medical emergency. Your savings could quickly deplete in a situation where you would be left responsible for all coinsurance, deductibles, and excess charges for a major medical situation.
It is important to know when to enroll in a Medicare supplement plan to ensure you get protection as quickly as possible.
When Should I Get a Medicare Supplement Plan?
The best time to buy a Medicare supplement plan is during your Medigap Initial Enrollment Period. This period varies from person to person. It starts six months before the day your Medicare Part B starts, which is typically the first day of the month you turn 65. It ends three months after the month you turn 65.
Enrolling in your Medicare supplement plan during this period is important. It ensures that insurance companies must approve you without any medical underwriting, and cannot reject you for pre-existing health conditions.
You can still enroll in a Medicare supplement plan outside of your Initial Enrollment Period, but there may be some additional challenges associated with this. For example, if you have any major health issues or take any expensive medications, you might not be as attractive of a beneficiary to insurance companies. This may result in a denied application or costly premiums.
The benefits of getting a Medicare supplement plan far outweigh the cost. As a senior, it is critical to ensure you have protection in all medical situations in order to preserve and protect your health and wealth.
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By David Lasman – “Ask Medicare Dave” | President – Senior Healthcare Team
About Medicare Dave
As a licensed, accredited and unbiased Medicare benefits expert, Medicare Dave’s focus is on helping folks to cover the out-of-pocket expenses that Medicare doesn’t cover.
I cut through the clutter of information to simplify complex and confusing topics in an easy to understand manner. By eliminating their stress and confusion, I enable people to feel safe, protected and happy.
My gift is informing, educating, & advising seniors on how best to provide full healthcare coverage at the lowest cost… and all of our services are totally FREE OF CHARGE to seniors!
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