In several weeks I will be turning 65 years of age and will be eligible for a way to offset 20 % of medical expenses not covered by Medicare Part B (80%).
In advance of this milestone I researched what would be the best option for me. In today’s article I will share what I learned with the goal to be of service to you.
Through my research, I discovered that I could either enroll in a Medicare Advantage Plan or in a Medicare Supplement (Medigap) Plan. Below I will share what I discovered that may benefit you as you turn 65.
I am not an insurance agent, nor do I know whether a Medicare Advantage Plan or a Medicare Supplement Plan would be right for you. My encouragement would be to do your own research to make that decision.
Note: If you have any per-existing conditions this information will be very important. If you have any per-existing conditions there is a guaranteed issue to be able to apply for and be issued medigap/supplemental coverage.
The guaranteed issue period is 6 months following the part B effective date, when you start receiving Medicare Part B. For example if Medicare Part B is effective on June1st, then the month of June is month one. December would be the last month six to apply for the medigap/supplemental plan.
Beyond the 6 month guaranteed issue, to be able to sign up for a Medigap or Medicare Supplement Plan you will have to answer many medical questions and undergo medical underwriting. The answers to these questions may make you ineligible or have a waiting period before being able to apply.
Note: Also, adding a Part D plan for your medications is very important once you turn 65. If you do not already have a prescription (Part D plan) or do not obtain one shortly after becoming 65 you will receive a monthly penalty, See this link for more information about this penalty: Part D late enrollment penalty.
State Health Insurance Information Program (SHIIP)
An organization and their staff that has been kind, patient and helpful in understanding and making my decision. State Health Insurance Information Program (SHIIP). Each state has there own SHIIP program that can be contacted as many times as you have questions and there is no charge or fee for calling or for guidance. They can help to answer your questions and guide you.
Medicare Advantage Plans and Medicare Supplemental Plans
There are Medicare Advantage plans that are advertised with no or little monthly premiums. These plans have co-pays for Dr. visits, hospital stays and other expenses that the 20 % Medicare Part B does not cover. Consequently, there can be more out of pocket expenses although there are no or little premiums required by Medicare Advantage Plans. Each company has a different structure.
In my experience, after my thorough research and wanting to keep things simple for me, I decided to choose a Medicare Supplement Plan. Click on the this link to compare Medicare Supplement (Medigap) policies. How to compare Medigap policies. Having a Supplement Plan instead of a Medicare Advantage Plan reduces or eliminates out of pocket costs of the remaining 20%.
How Medigap/Medicare Supplement Plans Work
Once you pay your Supplemental Plan monthly premium for the plan, your monthly Medicare Part B premium and meet your Medicare yearly deductible (currently $233), your out of pocket expenses or a portions of the (20%) are paid by the Supplement plan (see below for different supplement plan options).
These costs are covered provided that the Dr. and services you use accept Medicare.
Dental, Vision and Hearing are separate and not included in supplement plans. Check with your insurance provider to sign up for these options. Additional premiums are charged for Dental, Vision and Hearing.
In addition to the supplement plan you will need to obtain a Part D prescription plan, as Part D prescription plans are not included with Supplement Plans. Consult with your states SHIIP program for Part D options.
Different Medicare Supplement Plans cover different medical services and expenses. See the below Chart.
Below information is copied from: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
Compare Medigap plans side-by-side
The chart below shows basic information about the different benefits Medigap policies cover.
Yes = the plan covers 100% of this benefit
No = the policy doesn’t cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable
Compare Medigap Plans
|Plan A||Plan B||Plan C||Plan D||Plan F*||Plan G*||Plan
|Plan M||Plan N|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Foreign travel exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out-of-pocket limit**||N/A||N/A||N/A||N/A||N/A||N/A||$6,620 in 2022||$3,310 in 2022||N/A||N/A|
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, co payments, and deductibles) up to the deductible amount of$2,490 in 2022 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a co payment of up to $20 for some office visits and up to a $50 co payment for emergency room visits that don’t result in inpatient admission.
You live in Massachusetts, Minnesota, or Wisconsin
If you live in one of these 3 states, Medigap policies are standardized in a different way.