Health insurance is a central and important concern for most Americans, especially seniors since aging increases the likelihood of need for medical intervention. Because of this, programs have been developed to help keep seniors insured and give access to affordable care.
When it comes to Medicare, there are many plans available and each provides different levels and costs of coverage. In addition, the government also offers Medicare supplement plans to cover additional costs. Because of this, the process of picking the proper plan can sometimes create more questions than answers.
In this quick guide, we will explain and unpack some of the basics of Medicare and outline the best supplemental insurance options for those with additional needs.
What is Medicare?
Medicare is a government-subsidized insurance plan with certain eligibility restrictions. An individual is eligible for medicare if one or more of the following apply:
- They are over the age of 65
- They suffer from an end-stage renal disease
- They suffer with disabilities
In the case of persons with disabilities, Medicare can potentially offer coverage to younger individuals. Coverage is withheld until after a 2-year waiting period has elapsed and the individual seeking coverage can produce 2 years’ worth of Social Security Disability Insurance (SSDI) checks.
Medicare Plans: Original vs. Advantage
Individual coverage needs and financial ability is often the guiding factor in choosing between the different medicare plans. There are two “types” of Medicare offered: Original Medicare and Medicare Advantage. Both types are federal programs, but each have different covered services and thus different monthly premium costs.
Keep in mind that monthly premiums and deductibles change on a yearly basis. While updated information can be found on cms.gov, premiums can vary based on income and some plans may require a high deductible.
Original Medicare is separated into the following three plans:
Part A: Hospital Coverage
This plan covers inpatient hospital stays, skilled nursing facilities, some forms of home health care, and hospice.
Part B: Medical Insurance
This plan covers outpatient care, certain doctor’s services, preventative care, and medical supplies
Part D: Prescription Drug Coverage
This plan covers prescription drug costs to any of the original medicare plans in addition to potential coverage on some Medicare Cost Plans, Private Fee-for-Service Plans, and Medical Savings Account Plans.
Please note that Part D is offered by Medicare approved private insurance companies. As such, exact prices and extent of coverage may vary between plans and individuals.
Medicare Advantage
The skip from Part B to Part D is intentional– Part C is reserved for Medicare Advantage. As such, the Advantage plan includes everything in Parts A, B, and D.
Advantage functions as an insurance bundle offered by private insurance companies contracting through the federal Center for Medicare and Medicaid Services (CMS).
What is a Medigap Plan?
Even when an individual utilizes a Medicare health insurance plan, there are certain expenses such as copayments, coinsurance, and deductibles that the individual is required to pay out-of-pocket. Keeping track of these amounts can be burdensome and the expenses may add up. Therefore, to help with these out of pocket costs, an individual can apply for supplemental insurance, also known as Medigap. These supplemental plans may also include additional coverage such as dental care, vision care, and more.
Medicare Supplement plans are sold by private companies but each plan offered must follow federal and state guidelines. Insurance companies do not have to sell them but if supplement plans are offered, they must include standardized coverage.
It is important to note that all 50 states have standard coverage laws but Massachusetts, Minnesota, and Wisconsin are the only states that have their own state standards that differ from federal policies.
How Much Does Medigap Cost?
The cost of Medigap is difficult to broadly estimate because costs depend on the chosen plan, the company you choose, the state you live in, and your zip code.
Though companies must offer federal standardized coverage, rates may vary per insurance company based on age, gender, health condition, discounts, and more.
Remember: premiums paid for Medigap are fees paid in addition to Original Medicare premiums.
How to Purchase a Medigap Plan
If you have decided a Medigap plan is right for you, there are a few steps that need to be taken before purchasing a plan.
- Eligibility
You must ensure that you are eligible and currently enrolled in Original Medicare. Once this has been determined, you can begin the process of looking for individual insurance companies that offer a Medigap plan.
- Research
While the research process might take a little time, information about insurance plans can be found through internet searches, calling customer service phone numbers, or even contacting your state’s insurance assistance program. The government also provides a free to use Medicare provider lookup tool.
While close friends or family can also be a resource, it is important to take into consideration the potential differences in their health and living situation from your own. Choosing the right insurance supplement is ultimately about choosing what is right for you.
- Compare
Once you have begun the process of gathering information, you can begin the comparison. Important items to consider in your comparison are: monthly premium rates, the option for high-deductible plans, and whether or not you will receive aid with matters such as part b deductibles, part b coinsurance,or prescription drug plans.
- Purchase
Finally, it is time to purchase the plan itself. This is completed by contacting your chosen insurance company and purchasing your coverage directly through them.
Best Supplement Insurance Plans for 2021
In 2021, there are currently 10 Standard Supplement Insurance Plans available. The best plans are those that balance coverage and cost. Unfortunately 2 of these plans, Plan C and Plan F, are no longer available to new enrollees, therefore if you have not yet purchased supplement insurance, you have 8 to choose from in 2021.
Plans that offer more comprehensive coverage will incur higher premiums and vice versa. These plans can range from $62-$784 per month in 2021.
Below we have outlined our Top 3 Recommended Choices for Supplement Insurance in 2021:
Best Comprehensive Plan: Plan G
Plan G has one of the higher monthly premiums of up to $473, but this plan includes all coverages except for the Medicare Part B Deductible. This means that you are responsible for paying the $203 deductible in 2021 before costs are covered, but after that all coinsurance, other deductibles, and excess charges are covered.
Best Cheaper Plan: Plan N
Plan N is very similar to Plan G except, in addition to not covering the Part B deductible, it does not cover Part B excess charges. These charges can add up due to Part B covering routine care such as outpatient procedures and preventative care. If you are relatively healthy and do not foresee needing much additional care, this may be a good plan for you.
Best Cheapest Plan: Plan K
This plan is much cheaper than any other supplement insurance plan but that does come at a cost. This plan differs from all the other plans in that Medicare Part A coinsurance is covered at 100% but everything else is only covered at 50% or not at all. Therefore if you need outpatient procedures, blood, preventative care or skilled nursing, only 50% of these costs are reimbursed. This is a great plan if you only need assistance with coverage to offset costs, not to cover costs.
Special Considerations
Like the Medicare Advantage Plan, Medigap is purchased from private insurance companies. However, it is illegal for an insurer to sell you a Medigap plan if you already own Medicare Advantage. Medigap is only offered to those on the Original Medicare plan.
In addition, Medigap policies are specific to the individual. This means that if both you and a spouse would like the additional coverage, you will both need to purchase separate policies.
Furthermore, even with the addition of medigap, there are still some fees that might go uncovered. Unless otherwise specified, these generally include costs for vision and dental, prescription glasses, hearing aids, long term care, and private-duty nursing.
Another factor to consider when selecting your Medicare and Medigap coverage is based on doctors who accept medicare, most offices will accept the coverage but it is always a good idea to confirm before selecting a plan.
Selecting Your Insurance
Making sure your healthcare needs are met is an important necessity that should not be rushed but should also not be put off for later.
Choosing the right policy is not only a matter of knowing what you need today, but knowing what you may need in the future. This, in addition to the difficulty often involved in changing Medigap policies once one has been instated, is the main reason to choose a plan you can grow into as you age.
There are many factors to consider when making the right choice for yourself and we know it can seem overwhelming, but you do not have to do it alone. Our insurance agents are well educated on the major insurance companies plans when it comes to Medigap insurance, these companies include Blue Cross Blue Shield, AARP, Humana and more.
The Gebhardt Insurance Group offers years of experience in understanding the country’s most respected insurance providers to help individuals find the coverage they need when it comes to Medicare insurance, auto insurance, life insurance and more. Call us to discuss your options at (502) 836-3244.