Health insurance remains at the center of concern for most Americans, especially seniors. As such, programs such as Medicare and Medigap can help keep seniors insured and give them access to affordable care.
There are many Medicare plans available and each provides different levels and costs of coverage. Because of this, the process of picking a plan that is right for you can sometimes create more questions than answers.
In this quick guide, we will explain and demystify some of the basics of Medicare in addition to the best supplemental insurance options for those with additional needs.
What is Medicare?
Medicare is a government-subsidized insurance plan which certain eligibility restrictions. An individual is only 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 those two years worth of Social Security Disability Insurance (SSDI) checks.
Compare Plans: Original vs. Advantage
Your individual coverage needs and financial ability will often be the guiding factor in choosing between different medicare plans. Because of this, there are two “types” of Medicare offered: the Original Medicare and Medicare Advantage. While both types are still federal programs, their difference lies in the covered services of each plan and potential costs of monthly premiums for your health care coverage.
The Original Medicare is separated into the following three plans:
- Part A: also known as “hospital coverage,” this plan covers inpatient hospital stays, skilled nursing facilities, some forms of home health care, and hospice.
- Part B: also known as “medical insurance,” this plan covers outpatient care, certain doctor’s services, preventative care, and medical supplies
- Part D: also known as “prescription drug coverage,” this plan covers prescription drug costs to any of the original medicare plans in addition to potential coverage on some (though not all) 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.
The skip from Part B to Part D is intentional– Part C is reserved for Medicare Advantage. As such, the Advantage plan covers everything in A, B, and D, functioning as an insurance bundle offered by private insurance companies contracting through the federal Center for Medicare and Medicaid Services (CMS).
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.
What is the Medigap Plan?
Even when an individual utilizes a Medicare health insurance plan, there are certain expenses such as copayments, coinsurance, and deductibles, that an individual will still be required to pay out-of-pocket. To help with these costs an individual can apply for supplemental insurance, also known as Medigap.
The first important consideration of Medigap is that your monthly premium depends on not only the plan you choose, but your state and zip code. Furthermore, premiums paid for Medicare supplemental insurance plans are fees paid in addition to your pre-existing premiums for Part A and Part B plans.
While the coverage of Medigap varies by insurer, all plans offer a baseline standard of coverage and are clearly listed as “Medicare Supplemental Insurance.”
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.
First, you must ensure that you are eligible and currently enrolled in the Original Medicare. Once this has been determined, you can begin the process of looking for individual insurance companies that offer a Medigap plan.
While the research process might take a little time, information about insurance plans can both be found by searching individual providers on the internet, calling in to the company to speak with a representative, or even contacting your state’s insurance assistance program to be provided with information on different policies. The government also provides a free to use provider lookup tool at medicare.gov.
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 and your own. Choosing the right insurance supplement is ultimately about choosing what is right for you.
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 your part b deductible or, if applicable, your prescription drug plan.
Finally, it is time to purchase the plan itself. This is done by making a purchase directly through your chosen insurance company.
Premiums and Deductibles
Medicare premiums and deductibles relate to monthly fees needed to maintain coverage in addition to the amount of out-of-pocket expenses that must be paid before insurance begins to cover part of the bill.
Premiums are slightly different per plan and are updated on a yearly basis. For 2020, the following premiums apply:
- Standard monthly premium of $144.60
- $198 annual deductible for Part B coverage
Note: premium rates are also income dependent. When looking at pricing, make sure to check your income bracket to determine your exact expected rates.
Medigap also offers high-deductible insurance plans for those who wish to lower their monthly premiums. As with all supplemental plans, it is necessary to check-in and compare notes between individual providers on the market.
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. These generally include costs for vision and dental, prescription glasses, hearing aids, long term care, and private-duty nursing.
Making sure your healthcare needs are met is an important necessity that should not be rushed.
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.
The Gebhardt Insurance Group offers years of experience and some of the country’s most respected insurance providers to help individuals find the coverage they need. Call us to discuss your options at (502) 836-3244.