Original Medicare consists of Part A, which covers inpatient care, and Part B, which covers outpatient care. Most people are eligible for Part A and aren’t required to pay a monthly premium for that coverage as long as they or their spouse meet specific qualifications. Members must pay a monthly premium for Part B coverage. Although Original Medicare covers many costs, there are also out-of-pocket costs members are responsible for, such as deductibles and coinsurance.
This is where a Medicare Supplement plan can become very beneficial to some.
Medicare members have options of additional coverage to help cover those out-of-pocket costs. One of those options is a Medicare Advantage plan. These are plans offered by private insurance carriers and must provide Part A and Part B coverage that is at least as good as original Medicare. They may also provide Part D coverage for prescription drugs. Some Medicare Advantage plans require an additional monthly premium, and others offer a $0 premium. However, members may be limited to the plan’s network of providers and may be required to obtain referrals or prior authorization for certain services.
Another option members have to cover their out-of-pocket costs is a Medicare Supplement plan, also known as a Medigap plan. With a Supplement plan, members remain enrolled in Original Medicare for their Parts A and B coverage and pay a private insurer an additional monthly premium for the Supplement coverage. If you are enrolled in Medicare Advantage and select a Medicare Supplement plan, your Medicare Advantage plan will be canceled – you are not able to be enrolled in both at the same time. They may also choose a standalone Prescription Drug Plan, also known as a PDP or Part D. The coverage is also generally more comprehensive with a Supplement plan rather than a Medicare Advantage plan, with some Supplement plans covering 100% of out-of-pocket costs.
Other benefits of a Medicare Supplement plan are that members are not limited to a plan’s provider network. If the doctor or hospital accepts Medicare, then the member can continue to receive services. Members are not required to select a Primary Care Physician (PCP) or obtain referrals or prior authorizations for services as long as the care is a Medicare-covered benefit. Since members aren’t limited to a specific plan network, a Supplement may also work well for members who spend the winter in one part of the country and the rest of the year somewhere else. Medicare Supplement plans are also guaranteed renewable once you are enrolled, which means as long as you continue to pay your monthly premiums, your coverage can’t be canceled.
There are 10 different Medicare Supplement plans, and they are identified by a letter, such as Plan A, Plan B, and so on. They are standardized across states, with the exception of Massachusetts, Minnesota, and Wisconsin.
Supplement plans are also standardized across insurance carriers. For example, if you have Plan G from one carrier, the benefits would be exactly the same as those in Plan G from another carrier. What may be different is the cost, as carriers can determine the premium for each plan they offer.
Each Supplement plan must follow one of the Plan designs below. The key features of each plan design are noted.
So what Supplement plan is best for you? First, make sure to check and see what options are available to you. Then, review your current and expected healthcare needs to determine what type of coverage is most valuable to you. Compare that to each of the plan designs outlined above to see which plan design best meets your needs. Finally, review the insurance carriers who are offering the plan design you are interested in.
Now, you may be thinking that this can be a long-winded process by yourself, but by working with Medicare Peace Of Mind, you won’t have to do this alone! Our team can do this for you, saving you the time and hassle.
It’s also important to note that as of January 1, 2020, Medicare Supplement plans sold to members new to Medicare are not allowed to cover the Part B deductible. This means Plans C and F are no longer offered, but if you were already enrolled before 2020, you might be able to enroll in these plans.
Medicare Peace Of Mind can review your Medicare options. If you would like to learn more about Medicare Supplements or would like to enroll, contact us today at 970-233-0633.