datachie, Author at Senior Benefit Services

Medicare Plan K

So what exactly is Medicare Plan K? Plan K is one of the current standardized Medicare Supplement plans that may be available in your state. Why do we say ‘may be available’? Most carriers previously chose not to include this plan in their Medicare Supplement offerings in the past since it was not widely sold nor understood by most consumers and even many agents. This trend is slowly starting to change simply because more Medicare beneficiaries are looking for lowering cost alternatives to higher costing Medigap plans, but still do not want to enroll in a Medicare Advantage plan due to network restrictions.

Medicare Supplement Cost Sharing

Plan K offers many of the same benefits as other Medicare Supplement plans, but as the consumer you are taking on a ‘cost sharing approach’ instead of having most medical care covered at 100% between the Medigap plan and Original Medicare. So how does the cost sharing actually work? As an example let’s take the Medicare Part A deductible which is $1,600 in 2023.

Under Medicare Plan K the Part A deductible will be covered at 50% rather than 100% like you would find under the popular Medigap Plan N and Plan G. This means that in 2023 if you were to be admitted into the hospital you would be covering $800 of the Part A deductible while your insurance carrier would be covering the other $800. Unfortunately under Plan K the insured is responsible for the Part B annual deductible, any Medicare Part B excess charges, and any emergency medical charges outside of the United States.

The good news is that this plan does provide the insured with a annual maximum out of pocket limit of $6,940 for 2023. While many would be taken back by this amount, you might not be aware that most Medicare Advantage plans for 2023 have a out of pocket maximum of $7,500 (and that is even using in-network doctors). If a policyholder were to reach that out of pocket maximum then the Medicare Supplement Plan K would pick up 100% of the charges of areas originally covered by this plan’s benefits.

Pricing: Is it Worth It?

If we look at comparing the premiums for a 65 year old female (non-tobacco user) in the state of Maryland for a Plan K vs Plan N then here is how it breaks down.

Plan K Monthly Premium = $65.51 (average between 2 top priced carriers)

Plan N Monthly Premium = $95.77 (average between 2 top priced carriers)

On monthly premium alone the clear winner is Plan K with an annual savings of $363.12. So if the policyholder does not have any claims for the year then they would have saved over $300 by going with the Plan K. As we all know, the older we get, the more likely we are to experience health conditions that would require us to see a medical professional.

An individual falls and breaks a hip. She is admitted into the hospital as an inpatient. How does play out financially?

Just with the cost of the Part A deductible, their responsibility would be $800. With only one hospital stay, the $300+ in premium savings with Plan K is erased. This ends up costing the insured an extra $436.88 above their annual premiums. If the insured had a Plan N, then the Part A deductible would have been covered at 100%.

Takeaway

In certain states and at certain ages, the Medicare Supplement Plan K could very well be a solid alternative to a Plan N. At Senior Benefit Services we can compare rates across all our carriers and find the plan that will work best for you and your budget. Call us today at (800)924-4727 to get your FREE…No Obligation quote comparison.

Best Medicare Supplement Rates for Ages 70 To 75 (New For 2023)

Getting the best Medicare Supplement Rates for ages 70 to 75 can save you 100’s or 1,000’s of dollars a year. Finding out that you are overpaying for Medigap insurance is frustrating.

Medicare regulates all Medicare Supplement Plans regardless of the company you purchase your Medigap Insurance from, the coverage is the same.

I will explain how you can save money simply by speaking with a Medicare Supplement expert who will look for a plan that can cost much less than what you are presently paying but still give you the exact same coverage.

Best Medicare Supplement Rates For Age 70

By age 70, you are probably already enrolled in a Medigap plan.

The question is, what plan are you enrolled in?

Are you enrolled in Plan F, Plan G or Plan N?

And, are you getting the best Medigap Insurance rate for age 70?

It will cost you nothing to speak with one of our Medicare Supplement experts who will review your present health status and be able to find the best available rates.

Medicare gap insurance rates are less expensive for females than males but there are a few other factors that can save you money or increase your premiums.

Are you healthy, do you smoke or are you a non-tobacco user?

Pre-existing health conditions can increase your rates but some past health problems that you had a few years ago, may not affect your rates at all.

By age 70, you should be discussing your Medigap insurance with a Senior Benefits expert on an annual basis to ensure you don’t over pay another MedSup carrier for the exact same coverage you could get somewhere else.

Best Medicare Supplement Rates For Age 71

By age 71, you may be dealing with some minor health issues.

One of our top Senior Insurance Advisors had this advice for deciding on Medicare Supplement Plans Cost.

Anything can happen to anyone at any time so get the best plan you can afford (at age 71). Just because you are healthy now, doesn’t mean you won’t have an accident or become ill in the near future. This includes plans with 100% excess charge coverage and 100-day skilled nursing care coverage. A Plan G is the best for cost and coverage.

best Medicare supplement rates for ages 70 to 75 — Meet Shawn Graff who is one of our Senior Advisors who can help you find the best Medicare Supplement rates for ages 70 to 75

Best Medicare Supplement Rates For Age 72

Keep in mind that just because you were healthy when you signed up for your existing Medicare Supplement plan, doesn’t mean that you are getting the best rates for age 72.

All Medigap premiums increase each year but different carriers offer different rates and increase in different increments.

Even if you are a Male smoker with some health issues, regularly checking with a Medigap expert can result in much lower supplement insurance rates at age 72.

Sample Quote: Male – Non-Tobacco – Living in Hagerstown, Maryland

PLANS	PLAN F	PLAN G	PLAN N
AGE 70	$179.62	$146.67	$114.33
AGE 71	$182.88	$151.17	$117.67
AGE 72	$188.12	$156.33	$121.83
AGE 73	$191.67	$160.84	$126.08
AGE 74	$199.63	$166.66	$130.50
AGE 75	$208.78	$173.56	$135.67

Sample rates for Washington County Maryland as of 12/15/2022 and does NOT include any applicable discounts.

Best Medicare Supplement Rates For Age 73

When changing your Medigap policy there are a few things to consider.

First, what plan are you presently using?

If it is Plan F and you qualify to move to Plan G, this will save you a ton of money usually.

Because Plan F will not be available after 2020 to people new to Medicare Supplement Plans, the

premiums will increase due to the inability to keep adding younger and healthier Medigap users.

Taking advantage of this knowledge and investigating the move to Plan G can be one of the best financial decisions you make at age 73.

Best Medicare Supplement Rates For Age 74

What are truly the best Medigap policy rates for age 74?

“If you are looking at a true Medicare Supplement, the F, G and N are the main three plans. Plan L, K, M, only cover ½ the hospital deductible and have out of pocket maximums. So, in those cases, it is better to go Medicare Advantage. Very few of our customers opt for a high deductible supplement plan. “

Karen Simundson

Senior Insurance Advisor

Senior Benefit Services, Inc.

It is important to take advantage of changing Medigap policies as soon as possible.

Whether you are a male or female, smoker or non-tobacco user can all factor into your Medicare Supplement Ins Plans rates.

For instance, some medications you may take for a health issue may not affect your premiums.

However, if you have diabetes and have to take insulin, most companies will decline your coverage.

At age 74, a male or female looking to change Medigap insurance plans can save a tremendous amount of money if they are healthy.

Sample Quote: Female – Non-Tobacco – Living in Hagerstown, Maryland

PLANS	PLAN F	PLAN G	PLAN N
AGE 70	$155.43	$130.15	$97.01
AGE 71	$159.03	$133.95	$97.51
AGE 72	$163.58	$137.68	$100.97
AGE 73	$166.67	$139.86	$104.78
AGE 74	$173.59	$144.93	$108.95
AGE 75	$181.55	$150.92	$113.27

Sample rates for Washington County Maryland as of 12/15/2022 and does NOT include any applicable discounts.

Best Medicare Supplement Rates For Age 75

Statistically, the majority of people by age 75 will have some sort of health condition.

Some of these health conditions can result in you being declined coverage outside of the Medicare Supplement Open Enrollment Period.

It doesn’t matter if you are a male or female, whether you smoke or are a non-tobacco user, some health conditions, the Medigap carriers simply will just not insure.

Sometimes your health is great so long as you stay on your medications but even those medications can result in you being declined coverage.

It’s important to find the best priced plan for you at age 75, whether it is Plan F, Plan G or Plan N.

As you get older, it can be more difficult to change plans do to your health.

Taking Action!

Senior Benefit Services will be able to help guide you through choosing a Medicare Supplement Plan.

There are many factors that determine the Best Medicare Supplement Rates For Ages 70 to 75.

The Experts at Senior Benefit Services have been specializing in helping seniors make the best Medigap insurance choices for over 50 years!

Call now at 1-800-924-4727 or fill out the easy and convenient ‘Start Free Comparison’ form in this article.

Medicare Supplement Plans: What They Cover, Best Plans & Cost

I’m sure you can agree that turning 65 was really exciting… that’s until you had to learn about Medicare, the different plan options available, like Medicare Supplement Plans, and how they all work together.

But here’s the thing:

You can get educated on Medicare Supplement plans, (often called Medigap plans or Medsup plans) get covered, and move on with your retirement in less than an hour or two.

Today, this definitive guide will explain to you what Medigap plans are, what they cover, their costs, the best Medicare Supplement plans, how they work, and how to apply for coverage.

We recommend you get started with a free Medicare Supplement quote by state.

What Is Medicare

This guide wouldn’t be complete without going over at the least the basics of what Medicare is and how it works.

Medicare is health insurance offered by the federal government when:

- You reach 65 or older

You are younger and have a disability
You Have amyotrophic lateral sclerosis (ALS)
You are a U.S. citizen, or a permanent resident lawfully residing in the U.S for at least five continuous years.
You have End-Stage Renal Disease, sometimes called ESRD (which is permanent kidney failure requiring a transplant.)

There are a few different parts of Medicare, you can learn about them in the video below or check out our outline beneath the video:

Medicare Part A (Hospital Insurance)

Part A of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Basically, any hospital expenses that are critical to your care like a semi-private room, your meals, medications that are part of your inpatient care and nurse services.

Medicare Part B (Medical Insurance)

Part B of Medicare covers outpatient care, ambulance services, preventative services, medical supplies and certain doctors’ services.

For instance, you get a one-time “Welcome To Medicare” preventive visit for free where your doctor will do things like check your blood pressure, vision weight and height and make sure you are up to date with your preventative screenings like cancer screenings.

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage plans are also known as Medicare Part C.

These plans are offered by private health insurance companies and are approved by Medicare for people who are enrolled in Part A and B of Medicare. We Discuss the differences between these plans and Medicare supplemental insurance plans below – Link To Med-Sup vs Med Adv

Medicare Part D (Prescription Drug Coverage)

Part D of Medicare covers your prescription drug coverage.

These prescription drug plans are offered through private insurance companies that have been approved by Medicare.

Before you make any changes to your Medicare Plans, be sure to know how or if it will affect your Part D coverage if you are enrolled.

So, there you have it:

Medicare is health insurance provided by the federal government, and it is broken into 4 parts.

These parts are Medicare’s attempt at helping manage the costs of health care.

However, there are some gaps in coverage that can happen in the stand-alone Medicare coverage that will leave you open to expenses you didn’t expect, and that is where Medicare Supplement Plans or Medigap Plans come into play.

What Are Medicare Supplement Plans (Medigap)

Medicare Supplement plans are products that help supplement original Medicare and are offered through private insurance companies.

They help pay some of the hospital and medical costs for things that original Medicare doesn’t cover like:

Emergency Overseas Travel
Co-payments
Co-Insurance
Yearly Deductibles
Part B Excess Charges, etc…

This is where the nickname Medigap comes from, this policy fills the “gaps” that can be found in original Medicare coverage.

Below we discuss how Medicare Supplements work and what they cover.

What Does Medicare Supplemental Insurance (Medigap) Cover?

Before you can even attempt to enroll in Medigap plans, you must be enrolled in original Medicare, both Parts A & B.

You will need to stay enrolled in original Medicare to remain eligible for your Medsup or Medigap plan.

As of today, there are 10 standardized Medsup plans that you can choose from when you are deciding what to purchase. To answer the question of, ‘What are Medicare Supplement Plans?’ you have to take a much closer look at all of the details in each plan.

These plans are A, B, C, D, F, G, K, L, M, N; you can also get Plan F in a “high-deductible” version.

Outside of Massachusetts, Minnesota & Wisconsin, who have their own set of standard Medsup plans; most states have these 10 plans.

eHealthmedicare.com actually has a great map that shows Medsup plans by their state if you want more state specific information..

Now here’s the thing:

While the pricing can be different, all the benefits of each plan letter are the same no matter what insurance company you go through or where you live.

This means that a Plan G in Georgia with Company A will have the same benefits as a Plan G in Texas with Company B.

I am bringing this up because sometimes the companies that have the best pricing are probably ones you have never heard of before like Heartland or Lumico and you don’t want to lose out on savings just because of a name.

If Aetna or Blue Cross is more expensive, it isn’t because they are going to be offering more benefits so be sure to go with the company that has the best rate for your situation when you are looking at these plans.

Overall, all Medicare Supplement plans cover the below benefits:

Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or co-payment*
Blood (first 3 pints)*Part A hospice care coinsurance or co-payment*

*Coverage may be partial for some plans. Some Medicare Supplement plans will also cover:

Skilled nursing facility care coinsurance
Medicare Part A deductible
Medicare Part B deductible
Medicare Part B excess charges (the amount that a non-participating provider may charge above the Medicare-approved cost for a service)
Foreign travel emergency (up to plan limits)

Plan K and Plan L include an out-of-pocket limit.

Once your spending for Medicare-covered services reaches a certain amount, the Medigap plan will cover 100% of Medicare-covered costs for the rest of the year.

Now that you know what Medicare Supplement plans cover, how about we discuss the things they won’t cover.

Did You Know:You must be enrolled in Medicare Part A and Part B to get a Medicare Supplement plan.

What Does Medicare Supplement Insurance (Medsup) NOT Cover?

Medigap policies usually do not cover the following health services and supplies:

Long-term care (care in a nursing home)
Routine vision or dental care
Hearing aids
Eyeglasses
Private-duty nursing
Prescription drugs – You will need to enroll in a stand-alone Plan D Prescription drug plan
Routine Chiropractic Care and Acupuncture

If you need assistance in enrolling in a Prescription Drug Plan as part of our services we will help you through the process free of charge.

Medicare Supplement Vs Medicare Advantage (Often Called Plan C)

When you start doing your research on original Medicare you are going to get confused with all of the “M” words.

One of the most commonly asked questions is what is the difference between Medicare Advantage and Medicare Supplements.

While they are both products offered through private insurance companies they work and do two entirely different things.

Both of these plans cost money in addition to the plan premiums for your original Medicare.

You also can’t have both of these plans at the same time and below is a simple chart of the differences:

	Medicare Advantage	Medicare Supplements
In Relation to Original Medicare Parts A & B	Private health plan that provides Part A & B benefits directly in place of Regular Medicare.	Private gap coverage that pays all or most Part A & B out-of-pocket expenses.
Premium	$0 to more than $100 a month depending on the plan. Anyone enrolled will pay the same no matter of age or health history.	Average of about $125 to $225 a month. Can vary by age, health history, or Company.
Out-of-pocket costs	In-network medical deductibles and co-pays of $3,240 up to $7,500 a year, depending on the plan.	Very Low Cost to None (excluding the monthly premium)
Choice of doctors and hospitals	HMO: Plan providers only. PPO: Any provider, but out-of-network providers cost more.	Any Provider that participates in Medicare.
When Can You Purchase	When you first enroll in both Medicare A and B and annually thereafter during Open Enrollment (Oct.15 – Dec.7).	First six months after you sign up for Part B and are at least 65 years old.
Part D Prescription Coverage	Most plans include Part D coverage.	Not included. You must buy a separate Part D plan for this.
How Provider Is Paid	You pay deductibles and Co-pays directly to providers.	Medigap almost always automatically cuts a check to providers after Medicare pays its share.

Did You Know: All Medsup policies must be clearly identified as “Medicare Supplement Insurance.”

How Much Does Medicare Supplement Cost

The one thing you will run into is that even though the Medigap plans are required to offer the same standard benefits for each lettered plan, the insurance companies can change the premiums and the Medicare Supplement cost.

We recommend allowing us to shop around for you to find the best plan and best pricing since insurance companies can price their plan premiums based on the following things:

Community no-Age-Rated

These Medicare Supplement insurance plans charge premiums that are the same across the board, regardless of age and are usually more affordable than attained-age-rated products over time.

Issue-Age-Rated

These plans base their premiums on your age when you first enrolled in the program.

So, the younger you are when you enroll in this type of policy, the lower your monthly premium will be.

Attained-Age-Rated

Like issue-age-rated, these plans base their premiums on the age you were when you first bought a policy, but unlike issue-age-rated, premiums with this type of policy will increase as you get older.

Finding the most affordable option can be time-consuming and a bit confusing, but we make the process very simple for you and help save you both time and money.

Check out some of our sample rates below:

Sample Medicare supplement quotes
Age	Plan G	Plan F
65	$91.29	$106.74
66	$91.29	$106.74
67	$91.29	$107.42
68	$91.37	$108.48
69	$93.14	$111.72
70	$93.03	$114.26

Monthly premiums are based on a Non-Tobacco Female in Frederick County, VA. We averaged 3 of our top carriers together. Rates effective as of 12/15/2022.

Read our article on Best Medicare Supplement Rates for Ages 70 to 75

Did You Know: Premium costs may vary by the company, the plan, and your location, even for the same benefits.

Which Medicare Supplement Plan Is Best

There are 10 different Medicare Supplement Plans, or Medigap plans to choose from, and they all have their pros and cons.

You will find that the best plan is usually the one that works best for your situation and not merely a plan that is “The Best.”

Some plans are more popular than most which are the Plan F, Plan N, and Plan G because of all the benefits these plans offer.

However, we usually suggest that you go with the plan that works best for your situation, you can check out a brief description of each plan and their benefits below:

Insert Content Template or Symbol

Medicare Supplement Plans A – F
Benefits	Plan A	Plan B	Plan C	Plan D	Plan F
Part A Hospital Co-insurance	Yes	Yes	Yes	Yes	Yes
365 Hospital Reserve Days	Yes	Yes	Yes	Yes	Yes
Part B co-insurance / co-payment	Yes	Yes	Yes	Yes	Yes
Blood Benefit (first 3 pints)	Yes	Yes	Yes	Yes	Yes
Hospice coinsurance / co-pay	Yes	Yes	Yes	Yes	Yes
Skilled Nursing Facility co-insurance	No	No	Yes	Yes	Yes
Part A deductible	No	Yes	Yes	Yes	Yes
Part B deductible	No	No	Yes	No	Yes
Part B excess charge	No	No	No	No	Yes
Foreign Travel Benefit	No	No	80%	80%	80%
Out-of-pocket limit	N/A	N/A	N/A	N/A	N/A

Medicare Supplement Plans G – N
Benefits	Plan G	Plan K	Plan L	Plan M	Plan N
Part A Hospital Co-insurance	Yes	Yes	Yes	Yes	Yes
365 Hospital Reserve Days	Yes	Yes	Yes	Yes	Yes
Part B co-insurance / co-payment	Yes	50%	75%	Yes	Yes
Blood Benefit (first 3 pints)	Yes	50%	75%	Yes	Yes
Hospice coinsurance / co-pay	Yes	50%	75%	Yes	Yes
Skilled Nursing Facility co-insurance	Yes	50%	75%	Yes	Yes
Part A deductible	Yes	50%	75%	50%	Yes
Part B deductible	No	No	No	No	No
Part B excess charge	Yes	No	No	No	No
Foreign Travel Benefit	80%	No	No	80%	80%
Out-of-pocket limit	N/A	$5,240	$2,620	N/A	N/A

The most popular plans at the moment are Plan G, Plan F, and Plan N.

The Difference between Plan G & Plan F is that Plan G doesn’t cover your Part B Medicare Deductible.

Depending on the company and price, you actually can save more money with Plan G than you can in Plan F.

Another thing to mention is that Plan F is going away in 2020, while this won’t immediately affect you, it’s usually best, from my experience to go with a policy that will have the least amount of changes.

Plan N is usually purchased by people who are just entering into Medicare and don’t have much health history.

Again, we can’t stress this enough…

The plan that is best for you is going to be one that covers all of your health concerns as well as budget.

We can help you through this process over the phone, you can call us at (800) 924-4727

Did You Know: A Medicare Supplement plan can only cover one person, there isn’t a joint policy option.

How Do You Qualify & Enroll In Medigap Plans

Your eligibility for enrollment into a Medicare Supplement Insurance Plan (Medigap or Meetup) is dependent on you already being enrolled in both Medicare Parts A & B.

We think the best time to enroll in a Medigap plan is going to be during the Medigap Open Enrollment period.

This period begins on the first day of the month that you are both age 65 or older and enrolled in Part B.

This period lasts for six months and during this time you have a guaranteed-issue right to join any Medicare Supplement plan available to you where you live.

During this initial enrollment period, you can’t be denied primary coverage based on your medical history or pre-existing conditions.

In some states, you can enroll in a Medsup plan before the age of 65.

Did You Know: You can use your Medicare Supplement plan with any provider that accepts Medicare.

Medicare Supplement For Disabled Under 65

The answer to this question largely depends on the state that you live in.

While the Federal government doesn’t require insurance companies to sell Medicare Supplement policies to you if you are under 65, some states do have this requirement.

If you don’t know if your state offers Medigap policies for people under 65, please contact us at 1.800.924.4727, and we can help you check.

If you’re under the age of 65 and have Original Medicare due to being disabled, amyotrophic lateral sclerosis (ALS), or End-stage renal disease (ESRD), your state might let you apply for a Medicare supplement insurance plan.

However, you might not be able to get the policy option that you want, and the rates as well as your guaranteed issue rights won’t be valid until you actually turn 65 years old.

You will probably end up paying much more for your monthly premium or getting coverage that won’t cover pre-existing conditions.

It’s best to speak with one of our agents who can help you understand your state guidelines.

Did You Know: Not all Medicare Supplement plan types may be available in your state.

Is Medicare Supplement Guaranteed Issue?

To best answer this question we must first address your Guaranteed Issue Rights which are also known as your “Medigap Protections.”

According to Medicare.gov, Guaranteed issue rights are merely rights that you have in specific situations when an insurance company is required by law to sell or offer you a Medigap policy.

In these situations, an insurance company:

Must sell you a Medigap policy and can’t deny you coverage
Must cover all your pre-existing health conditions
Can’t charge you more for a Medigap policy because of past or present health problems

In most cases, you get your Medigap Protections when you have other health coverage that changes in some way, like when you lose the additional health care coverage.

In other cases, you have a “trial right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind later on.

You have a guaranteed issue right in these situations:

When You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving the care in your area, or you move out of the plan’s service area.
If You have Original Medicare, and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare (Trial Right).
You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)
Your Medigap insurance company goes bankrupt, and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.

It’s also good to note that there may be times when more than one of the situations above applies to you.

When this happens, you can choose the guaranteed issue right that gives you the best choice and if you are still unsure, feel free to fill out our form or give us a call at 1.800.924.4727.

Did You Know: Usually Medicare Supplement plans are guaranteed renewable as long as you continue to pay your premium.

Taking Action

When it comes to purchasing Medicare Supplement plans things can become a bit confusing, and it is easy to procrastinate just to avoid the pain you may associate with learning everything you need to know before purchasing coverage.

However, it is best that you take action as soon as you become eligible for such coverage.

But here’s the best thing:

We are here to assist 100% of the way, from educating you on the product, quoting you and walking you through a simple 10-minute application.

You can fill out one of our quote forms below, or call us today to get covered at 1.800.924.4727

Medicare Out of Network (Advantage Plan Confusion)

Medicare out-of-network confusion continues to remain a big issue with Medicare Advantage plans. A recent letter that was sent out by The Mayo Clinic (Florida location) has caused quite a bit of uproar due to the facility urging Medicare beneficiaries to reevaluate staying in a Medicare Advantage plan. In addition, the letter reminded Mayo Clinic patients that they do not participate as an in-network facility and will no longer schedule patients who have a Medicare Advantage plan that would classify The Mayo Clinic as ‘out-of-network”.

Mayo Clinic letter — The Mayo Clinic reminds Medicare patients that they are out of network with most Medicare Advantage plans.

Earlier this year a survey released by MedicareGuide.com found that 4 out of 10 Medicare Advantage enrollees believed that they do not have to stay in-network for care. This is very alarming since the network restrictions are one of the key ways that Medicare Advantage plans keep overall costs down. Consumers are not understanding that you are trading the flexibility of provider access for low to no premiums and being restricted to use only providers in the plan’s network.

Many retirees who enroll in a Medicare Advantage plan do so for the low-cost premiums and ‘extra benefits’ they would receive not typically found in Original Medicare. A large percentage of those retirees do not understand that they are in essence signing over their Medicare benefits for Parts A & B to a private insurance company. Those amounts typically come in around $1,000 per month on average (before bonuses that the insurance company may get) for non-special needs plans (SNPs) or dual eligible plans (DSNPs). Both SNP and DSNP plans get paid an even higher amount from Medicare. According to the Medicare Trustees report, in 2019 payments to private Medicare Advantage plans were approximately $321 per enrollee higher than what Medicare would have spent on these same folks if they had been in traditional Medicare (Parts A & B). While $321 per enrollee for the year might not seem like a large amount of money, the total for increased spending by Medicare for these folks equates to an estimated $7,000,000,000.00 (seven billion dollars) in additional costs to the Medicare program. For 2022 it is expected to swell to $12,000,000,000.00

DENY…DENY…DENY!

Be careful of going out of network in a Medicare Advantage plan!

With this much additional money being spent, one would assume that more benefits are being paid out on behalf of enrollees. That assumption is wrong. In fact, one of the most common reasons for Medicare Advantage enrollees wanting to return to original Medicare comes when a prior approval for a procedure is delayed or even denied. In the 2022 Office of The Inspector General (OIG) report there was a concern for “the incentive for Medicare Advantage plans to deny beneficiary access to services and deny payments to providers in an attempt to increase profits.” One would think with all the additional money coming into Medicare Advantage plans that there would be a focus on reducing the out-of-pocket costs enrollees face. Sorry to say that is not always the case.

Did you know in a Kaiser Family Foundation report, over 50% of the Medicare Advantage enrollees would incur higher out of pocket costs for a 7-day hospital stay than those with Original Medicare?

Takeaway

As we have said many times over, Medicare Advantage plans are not bad if enrollees fully understand the tradeoffs. For those younger Medicare beneficiaries who are possibly in better health, the likelihood of them needing prior approval for a high costing procedure or facing a lengthy stay in the hospital are lower than older Medicare beneficiaries whose health is likely to continue to decline. It is vitally important that Medicare Advantage enrollees understand that their coverage is being provided by private insurance companies and not Medicare itself. Unlike Original Medicare, where they would not face having to get prior approval for most services or be limited to a certain network of doctors, Medicare Advantage plans use these to reduce costs and increase profits. We believe that there is nothing wrong with this since private insurance companies are a business that must make a profit. Where we find issues is when the enrollees do not fully understand the limitations and restrictions of these Medicare Advantage plans and how the benefits are affected in an out of network situation. To discuss what plan options work best for your individual needs, contact us at (800)924-4727 to get a dedicated advisor to review your current situation.

Medicare Supplement vs Medicare Advantage (Pros and Cons)

Medicare Advantage vs Medicare Supplement

Today I want to go over the common misunderstandings between getting a Medicare Supplement vs Medicare Advantage plan (pros and cons).

When you go onto Medicare you really have two options when we drill things down. You can choose to enroll in a Medicare Advantage plan or stick with original Medicare Parts A & B while signing up to be in a Medicare Supplement/Medigap plan and getting a stand-alone Medicare Part D prescription drug plan.

Keep in mind that most folks must pay for their Part B monthly premium out of their social security check, no matter which option they choose.

Medicare Advantage

So, let’s look at a Medicare Advantage plan which is many times referred to as Part C of Medicare. To make these plans look great, they are typically compared to someone just having Original Medicare Parts A & B. The reality is that most folks who have Original Medicare also will sign up for a Medicare Supplement plan, so the comparison that you hear about is like comparing Apples to Oranges.

Typically, when you enroll in Medicare Advantage plans you are going to get your health insurance and prescription drug insurance bundled together. These types of plans are referred to as MAPD which is simply a Medicare Advantage plan with prescription drug coverage. When you sign up for one of these plans, you need to understand that your benefits are no longer being paid by Medicare to a doctor of hospital but rather thru the private insurance company you sign up with. The doctor or hospital is going to bill your private insurance company directly. The reason for this is that each month Medicare is basically sending your private insurance company a check for all your entitled benefits. It is up to the private insurance company to manage your care so that they can still make a profit.

Is There A Free Lunch In There Somewhere?

So how do they manage your care. Well, they do that by having you use their network of doctors, hospitals, and other providers. The plan will typically use either an HMO or PPO network.

What initially draws people to Medicare Advantage plans is the affordability. In many parts of the country there are many plans with premiums as low as $0 per month. A knee jerk reaction is to focus on the monthly premium rather than what your actual financial exposure is each calendar year. When comparing these plans, you need to remember that there is no such thing as a free lunch. If the premium is $0 per month, how is the insurance company going to make any money? Remember I said earlier those doctors and hospitals will no longer bill Medicare but rather the private insurance company? That insurance company is receiving thousands of dollars from Medicare, so the lower amount of expenses that they pay out means they will have more in profit at the end of the year. Not only do they control expenses by limiting you to use their network of doctors, but they also expect you to help pay for the medical expenses along the way thru co-payments and co-insurance.

Do You Want Flexibility?

This is the first place that Advantage plans lose a point when compared to a Medicare Supplement. For that lower premium you first will lose quite a bit of flexibility and choice in which doctors you can see or even which hospital you might be able to go to due to the network of providers the plan has contracted. We typically see HMO plans with the lowest of premiums since they are the most restrictive. Simply put, if you want to see a doctor or go to a hospital that is not in the plans’ network, then you are going to be paying all those expenses out of your own pocket. There will not be any help from Medicare since that money has already been sent to the Medicare Advantage plan.

Next let’s look at how you will be sharing in paying for your medical expenses. At first you might say, well why do I have insurance if I am going to be paying for these expenses anyway. Keep in mind that for the low premium or no premium Medicare Advantage plan, you are in essence signing up to share the costs with the private insurance company (ie. pay as you go). An example of this would be that when you go to see your primary care physician you make a $20 co-pay. While this doesn’t sound bad, the co-pays for each day you are in the hospital will typically come in around $300 per day. So for a 5 day hospital stay, you will owe the hospital $1,500.

On the flip side of co-pays, you have co-insurance payments. These payments are a percentage of the actual costs rather than a flat dollar amount. So, if a service that you need has a 20% co-insurance payment and costs $3,000 then you will owe $600 of that out of your own pocket. Now the good news is that Medicare Advantage plans will have what is called a maximum out of pocket limit. This is a cap on the maximum amount of money that will come out of your pocket each calendar year for medical expenses. Right now, that amount is coming in around $7,500 for HMO network plans. If the plan uses a PPO network, the maximum amount out of pocket for in-network expenses is around $7,500 but out of network has its own maximum out of pocket which is around $10,000.

Medicare Plan Comparison — Medicare Supplement vs Medicare Advantage (Pros and Cons)

The last component that I believe that everyone who is considering a Medicare Advantage plan should look at is the prescription drug coverage. It is very important to not only make sure that your doctors are part of the network, but that your pharmacy is a preferred pharmacy with the plan and that all your prescriptions are covered. In addition, you need to see how the private insurance company is going to classify your prescriptions.

What I mean by this is, are they going to classify them in a lower tier such as Tier 1 which has the lowest co-payment costs or are they going to classify them in a higher tier which could be one that requires you to pay a higher co-payment or even possibly a percentage of the prescription costs rather than a small co-pay.

Medicare Supplement Plans

Now let’s compare the Medicare Advantage plan to a Medicare Supplement plan. Instead of a lower premium, a Medicare Supplement plan could start off in the $100 plus per month range. For many years the Plan F has been the most popular plan. If you went onto Medicare starting January 1^st of 2020 or after, you cannot get the Plan F. This is the reason why Plan G has become one of the most popular plans that folks choose. With the Plan G, your yearly exposure is basically the Part B deductible which is a total of $233 for 2022 and will be $226 for 2023.

Many will question why in the world would they pay over $100 per month for a Medicare Supplement plan when they could get a Medicare Advantage plan for as little as $0 premium. The answers are simple.

They can truly budget their overall medical costs each year. With a plan G they will pay the monthly premium which we will say is $120 and they will be responsible for the Part B deductible which is another $233. The total for the year is $1,673 no matter how many doctors they see, how many days they spend in the hospital. In essence they have reduced their out-of-pocket exposure from $7,500 to only $1,673 for the year.
With original Medicare and a Medicare Supplement there are absolutely no networks. You can choose your family doctor, the specialists you go to see, and which hospitals you want to use. You are in control of where and from whom you get your care from. I don’t know about you, but if I am diagnosed with something severe that is going to require a specialized surgery, I want to go see the surgeon who has done this procedure not only many times but has the highest success rate in the country versus picking a surgeon out of a book that I know nothing about.
Very rarely does Medicare require any prior authorization. This means that if your doctor says you need something, then you can get it. With a Medicare Advantage plan, if the plan doesn’t authorize the service first, then it will not be covered. Prior authorization is basically a gatekeeper that allows the plan to decide whether you really need what the doctor is requesting.

In addition to a Medicare Supplement plan you are going to need to sign up for a stand-alone Medicare prescription drug plan. Yes, these plans have a monthly premium that would be in addition to your Medicare Supplement premium. Once again you might say, why would I want to pay for this as an extra expense when I can get prescriptions covered thru a Medicare Advantage plan. The answer is that by comparing stand-alone prescription plans you have many to choose from which would allow you to go with the plan that covers your prescriptions at the lowest costs. With a Medicare Advantage plan, you have to use their list of approved drugs and what they require you to pay out of your own pocket in co-pays and co-insurance.

What To Start With

For someone new to Medicare, it may sound like a great idea to start off with a low costing Medicare Advantage plan when you are your healthiest and then switch to a Medicare Supplement as your health begins to decline. In theory, this would be a perfect way to save money. In reality, this typically does not work.

While there is a trial right exception that allows you to start off with a Medicare Advantage plan and then switch back to original Medicare and get a Medicare Supplement with no underwriting, this ends after 12 months of being in the Advantage plan. In addition, if you were in a Medicare Supplement plan, switched to an Advantage plan and then decided you didn’t like it, then you could get your Medicare Supplement plan back with no underwriting if all this was done in less than 12 months.

So, to return to my earlier statement about this typically not working is more so for those who start off in a Medicare Advantage plan and stay in an Advantage plan for over 12 months. Once this happens, and then you decide to get a Medicare Supplement plan, you will need to go through the underwriting process and could be declined. Remember, we said that a person would stick with the Advantage plan until their health declined and then make the change. Once your health begins to decline, then it will be much harder to get a Medicare Supplement plan. This is a big concern that needs to be addressed when comparing Medicare Supplement vs Medicare Advantage.

Which Is Better?

If you are like most folks who read this article, you might be thinking that I am 100% opposed to anyone having a Medicare Advantage plan. Let me say that this is not the case at all. I believe that there are a number of folks who would benefit from a Medicare Advantage plan based on their particular needs and financial situation. What I am against is these plans being marketed in such a way that they appear to be the next best thing since sliced bread. You need to fully understand Medicare Advantage vs Medicare Supplement…the pros and cons, before making such an important decision.

So let me give you just a couple of examples of who a Medicare Advantage plan could benefit. The pros include:

Example 1

Individual is on a very tight fixed income and simply cannot afford health insurance without having to give up being able to buy their monthly necessities or pay their utility bills. These might be folks who are even just above the threshold of qualifying for Medicaid benefits. In addition, this individual does not travel regularly, and their doctors and local hospital are part of a Medicare Advantage plan’s network. For this person, going on original Medicare only without a Medicare Supplement, would leave them financially exposed to a 20% coinsurance under Part B (with no out of pocket maximum) of Medicare in addition to the Part B deductible that they would have to cover each year. With a Medicare Advantage plan they would at least have an annual maximum out of pocket (MOOP) of around $7,550 (maximum for 2022). In addition, they would have prescription drug coverage thru their Medicare Advantage (MAPD) plan. The pros definitely outweigh the cons for this individual.

Example 2

Individual is under the age of 65 and on Medicare due to a disability. In many states, they cannot get a Medicare Supplement plan, or if they can it might just be a bare bones plan such as Plan A. For this person, they to can have the knowledge of knowing that if they sign up for a Medicare Advantage plan, that they will at least have a maximum out of pocket for a given year and have prescription drug coverage to go along with their health insurance.

While these two examples do not include every situation, the biggest takeaway is that neither Medicare Supplement nor Medicare Advantage is a one size fits all. For those folks who want to go the route of an Advantage plan, then we always recommend that they look at a hospital indemnity plan to help cover the larger out of pocket expenses (such as hospital daily co-pays or cancer treatment) and to save as much money each month in an emergency fund that can help offset the $7,500+ in maximum out of pocket exposure for a calendar year.

Think of this as a safety feature just in case you are diagnosed with a serious health condition such as cancer. The chemo treatments alone could very well have you spending your maximum out of pocket in just a matter of months.

The Last Word

As we said earlier, everyone has their own personal situation and needs. There is much to know when comparing Medicare Supplement vs Medicare Advantage (Pros and Cons), so make sure you have everything you need to make an informed choice. Contact a Senior Benefit Services advisor to get the guidance you need for this important decision. Remember, not only is our service free, but there is never any obligation or pressure to work with us. To get started immediately simply call (800)924-4727 or click on the Get Help button below.

Does Medicare Cover Audiologist?

First let’s dive into exactly what an audiologist is and does.

Audiologists are health care professionals who specialize in disorders dealing with hearing, balance, and other neural systems. Once a disorder is diagnosed these healthcare providers fit and dispense hearing aids and other types of listening devices if appropriate. Keep in mind that an audiologist does not perform surgery. If you suffer from a hearing issue that requires surgery, then you will need to see an ENT doctor.

Types of Hearing Loss

While hearing loss can come in many forms that can range from minimal to total loss of hearing. There are two broad categories of hearing loss:

Sensorineural hearing loss – which is when there is usually permanent damage to the inner ear or auditory nerve.
Conductive hearing loss – occurs when sound waves cannot reach the inner ear. Typically medical treatment or surgery can correct the hearing loss.

As we age, the odds of hearing loss increase. It is estimated that 1 in 3 people between the ages of 65 and 74 suffers from a certain degree of hearing loss. For those older than 75 nearly half has difficulty hearing clearly. This type of hearing loss is often times called Age-Related Hearing Loss but is medically diagnosed as Presbycusis. This type of hearing loss comes on gradually as we get older and it seems to run in families. Additionally this type of hearing loss usually (but not always) occurs in both ears. Once the hearing loss has progressed substantially, many older adults will look to hearing aids as a solution.

What Does Medicare Cover?

So…does Medicare cover audiologist? Medicare will cover diagnostic exams with an audiologist when a healthcare professional such as a physician, clinical nurse specialist, nurse practitioner, physician’s assistant or other approved provider refers you to an Audiologist to determine appropriate medical care for your hearing issue. If this criteria is met then Medicare Part B will generally cover 80% of the approved charges (after the annual Part B deductible has been met) leaving you or your Medicare Supplement to pay the other 20%.

So does this mean that a healthcare professional can refer you to an audiologist for a routine hearing test and Medicare will cover it? No. Medicare does not cover routine hearing tests, hearing aids, or the exams for fitting of hearing aids.

Does a Medicare Advantage plan cover hearing aids?

If you are covered by a Medicare Advantage plan you could possibly have some coverage for hearing aids. While not all plans provide this additional coverage, some do. Many times there are strict limitations on the actual benefits and coverage limits for hearing aids. Some plans may cap out a certain dollar amount they will pay, while other plans may pay a higher amount towards hearing aids, but will limit the purchase to once every few years.

Keep in mind that most Medicare Advantage plans use a network, such as a PPO or HMO. This means that if your plan does actually provide benefits toward hearing aids, you will need to see an audiologist that is part of that plan’s network.

How Else Can You Get Benefits For Hearing Aids?

If you are on traditional Medicare Parts A & B (whether you have a Medicare Supplement or not) you can always purchase stand-alone coverage for hearing benefits. While these plans are not usually sold with just hearing benefits, you actually get 3 areas of coverage with them. This includes dental, vision, and hearing. To find out more about these plans click here.

Takeaway

If you are having hearing issues, your first step should be to schedule a visit with your primary care physician to discuss your concerns. If you have questions about obtaining coverage for possible future hearing issues, then feel free to call us at (800)924-4727 or click on the Get A Quote Now button above.

Medicare in Maryland

o how is Medicare in MD different than Medicare in any other state?

Maryland is actually a very interesting state when it comes to Medicare options and hcsgow insurance carriers must do business here. When we look at Medicare in MD, we are going to break it down into a couple of categories.

Medicare Supplement in Maryland
Medicare Advantage in Maryland

Medicare in MD – 12 Questions You Must Ask Before Buying A Plan

Medicare Supplement in Maryland

In the state of Maryland, you will find that most folks on Medicare have a Medicare Supplement plan over a Medicare Advantage plan. While there are several reasons for this, we are going to start by looking at how the pricing is done by insurance carriers.

When you look at Medicare in MD you will quickly see on the Medicare Supplement side that there is no area factoring allowed. Area factoring is a practice where an insurance company can charge more in premium for those folks who live in what are known as high Medicare usage areas. This means that if you happen to live in a zip code where Medicare typically pays more in claims, then you will pay a higher premium for the exact same plan as someone who lives in a lower usage area.

What You Should Know About Medicare Supplements in MD — Medicare Supplement plans in Maryland offer the most flexibility when it comes to seeing providers and hospitals of your choosing.

In the state of Maryland, this practice is not allowed which means someone who lives in Baltimore, Maryland will pay the exact same price as someone who lives in Hagerstown, Maryland (same age, sex, and tobacco usage), Frederick, Maryland or even Cumberland, Maryland. It simply doesn’t matter where you live in Maryland because there is NO area factoring.

Medicare Supplement Rates in Maryland

We are fortunate to have so many available insurance carriers in the state, which helps keep pricing quite competitive. Some of our favorite carriers offer great pricing on multiple plans. In addition to competitive premiums, most of the carriers also offer additional discounts such as a household discount which many times doesn’t even require both spouses to have a policy with that insurance company. This is beneficial when one spouse might have severe health issues that would keep them from being accepted by the new carrier, but still allows the healthier spouse to get the best pricing possible. In fact, several carriers have a household discount if there is simply another person living in the house with the policyholder who is over the age of 50. When looking at Medicare in MD you want to make sure that you are taking advantage of every possible discount that you can.

Medicare Supplement Carriers in Maryland

When looking at Medicare in MD you will quickly see that the amount of Medicare Supplement carriers far outpaces the amount of Medicare Advantage carriers.

Currently there are well over 30+ Medicare Supplement carriers doing business in the state of MD. With this many carriers available it allows us to find not only competitively priced plans, but also ones that have different levels of underwriting. The different levels of underwriting allow those folks with certain health conditions to find coverage as well. They might not qualify for one company due to their health condition, but another company may be fine with that condition.

Medicare Supplement Plans in Maryland

While insurance companies can offer up to 10 standardized Medicare Supplement plans, most will elect to only offer 4-6 plans. Currently the most popular Medicare Supplement plans being purchased in Maryland are:

Medicare Supplement Plan G
Medicare Supplement Plan N
Medicare Supplement Plan F

It is important to remember that only those Medicare beneficiaries whose effective dates for Part A and Part B was prior to January 1, 2020 can purchase a Plan F.

F Plan Benefits

Covers Basic Benefits
Covers Part A deductible
Covers Part B deductible
Covers Part B Coinsurance of 20%
Covers Part B Excess Charges at 100%
Covers Skilled Nursing Co-payments days 21-100
Covers Foreign Travel Emergency Care (Lifetime Max $50,000)

G Plan Benefits

Covers Basic Benefits
Covers Part A deductible
No Coverage for Part B Deductible
Covers Part B Coinsurance of 20%
Covers Part B Excess Charges at 100%
Covers Skilled Nursing Co-payments days 21-100
Covers Foreign Travel Emergency Care (Lifetime Max $50,000)

N Plan Benefits

Covers Basic Benefits
Covers Part A deductible
No Coverage for Part B Deductible
Covers Part B Coinsurance of 20% (co-payment must be made first)
No Coverage for Part B Excess Charges
Covers Skilled Nursing Co-payments days 21-100
Covers Foreign Travel Emergency Care (Lifetime Max $50,000)

Medicare Supplement Prices in Maryland

Comparing a specific plan for a certain age often reveals monthly rates within a dollar of each other. An example of this would be for a 65-year-old female who is a non-tobacco user and wants a Plan G. You will notice that here in 2024 the rates are close to one another.

Bankers Fidelity – $131.70
LifeShield – $133.24
American Home Life – $137.74

While Plan G is still one of the most popular plans in Maryland, the Plan N is also a favorite of those folks who want solid coverage but at even a lower monthly premium. Using the same criteria as we did above, here are the current monthly rates for 2024.

American Home Life – $99.51
LifeShield – $99.53
Bankers Fidelity – $100.82

Keep in mind that the above rates do not factor in a household discount which can reduce premiums anywhere from 6% – 14% in Maryland.

Medicare Advantage in Maryland

The state of Maryland does not have as many Medicare Advantage plans to choose from as other states. In Maryland, carriers with Medicare Advantage plans typically offer PPO or HMO networks. An HMO network restricts benefits, only paying providers within the network, while a PPO network allows coverage for payments to providers outside the plan’s network. These non-participating providers will still be paid at a lower rate, so there will be more out of pocket expenses for the policyholder to pay. When considering a Medicare Advantage plan it is very important to understand what services charge a co-pay and what services will be charged at a co-insurance amount. While one service might be a $20 co-pay, another service or procedure might be a 20% co-insurance payment. On a $1,000 charge, a 20% co-insurance would be $200.

Important areas to look at when considering a Medicare Advantage plan in addition to monthly premiums:

What is the Maximum Out of Pocket Costs (MOOP)? In Maryland the MOOP ranges anywhere from $5,200 – $8,850 depending on the county you reside in for 2024.
What type of network does the plan use? Most plans use either a PPO or HMO network. While a PPO network will give you more flexibility, you could also incur additional out of pocket costs by using a provider outside the network.
Are your doctors and hospitals part of the network? In Maryland there are hospitals that will not take certain Medicare Advantage plans. As well there are doctors who simply do not want to be part of the networks that these plans use.
Are your prescriptions covered in the plan’s formulary? Unlike getting a stand-alone Part D prescription drug plan where you can pick one that covers all of your prescriptions at the lowest out of pocket costs, the Medicare Advantage prescription portion might not cover some of your prescriptions or cover them at the lowest out of pocket costs for you. In addition to checking the formulary you also need to see which tier your prescriptions fall into. The higher the tier the more you will pay out of pocket for that prescription.
While paying a $20 co-pay may not seem like much money, one of the biggest areas of financial exposure with a Medicare Advantage plan is the hospital co-pay. This daily co-payment can range from as low as $330 per day for days 1-3 to $375 per day for days 1-6. Just how different can this be financially? Well the $330 per day for 3 days equals $990.00 out of your pocket versus $375 per day for 6 days which equals $2,250 out of your pocket. As you can see, a hospital stay depending on your plan could pose a financial hardship. Instead of trying to cover this out of your savings, you can leverage a hospital indemnity plan that has a very minimal monthly cost to cover this type of large expense.

Availability of Medicare Advantage in Maryland

The number of carriers choosing to do Medicare Advantage business in Maryland differs by county. Yes, you read that correctly…they can limit their plan offerings to certain counties. Unlike Medicare Supplement plans that must be offered in all counties and be guaranteed renewable, a Medicare Advantage plan can be offered in as many as all counties or as few as just one. Also, Medicare Advantage plans are not guaranteed renewable which means that the plan can choose at the end of the contract year to exit the market in a particular county or even the whole state.

Plans by county/city:

Baltimore/Baltimore City – 6 carriers offering a total of 29 plans

Washington County/Hagerstown – 3 carriers offering a total of 8 plans

Frederick County/Thurmont – 5 carriers offering a total of 12 plans

Allegany County/Cumberland – 1 carrier offering a total of 2 plans

When you look at Medicare in Maryland you will see that there are far more choices for Medicare Supplement plans than Medicare Advantage Plans. This doesn’t necessarily mean that the Medicare Advantage plans are not beneficial to certain folks. It does mean that there are fewer choices and far less competition among them.

Takeaway

Choices for Medicare in MD can be overwhelming, so don’t try going at it alone. Contact Senior Benefit Services, Inc to explore and understand all your options. Call us at (800)924-4727 and you will see how ‘We Make Medicare Easy’.

What Will Medicare Cost Me in 2023?

So How Much Will Medicare Cost in 2023?

Medicare cost for 2023 showed an increase to Part A deductible, but a small decrease to the Part B annual deductible over 2022.

In addition, the daily co-payments under Part A of Medicare showed increases in each phase. The Medicare Part B coinsurance still remains at 20% as it always has.

If you worked 40 quarters during your lifetime, you will not be charged the Part A premium listed above. During your working years, the Part A premium was paid thru your Medicare taxes from each payroll cycle.

The deductible for Part A increased from $1556 in 2022 to $1600 for 2023. For days 61-90 of inpatient hospital care the daily co-payment rose from $389 per day in 2022 to $400 per day for 2023. This will be an increase of $11 per day. The lifetime reserve days which are days 91-150 of inpatient hospital care rose from $778 per day in 2022 to $800 per day for 2023. This will be an increase of $22 per day.

Finally under Part A of Medicare the daily co-payment for skilled nursing facility care will increase from $194.50 per day in 2022 to $200 per day in 2023. This will be an increase of $5.50 per day.

To compare our current chart to 2022 numbers click here. To see the Medicare Fact Sheet click here.

To read about the 3 Most Common Questions Asked About Medicare Part A click here. To read about the 3 Most Common Questions Asked About Medicare Part B click here.

Wondering if you are paying too much for your current Medicare coverage? Get a FREE, NO OBLIGATION quote by clicking below or call (800)924-4727 for immediate service.

Medicare Open Enrollment 2023

Medicare Open Enrollment Period 2023…Get Ready…Get Set…GO!

Let the craziness begin! The Medicare Open Enrollment 2023 period is upon us and everyone is having to suffer. Personally, I think having to watch commercial after commercial on the television about Medicare Advantage plans is about as fun as listening to nails on a chalkboard!! You know the commercials…Joe Namath and JJ Walker talking about ‘getting the benefits you are entitled to’. Of course, these commercials are not all they seem to be. Too learn more about the Medicare Advantage commercials check out our article found here.

So Why Is It Called The Open Enrollment Period?

That is a fantastic question, since the enrollment period from October 15^th – December 7^th was actually the Annual Election Period. For some reason years back, Medicare started running commercials themselves and kept referring to this period as the Open Enrollment period.

The reality is that the Open Enrollment period for Medicare Advantage plans starts on January 1^st of each year and runs until March 31^st. Of course, this just adds more confusion to an already confusing time. Well, enough complaining, let’s move on to what you should be doing to make the enrollment periods easier to navigate.

Keep in mind that no matter what the commercials say, or all of the junk mail pieces you get in your mailbox, you do not have to make changes during the Annual Enrollment Period or the Open Enrollment Period. If your Medicare Advantage or stand-alone Part D Prescription plan works great for you, and you did not notice any major changes in your Annual Notice of Change letter, then you can simply stay where you are. If you find that your plan isn’t working for you or there are major changes coming for the following year that will negatively impact you, then a change will likely be needed.

In this post I will explain how these periods of enrollment differ, and how they can be used. Just sit back, relax and know that by the end of this article you will have an idea of exactly what you need to do.

What Can I Do During the Annual Election Period?

As we stated earlier this is also now called the Medicare Open Enrollment Period on most commercials that you see. During the period of October 15^th – December 7^th you can:

Stay in your current plan if it works well for you
Change from one Medicare Advantage plan to another Medicare Advantage plan
Change from one stand-alone Part D Prescription plan to another stand-alone Part D Prescription plan
Change from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C)
Change from a Medicare Advantage plan to Original Medicare and enroll in a stand-alone Part D Prescription plan.

What Are Some of the Reasons Why I Would Change My Plan?

Your Annual Notice of Change letter shows that your prescriptions will either not be on next year’s formulary (list of approved medications) or moves to a higher tier which will cost you more in either co-payments or co-insurance. A prescription moving from a Tier 1 to a Tier 2 is not going to be outrageous, but a Tier 2 prescription moving to a Tier 4 will be. You will actually go from making a flat co-payment to paying a percentage of the actual prescription cost.
The Medicare Advantage plan you have will have a change in the provider network. This means that maybe a hospital you like to use or your favorite doctor has decided to no longer be part of the plan’s network.
The Medicare Advantage plan is no longer available in your resident county. When this happens, you will either need to choose another Medicare Advantage plan or return to Original Medicare and enroll in a stand-alone Part D Prescription plan.
The Medicare Advantage plan has a premium increase for next year that makes it unaffordable, and you want to enroll in a less expensive plan.

The key thing to remember is that our advisors here at Senior Benefit Services, Inc can help you navigate thru these rough waters. If you really need to make a change, they will advise you on your best options. If you don’t need to make a change, then they will advise you to remain in your current plan and just ignore all the junk mail, television, and radio commercials.

What Should I Do If I Have a Medicare Supplement plan?

The great news is that the Annual Election Period (Medicare Open Enrollment Period) does not apply to Medicare Supplements. The reason why is that each year your Medicare Supplement core benefits will not change. If you have a plan that covers the Part A deductible, then your plan each year will continue to cover that cost. It doesn’t matter that the Part A deductible goes up every year, because your Medicare Supplement plan will still cover it.

This means that you do not have to make any changes to your Medicare Supplement plan during this period of time.

What If My Medicare Supplement Premium Went Up This Year?

Sorry to say, but Medicare Supplement plans are health insurance policies and due to rising medical costs and claims being paid out, these plans will typically go up each year.

While your premium may go up, your benefits don’t go down.

You are free to shop your Medicare Supplement plan during the Medicare Open Enrollment 2023 Annual Enrollment Period, the same as you are free to shop your plan any other time of the year.

One point that I want to make very clear is that the Annual Election Period (Open Enrollment Period) does NOT provide any special provisions to guarantee you to get another Medicare Supplement.

Wait A Minute…the Medicare Commercials All Say Now Is the Time to Make Changes and I Can’t Be Turned Down!

This is 100% true for Medicare Advantage and stand-alone Part D Prescription plans. Keep in mind that Medicare Advantage plans typically only have 1 health question on their application and that asks whether or not you have End Stage Renal Disease (ESRD). The stand-alone Part D prescription plans have no health questions at all. This is the reason why you can easily change these plans.

Since this enrollment period has never applied to Medicare Supplement plan (since it originated in 2006) you would have to answer the health questions and qualify to get a new Medicare Supplement plan.

To see if you can lower your Medicare Supplement plan premiums, simply click on the button below. It is easy, fast, and there is absolutely no obligation.

What Can I Do During the Medicare Advantage Open Enrollment Period?

This period which runs from January 1^st – March 31^st allows you to:

Switch to a different Medicare Advantage plan (if you are already enrolled in a Medicare Advantage plan to begin with).
Switch from a Medicare Advantage plan to Original Medicare. You will also now need to enroll in a stand-alone Part D Prescription plan so that you do not incur a penalty.

IMPORTANT REMINDER: This is for Original Medicare only and does not pertain to Medicare Supplements.

What Are My Next Steps?

To make this easier, lets break it down into three categories:

Category 1 – You are an existing client of Senior Benefit Services, Inc. The first thing you should do is review your Annual Notice Change Letter to see if there are any plan changes that will negative effect you. The next step would be to also take note if you had any new prescriptions added this year that are in a higher Tier pricing. While your current plan may cover it, another plan may cover the prescription at a lower Tier pricing which saves you more money. If there are notable changes to your coverage or changes in your prescription costs, then you should contact your Senior Benefit Services advisor to schedule a review. Many of our clients simply prefer to have a standing annual review each year for peace of mind.

Category 2 – You are not an existing client of Senior Benefit Services, Inc. but feel that our well-known top shelf service would be of great value, then feel free to call (800)924-4727 and we will have an advisor assigned to you.

Category 3 – You are someone who enjoys doing everything yourself. While this path is filled with lots of confusing information to digest and understand, you can opt to do this. Keep in mind that you will not be saving any money since premiums are set by the plans and approved by CMS, but you can call Medicare directly at 1-800-MEDICARE for help or go to Medicare.gov and use the Plan Finder on their website.

We would enjoy having the opportunity to show you why so many Medicare beneficiaries love working with our company and have been with us for decades. You will always receive straightforward, honest advice that benefits you and not the insurance company. Contact us to make the Medicare Open Enrollment 2023 season relaxing. Remember…We Make Medicare Easy!

What Does Medicare Cost Me in 2022?

So How Much is Medicare Going To Cost Me in 2022?

Medicare cost for 2022 showed an increase not only for Part A but also for the Part B deductible over 2021.

As always, your basic costs change each year in both premiums you pay for Part B coverage and the additional amounts that you will pay for deductibles and co-payments under Original Medicare. To see the current Medicare cost for 2022 please refer to the image below.

If you worked 40 quarters during your lifetime, you will not be charged the Part A premium listed above. During your working years, the Part A premium was paid thru you Medicare taxes from each pay period. The deductible for Part A increased from $1484 in 2021 to $1556 in 2022. For days 61-90 as an inpatient the daily copayment rose from $371 per day in 2021 to $389 per day in 2022. The lifetime reserve days which begin on day 91 as an inpatient rose from $742 per day in 2021 to $778 per day in 2022. The daily co-payment for skilled nursing facility care increased from $185.50 per day in 2021 to $194.50 per day in 2022.

The standard Medicare Part B premium had a substantial increase from $148.50 per month in 2021 to $170.10 in 2022. To find out more about the changes in Medicare Part B premiums and why this occurred in 2022 listen to our short video below.

For recently approved Medicare 2023 costs click here. To compare our current chart to 2021 numbers click here. To see the Medicare Fact Sheet click here.

Wondering if you are paying too much for your current Medicare Supplement coverage or have questions about any type of other health insurance benefits you have? Get a FREE, NO OBLIGATION quote by click below.

Does Medicare Cover Foreign Travel

Traveling Abroad With Medicare

Well its that time of year when folks are doing a bunch of traveling. Keep in mind that traveling domestically is different than Medicare foreign travel. The great news is that anyone on Original Medicare can travel anywhere in the United States and have access to medical care from almost any hospital or doctor.

So now you might be wondering “What’s the bad news?” Keeping in mind that the Medicare program is unique to the United States, it is not designed to provide benefits outside of the U.S. or its territories. Medicare usually does not cover health care expenses when traveling outside the U.S., but there are some exceptions such as:

Part B of Medicare may pay for care received on board a ship as long as it is within territorial waters, but it won’t pay for those services when a ship is more than 6 hours away from the nearest U.S. port.
Medicare may pay for certain expenses in a foreign country if you are in the U.S. when a medical emergency occurs and a foreign hospital is closer than the nearest U.S. hospital.

How To Prepare

The good news is that with a little bit of advance knowledge and preparation, you can travel pretty much worry free about unforeseen medical expenses. Currently most folks on Medicare fall into 1 or 2 groups. They either have Original Medicare with a Medicare Supplement or they have a Medicare Advantage plan. Let’s go quickly review how each works for foreign travel.

Some Medicare Advantage Plans provide you with worldwide emergency coverage. Not all Medicare Advantage plans provide additional foreign travel coverage so it is imperative that you review your coverage before traveling. Some plans that do provide additional foreign travel emergency care may want you to notify them before leaving the country. If your Medicare Advantage plan does not provide additional benefits for foreign travel, it must still provide the same benefits that original Medicare would cover (see exceptions above). Once again this is for emergency care only and not for routine types of visits. Keep in mind that many foreign hospitals do not bill the plan directly so you will likely have to pay for these costs upfront and then submit an itemized bill to your plan for reimbursement. Be sure to keep all of your medical receipts if anything unexpected happens.

For those folks on original Medicare and have a Medicare Supplement, the coverage will work a bit differently. Original Medicare will not pay outside the U.S. (unless it qualifies as a listed exception) so you will need to have any of the following Medicare Supplement plans to provide your coverage:

Plan C
Plan D
Plan F
Plan G
Plan M
Plan N

The Medicare foreign travel benefit found in these plans is very simple. There is a separate $250 deductible and then the plan will pay 80% of the costs up to a lifetime maximum of $50,000. Keep in mind that your coverage is in effect during the first 60 days you are out of the country.

Take Away

So as you can see, you actually do have coverage under certain Medicare Supplement and Medicare Advantage plans. With coverage being more restrictive outside the U.S. it is always best to purchase an additional travel policy to help supplement your existing coverage. A word of caution, not all travel plans provide emergency health benefits, so be sure to get one that specifically does. Check the fine print for such things as will the plan pay actual charges or ‘usual and customary‘, and how pre-existing conditions are treated. If the policy will not cover pre-existing conditions and you have a Medicare Supplement plan with foreign travel benefits, then you could use your travel plan for any emergency or sickness not related to a pre-existing condition (and vice-versa for anything related to a pre-existing condition). These plans can usually be purchased thru a travel agent and can provide coverage past 60 days. Medicare foreign travel planning will make your next international trip much more relaxing.

Does Medicare Cover Vision, Eye Exams, Glasses, and Cataract Surgery

Besides dental, one of the most asked questions is Does Medicare Cover Vision? The first thing to remember is that vision care has a wide range. It could be something as simple as getting glasses for reading to getting cataract surgery performed.

Fortunately, Medicare provides coverage stronger coverage for vision care than dental benefits.

While there are some stipulations and exceptions, Medicare’s vision coverage is pretty good when it comes to issues that are part of the aging process.

Inside you will find out how Medicare covers vision, eye exams, glasses and cataract surgery.

What Original Medicare Doesn’t Cover

Original Medicare will not cover things such as:

routine vision exams known as eye refractions
glasses (unless prescribed after a cataract surgery)
contact lenses.

In addition, if you do get corrective lenses after cataract surgery, Medicare will not cover any costs for upgraded frames.

What Original Medicare Does Cover

Original Medicare will cover such things as:

Medically necessary treatment for eye problems including:
- Cataracts
- Macular Degeneration
Eye exams for diabetic retinopathy (if you have diabetes)
Glaucoma tests if you have diabetes or classified as high risk

What Medicare Medicare Supplements Will Cover

Medicare Supplement plans are designed to help cover the costs left over after Medicare approves a charge and covers their portion. Since your Medicare approved vision services would be provided under Part B of Medicare, your supplement would typically cover the remaining 20% of approved charges. If you were on Medicare prior to January 1, 2020 then you might have a Plan F or Plan C that would also cover the Part B annual deductible. If you went on Medicare January 1, 2020 or after then Plan F and Plan C are not available to you so therefore you would have the Part B deductible to pay first before your plan would kick in.

While Medicare Supplements were not designed to cover routine vision exams or corrective lenses, some Medicare Supplement insurance carriers offer a discounted vision benefit as a value add. For more robust benefits you can purchase a private plan that could include not only vision benefits, but also dental and hearing.

Do Medicare Advantage Plans Cover Vision Benefits?

Just like original Medicare, a Medicare Advantage plan will cover the same type of medically necessary benefits.

In addition, Medicare Advantage plans typically do cover some of the routine services such as an eye exam and an allowance to use towards glasses.

Not all Medicare Advantage plans offer the same additional vision benefits. In addition, some require you to pay an additional amount to add benefits such as these and dental to their plans. Always be sure to check your plan’s benefit disclosure.

Take Action!

Hopefully, this article helped to give you a better sense of how vision benefits are handled with Original Medicare, Medicare Supplements, and Medicare Advantage plans.

Senior Benefit Services has been in the Medicare business for over 50 years and understands your concerns.

To make sure everything is understood correctly, give a Senior Benefit Services Expert a call today at (800)924-4727!

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