Medicare Advantage Archives

Medicare Annual Election Period 2024: Part 2

As promised, in this part we will be talking about the Joe Namath and JJ Walker television commercials, and why when things sound too good to be true…they usually are!

UPDATE: New rules will prevent misleading advertisements such as this from being aired.

In Part 1 we started discussing the Medicare Annual Election Period and what kind of changes you can make to your existing coverage. We discussed the initial prep work that you could start doing in regard to your prescriptions. In Part 2 we are going to look at why you might need to change your Medicare Advantage plan and some of the common questions and the confusion surrounding the commercials we see on television with Joe Namath and JJ Walker.

Why would you need to change your current Medicare Advantage plan?

Keep in mind that most Medicare Advantage plans have a built-in prescription drug plan component. Sometimes Medicare Advantage plans remove drugs from their formulary that they once covered. An example would be that you are on Crestor, but the plan replaces that drug with the generic Rosuvastatin. You might decide that you want to continue to take Crestor. At this point you would need to either find another Medicare Advantage plan that covers this prescription or be willing to pay for Crestor out of pocket.
If you have recently been put onto a new prescription or have to switch to a different prescription you need to make sure that it will be covered in the upcoming plan year formulary.
Medicare Advantage plans also make increases to their daily hospital co-pays which can expose you to a large amount of money out of pocket. While many of our clients use a hospital indemnity plan to help offset these expenses, you will still want to know what your financial exposure is each time you would have to go into the hospital.
In certain situations, a Medicare Advantage Plan carrier may decide to not renew their plan in a certain county(s) or even a whole state. If this were to happen you would need to find a new Medicare Advantage Plan or you prefer to switch back to original Medicare and get a Medicare Supplement and stand-alone Part D prescription plan.
Finally, remember that physicians and other providers are not required to participate in any plan’s network. If you are in an HMO and your doctors decide to no longer accept that plan, then you will need to find another doctor or another plan which they accept. If you are in a PPO and your doctors decide to no longer accept that plan, then you have an extra option. A PPO plan will allow you to see a doctor who is out of network, but you will usually have to pay a higher amount of the expenses than you normally would if they were part of the plan’s network.

The Medicare Annual Election Period is where you can make the needed changes to your Medicare Advantage Plan.

Do you need to change your current Medicare Supplement plan?

No, the Medicare Annual Election Period is for changes to Medicare Advantage and Part D Prescription drug plans. You can look at switching your Medicare Supplement plan to another Medicare Supplement plan at any time of the year. If you would like a free, no-hassle, no-obligation price comparison then we have you covered!

Are you required to make any changes during the Annual Election Period?

No, if you are satisfied with all your current coverage the way it is, then there is nothing for you to do. To see what changes you can make during this period check out our article here.

What if you decide that you want to switch from a Medicare Advantage Plan to a Medicare Supplement plan?

The first thing you will want to do is contact Senior Benefit Services to find out if you can qualify health wise for a Medicare Supplement. Keep in mind that the Annual Election Period allows you to switch back to Original Medicare, but it does not guarantee you acceptance into a Medicare Supplement plan.

If your health allows you to qualify for a Medicare Supplement plan, then you will also need to enroll into a stand-alone Part D prescription drug plan. It is important to find a plan that will cover all your prescriptions at the lowest total out of pocket costs.

While this can sound a bit overwhelming, Senior Benefit Services will make it extremely easy and do the heavy lifting for you.

Wouldn’t I get more benefits if I call the 800# on the Joe Namath commercial?

Nope! Before we get into the commercial themselves, keep in mind that many times these commercials are not for an insurance agency, but rather what is called a lead aggregator. A lead aggregator runs these commercials and when a consumer calls in, they are transferred to an agent or call center that has paid for a lead. This means you could end up talking to just about anyone without knowing their background or experience.

Let me be perfectly clear, we have nothing against Joe Namath or JJ Walker. They are being paid to do a commercial and read a script. They likely don’t even know very much about what they are reading, so lets be sure not to blame them or accuse them of being in the wrong.

As for the commercials themselves, they are more of a blend of different types of plans rather than one specific plan. What this means is that some of the benefits might be for those who are on both Medicare and Medicaid due to having a low annual income. If you are not on Medicaid then you will not be able to get those benefits.

Also, you need to understand that some benefits might only be available in certain plans that are in certain counties of the state you are a resident of. The easiest way of understanding this would be to think of a big box gym such as Gold’s. Let’s say that in the state of Florida they have 50 locations, but the only location that has not only all the latest equipment, but has an indoor pool, tanning beds, daycare, and saunas is located in Orlando. Instead of coming right out and telling you this in the commercial, they talk about all of these wonderful amenities in hopes that you will at least go visit your local Gold’s Gym. In other words, they want to get you in the door. The same goes for these Medicare Advantage commercials where they sole focus is to get you to call in so they can sell the lead to someone. None of the plan benefits that are discussed in the commercial might be available in the county you reside in, so they will simply try and sell you another plan. The sole purpose of the commercial is to get you to call. Too bad you wouldn’t get to talk to Joe Namath or JJ Walker.

Learn About Common Scams That Target Seniors

Instead of dealing with this type of nonsense, wouldn’t it be much better to call Senior Benefit Services and find out what is available to you based on where you live? There is no pressure, cost, or obligation to work with us.

Call (800)924-4727 or click here today to get honest information without any pressure or misleading information. Our agents make Medicare easy!

Medicare Open Enrollment 2024

Medicare Open Enrollment Period 2024…Get Ready…Get Set…GO!

Let the craziness begin! The Medicare Open Enrollment 2024 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.

UPDATE: Due to newer legislation, these types of confusing commercials are no longer allowed. Don’t get too excited, since these advertisers will work hard to find ways to work around the newer advertising rules, but hopefully they should not be as hard to watch. Personally they are a great time to go grab a glass of water and take care of your health.

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?

Starting January 1, 2025 the maximum out of pocket cap for prescriptions will be $2,000. There is no longer a coverage gap that Medicare beneficiaries must worry about.
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!

Wegovy Covered by Medicare: A Possible Game-Changer in Weight Loss for Seniors

Is Wegovy covered by Medicare?

It’s official, Medicare has approved the weight loss drug Wegovy to now be covered under Part D of Medicare with certain restrictions.

Weight management becomes increasingly challenging as we age, and for those navigating the golden years, effective solutions can seem elusive. However, the recent landmark approval of Wegovy, a revolutionary prescription weight loss medication, by Medicare has sparked a glimmer of hope for countless seniors nationwide. This comprehensive guide will enlighten you on the drug Wegovy, its Medicare approval, and how you or your loved ones might be eligible to benefit from this groundbreaking treatment.

Understanding Wegovy: A Beacon of Hope in Obesity Management

Wegovy, also known by its generic name Semaglutide, has emerged as a beacon of hope for individuals struggling with obesity. A sister to the widely acclaimed medication Ozempic, it has been found to induce significant weight loss, making it a groundbreaking advancement in the world of prescription weight loss drugs. Semaglutide, initially developed for diabetes management, demonstrated remarkable weight loss results during clinical trials, leading to its re-purposing and optimization for obesity treatment.

How Wegovy Works

Wegovy works by mimicking a hormone that regulates appetite, leading to a decreased craving for food. It also slows down the process of emptying the stomach, which contributes to a feeling of fullness. The combination of these effects has shown to result in notable weight loss for those participating in the studies.

The Road to Approval

On June 30, 2021, the U.S. Food and Drug Administration (FDA) granted approval for Wegovy as a chronic weight management treatment in adults with obesity or overweight with at least one weight-related condition. This decision marked a pivotal moment in the approach to obesity treatment, providing a pharmaceutical option that significantly augments traditional methods such as diet and exercise. In March 2024 the U.S. Food and Drug Administration (FDA) approved an additional indication that Wegovy can be used to reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with heart disease and obesity. This approval is what opened the door to Medicare now approving coverage for Wegovy.

Medicare’s Monumental Decision To Cover Wegovy

While this decision does not change current regulations barring Medicare from paying for obesity drugs, it does provide benefits for those who are obese and are at risk for a cardiovascular event.

What Medicare’s Approval Means for Seniors

Medicare’s endorsement of Wegovy gives seniors access to a potentially life-changing medication that was previously out of reach for many due to cost considerations. The coverage under Medicare Part D Prescription Drug plans significantly lowers the financial barrier, potentially expanding the reach of this therapy to those who could benefit most from it.

Eligibility Criteria and Cost Coverage

Are you eligible to have Medicare cover Wygovy

Here is where things get a bit murky.

To qualify for coverage under Medicare, individuals need to meet specific eligibility criteria.

Medical Necessity – the treatment using Wegovy must be medically necessary due to cardiovascular disease. Your physician must first deem it necessary as a suitable treatment.
BMI Requirements – your Body Mass Index (BMI) must be classified as obese, and you are being treated for heart disease and/or at risk for stroke.
Prior Authorization – some Medicare Part D prescription drug plans may require your physician to submit for prior authorization and provide supporting details on why you should qualify.

It is important to understand that Medicare did not approve Wegovy for weight loss. If you are wanting to take Wegovy solely for weight loss, then you will be required to pay all costs.

Navigating Medicare Approval for Wegovy

Securing Medicare approval for a prescription drug can be a complex process, but with the right knowledge, it becomes a more navigable terrain. Here’s what you need to know to ensure the successful navigation of Medicare’s approval process for Wegovy.

Consulting Your Healthcare Provider

The first step is to consult with your healthcare provider to determine if Wegovy is a suitable option for your weight management goals. Your physician will assess your medical history and current health status to provide personalized advice and support in your decision to pursue Wegovy as part of your treatment plan.

Verify With Your Medicare Part D Plan

The reality is that not all Medicare Part D Prescription Drug plans are going to cover this expensive prescription. Those that do may have varying costs associated with this particular drug, so it is important for you to know what kind of financial exposure you are opening yourself up to.

Recording Your Efforts

Consistent record keeping of your weight loss efforts is crucial for Medicare approval. Documentation of dietary changes, exercise regimens, and participation in weight management programs establishes a history of effort that fulfills Medicare’s stringent criteria for drug coverage.

Filing for Prior Authorization

For most Medicare drug plans, prior authorization is a prerequisite for coverage of Wegovy. This entails your healthcare provider submitting a request to Medicare, justifying the medical necessity and appropriateness of the medication for your particular case. Once approved, this step paves the way for access to Wegovy through your Medicare Part D plan.

The Impact of Wegovy on Senior Health

The introduction of Wegovy into the arsenal of treatments for seniors with obesity could have a profound impact on their health and quality of life. With obesity being a significant risk factor for many chronic diseases prevalent in the elderly population, the potential for substantial weight loss through Wegovy offers a pathway to better health outcomes. It is important to remember that Wegovy should be used in conjunction with a reduced calorie diet and exercise.

Frequently Asked Questions About Medicare’s Approval of Wegovy

Understanding the nuances of Medicare’s coverage of Wegovy can be fraught with questions. Here, we address some of the common queries that may arise for seniors and their caregivers.

Did Medicare Approve Wegovy for Weight Loss?

No. Medicare is prohibited from covering weight-loss medications. Medicare’s approval of Wegovy is based on the approval of the FDA’s expanded use of the drug to reduce the risk of heart attacks and strokes. The bonus side effect is that it reduces appetite, which will help many folks lose weight.

Are Medicare Part D Plans Already Covering Wegovy?

No. As of this time of this article, only the approval by The Centers for Medicare & Medicaid Services has taken place. There is a chance that later in the year we could start seeing Part D plans begin to offer coverage for Wegovy.

Will Medicare Advantage Plans Cover Wegovy?

Maybe. Once again when we talk about Medicare Part D coverage, this is provided both by stand-alone Part D Prescription plans (PDP) and thru Medicare Advantage plans that have a built-in prescription drug benefit (MAPD). The Part D prescription component in a MAPD plan will have its own formulary list (just like a stand-alone PDP plan).

How Do I Start the Process to Get Wegovy Covered Through Medicare?

The process typically begins with a discussion with your healthcare provider, followed by documentation of treatment for cardiovascular disease and a request for prior authorization from your Medicare drug plan after it has added Wegovy to its formulary list.

It is important to follow the recommendations of your healthcare provider. There are reasons why you hear all the medical disclosures (including side effects) during a prescription television commercial.

Will Medicare Cover the Full Cost of Wegovy?

The extent of coverage for Wegovy varies by Medicare Part D plan. Some plans may offer full coverage, while others may require a copayment or coinsurance.

Final Verdict of Wegovy Now Being Covered By Medicare

The approval of Wegovy by Medicare marks a significant step forward in the battle against obesity, for seniors who are at risk for cardiovascular events. By understanding the criteria for Medicare coverage and proactively engaging with the process, seniors can now possibly access a cutting-edge treatment that may transform their efforts in weight management.

While we all anxiously await to find out how many Part D plans will start covering Wegovy, take the time to find out if you are paying too much for your current Medicare insurance plan.

This article is for informational purposes only and is not intended to provide any medical advice. All medical advice should be sought from your current healthcare provider.

Sources for Quoted Information

Are Medicare Advantage Plans Really That Bad?

Lately, some have wondered if Medicare Advantage Plans are bad. If you have been reading the news lately you have likely seen articles that are talking about how many seniors feel ‘trapped’ in a Medicare Advantage plan. We all know that bad news sells while people often overlook good news.

The reality is that the truth usually lies somewhere in between. This article decodes the pros and cons of Medicare Advantage plans, aiding your decision-making process. As you approach your golden years, the many decisions surrounding your healthcare can be both complex and crucial.

Among the myriad of choices, selecting the right Medicare plan is one of the most significant. Lately, Medicare Advantage (MA) plans have stirred up quite the debate, with opinions ranging from godsend to the scourge of elders’ healthcare.

But let’s dive deeper into the sea of healthcare options—do Medicare Advantage plans deserve their mixed reputation?

The Beginning of Medicare Part C: The BalancedBudget Act

If we start from the beginning, the Balanced Budget Act of 1997 (BBA) introduced Medicare Part C (now known as Medicare Advantage) and to put it mildly became a bit of a disaster. Seniors flocked to these plans for primarily one reason, the prescription drug coverage benefit. Of course, the low cost of many of these plans didn’t hurt either. Over the months, it was a bit of the wild West and insurance companies were offering crab and even steak dinners to seniors just to come hear about the plans. Many folks signed up right at the dinners and jumped head first into these new plans.

Suddenly many of these Medicare beneficiaries were smacked in the face with why these plans were so low costing. Unlike original Medicare, these Part C plans required seniors to use a doctors who participated in the plan’s network. Since many of these carriers rushed their plans to market, the networks were very small. Many seniors were having to pick a new doctor and give up the ones they felt comfortable with. In addition to network issues, folks were also now dealing with pre-authorization requirements to continue to see a specialist for their more complicated health issues. The one thing that kept them in the plan was the prescription drug benefit, which at that time was one of the only ways that seniors could get help with the high costs of their prescriptions. Sadly these plans quickly started to exit the market and seniors went back onto original Medicare and paying for all of their prescriptions out of pocket.

Part C of Medicare going away — Medicare Part C exits the market

In 2003 Medicare Advantage and stand-alone Part D prescription drug plans were introduced back into the market. If you are thinking that Medicare Advantage was basically a rebranding of Medicare Part C then you are on the right track. The problem once again was the lack of robust networks and many doctors pushing back against joining them. Many seniors remembered the fiasco of Medicare Part C back in the 1990s and were hesitant to enroll in the newer Medicare Advantage plans even though these plans had low daily hospital co-pays and reasonable maximum annual out of pocket limits for the plans. By the end of 2004 out of the 41 million Americans on Medicare only about 5 million were enrolled in a Medicare Advantage plan.

Medicare Part C returns as Medicare Advantage

Fast forward to 2023 and out of the 65 million Americans enrolled in Medicare just under 32 million were enrolled in a Medicare Advantage plan. In less than 20 years there has been an increase in Medicare Advantage plan members of 540%. That is quite a remarkable number.

How they differ from Original Medicare

The primary distinction lies in how they manage and pay for your healthcare benefits. While Original Medicare allows direct payment for healthcare goods and services, Medicare Advantage (MA) contracts with a network of providers, which dictates your access to care.

This basically means that instead of original Medicare paying benefits to your doctor, they are paying all your Medicare annual allowance to the Medicare Advantage plan you have enrolled in. It is then up to the MA plan to manage your healthcare costs.

If you have more expenses than what was paid by Medicare to the MA plan, then the plan loses money on you. If you have a healthy year then the MA plan makes money.

Additionally, MA plans receive federal subsidies from the Centers for Medicare and Medicaid Services (CMS) which helps with their profitability.

Pros of Medicare Advantage Plans

Despite their critics, Medicare Advantage plans have numerous advantages that make them a worthy competitor against Original Medicare. Let’s unpack these benefits to show a balanced side of the story.

Lower out-of-pocket costs

The financial burden of healthcare can be significant for seniors. Medicare Advantage plans cap out-of-pocket spending for Part A and B services, providing predictability in healthcare costs. We know these caps as the plan’s Maximum Out of Pocket (MOoP).

This can be especially beneficial for those who face chronic health conditions that necessitate frequent doctor visits or hospital care. When an individual is covered only by Medicare Part A and Part B (without a Medicare Supplement) they do not have an annual cap.

Care Coordination

Another plus of Medicare Advantage is the focus on care coordination. Some plans offer nurse hotlines, wellness programs, and other resources to help beneficiaries manage their health more effectively. The attention to coordination can reduce medical errors and can make the patient experience smoother.

Cons of Medicare Advantage Plans

While the benefits paint a rosy picture, it’s crucial to address the drawbacks. Medicare Advantage plans have their shortcomings and may not suit everyone perfectly.

Limited provider network

Enrolling in a Medicare Advantage plan often means adhering to a specific network of doctors and hospitals. This can be restrictive, particularly for those who have established relationships with healthcare providers.

While the networks have become more robust over the last 20 years, they still pale in comparison to the number of providers who accept original Medicare. It’s essential to ensure that your preferred healthcare professionals are part of the plan’s provider network.

If the MA plan you are looking at uses an HMO network, then you need to understand that if you see a provider not in the plan’s network, then you are responsible for 100% of the medical bills.

Since CMS directly pays all your benefits to the MA plan, you can’t ask Medicare to cover the costs.

Potential for higher costs in certain situations

While MA plans offer a ceiling for out-of-pocket costs, they can also lead to higher expenses if care is sought outside the network.

Emergency care and urgent care services can potentially not be as covered as well as with the traditional Medicare program, which doesn’t have the same provider restrictions. As we mentioned earlier, an HMO network is the most restrictive and requires you to use a provider that participates in the plan’s network.

If your MA plan uses a PPO network, then you would have coverage when using a provider not in-network. There are serious pitfalls that you need to be aware of when using a non-participating provider.

Most plans have a separate maximum out of pocket cap for in-network vs out-of-network. The MA plan may have a MOop of $7,000 for in-network, but a separate MOop of $10,000 for out-of-network.

In addition, seeing an out-of-network provider can be billed differently. Instead of paying a $50 co-pay for the specialist, you might be required to pay 20% of the cost. These situations can lead to much higher amounts of expenses being paid out of pocket.

Annual changes in plan coverage

Medicare Advantage plans can alter their coverage on a yearly basis, including prescription drug formularies and benefits. This means they may not cover next year what they coveredd this year.

A Medicare Advantage plan does an annual contract with CMS, which means that they can choose not to continue to offer the plan in a certain county or even state. This means all those enrolled in that plan would have to find a new plan or return to original Medicare.

Beneficiaries need to review their plans and potentially switch annually, causing potential inconvenience and confusion.

Considerations for Seniors

You may wonder what all this means for you. How do you know if Medicare Advantage is the right choice? The answer to this question, as we often find in healthcare, is that it depends. Here are some factors to consider when navigating the maze of Medicare Advantage options.

Factors to consider when deciding on a Medicare Advantage plan

Your health status – If you’re relatively healthy, you may find that the additional benefits of an MA plan are more advantageous. However, those with more complex or severe health needs might prefer the flexibility and broader coverage of Original Medicare.

A key point to remember is that your focus should be the core benefits of the plan and not the add-ons. Many times, the add-ons are the ‘sizzle’, but you need to be more concerned with the ‘steak’.

Don’t get us wrong, having dental benefits is great, but if your plan makes you responsible for a daily co-pay of $350 for up to 5 days in the hospital, those extra benefits quickly dry up.

An example of this would be having $1,500 of dental benefits but ending up in the hospital for 5 days with a $350 per day co-pay. This hospital stay would mean you having to come up with $1,750 out of your own pocket.
Location – Provider networks can vary widely by geographic area, so where you live can significantly affect your choice of MA plan.

Rural areas, for example, may have more limited options than urban centers. In fact, we have found that in many rural areas, doctors are less likely to join a plan’s network.
Your lifestyle and health care preferences – If you have specific needs or prefer a particular style of care, such as integrative or alternative medicine, you’ll want to ensure that the MA plan you choose aligns with those preferences.

How to evaluate plan options

Diving into the details is essential. Look beyond the surface benefits and consider the cost-sharing arrangements, such as premiums, deductibles, co-payments, and coinsurance.

Does the plan cover the specific services and treatments you anticipate needing?
How easy is it to access care if you’re out of town or need a specialist?
Does the plan cover all your prescriptions in their formulary?
Does the plan require you to do step-therapy? (trying other lower costing prescriptions before the plan will pay for the higher priced one you want).

These are just a few of the aspects that require thorough examination.

Comparing Medicare Supplement to Medicare Advantage

Everything we discussed above is comparing original Medicare Parts A and B to Medicare Advantage. The reality is that most folks on original Medicare also have a Medicare Supplement plan. When you do a comparison between a Medicare Supplement and a Medicare Advantage plan, things change dramatically.

Read our article Medicare Supplements vs Medicare Advantage Plans

Frequently Asked Questions (FAQs)

Why are people against Medicare Advantage plans?
- One of the biggest issues folks have with Medicare Advantage plans after they enroll in one is the use of networks. Under original Medicare there are no networks, so you can see any provider who accepts Medicare.
What is the downside of a Medicare Advantage plan?
- Besides network restrictions, needing a referral or prior authorization to see a specialist is a major downside. A Medicare Advantage plan typically requires these, but original Medicare does not.
Why are people leaving Medicare Advantage plans?
- There are several reasons why people leave Medicare Advantage plans and return back to original Medicare include such things as:
  - Prior-authorization requirements
  - Procedure denied by the plan
  - Doctors complaining to their patients about the plan (such as slow payment from the insurance carrier)
Is Medicare Advantage under investigation?
- In 2023 several Medicare Advantage plans came under scrutiny by the Senate for several issues:
  - Use of an algorithm to deny care that patients need.
  - Overbilling Medicare by saying that members were sicker or had illnesses that they really didn’t have which allowed the plans to be paid a higher rate. This abuse was documented in a report from MedPac that was sent to Congress.
Can I drop my Medicare Advantage plan and go back to original Medicare?
- Yes, but there are certain restrictions that you must adhere to.
  - During the Annual Enrollment Period (AEP) which runs from October 15^th – December 7^th of each year, you can drop an existing Medicare Advantage plan and return back to original Medicare and enroll in a stand-alone Part D prescription drug plan.
  - If you enrolled for the first time in a Medicare Advantage plan you can disenroll within the first 11 months and return back to original Medicare and enroll in a stand-alone Part D prescription drug plan.
Is Medicare Advantage draining Medicare?
- In a report written by the Center for Economic and Policy Research it was reported that an individual on a Medicare Advantage plan costs Medicare more each year than an individual still on original Medicare.
  
  The study cites that in 2020 CMS spent $1,538 more per Medicare beneficiary enrolled in a Medicare Advantage plan than it would for that same person to be enrolled in original Medicare.

So What Can We Conclude Regarding Medicare Advantage Plans?

Are Medicare Advantage plans really that bad? The truth, as always, is somewhere in the middle. They offer a host of advantages, including cost containment, supplemental benefits, and improved care coordination.

However, they also come with their share of inconveniences, such as provider network restrictions and the potential for increased costs under certain circumstances. It’s not about good or bad; it’s about what aligns best with your individual needs and preferences.

Contact Senior Benefit Services today at (800)924-4727 to see what type of plan is best for your personal needs.

Does Medicare Cover Dentures?

Many retirees want to know if Medicare will cover the cost of dentures. Medicare provides comprehensive healthcare but offers notably limited dental care benefits. This article delves into the extent of dental coverage under Medicare, shedding light on the options available for individuals seeking dental care.

The Scope of Medicare Dental Coverage

Medicare, established in 1965, was not designed to cover routine dental care, including dentures. At that time, authorities did not consider dental care routine medical care.

A 1980 Congress statute highly restricts Medicare’s dental coverage due to a dental exclusion. As a result, Medicare seldom covers dental procedures like extractions and fillings, which are essential for maintaining oral health.

Medicare does not cover denture costs, deeming them not medically necessary under Parts A and B.

Will Dental Ever Be Covered Under Medicare?

Factors prevent the inclusion of dental benefits under Medicare, despite widespread desire. It is important to keep in mind that there are almost 66,000,000 people on Medicare.1 Yes, you read that correctly….66 million!

To cover one dental visit of $120.00 for each Medicare beneficiary, taxpayers would have to fund an additional $7,920,000,000.00 into Medicare. Taxpayer dollars fund programs like Medicare and Social Security, as we all know.

So where do we come up with another $8 billion dollars to cover $120 per person in dental bills? If you answered raising taxes, then you are on the right page.

So how much are dentures. Roughly a complete set of ‘mid-priced’ dentures costs between $1,000 – $3,000. A single denture plate can run between $500 – $1,500.2

Just using these costs for a complete set of ‘mid-priced’ dentures and not for a ‘premium’ set, here is how it would look for providing this to just 10% of the Medicare beneficiaries.

65,748,297 Medicare beneficiaries x 10% = 6,574,829 sets of dentures

6,574,829 sets of dentures x $2,000 (average of ‘mid-priced’ dentures) = $13,149,658,000.00 in additional costs for 1 year.

Offering dental coverage through Medicare, including routine visits and dentures for 10%, will require taxpayers to fund an additional $21 billion.

Last, but not least, the American Dental Association is against this proposal since it would likely result in pay cuts to dentists.

Options for Dental Coverage Under Medicare

Given Medicare’s limited dental coverage, individuals have a few options to consider for their dental care needs:

Self-Pay

Many Medicare recipients choose to pay out-of-pocket for dental services, especially those with generally healthy teeth who may only require routine cleanings.

Some may opt for dentists’ internal plans, which can offer a number of cleanings per year and discounts on other services.

Private Insurance

Dental insurance plans provided by insurance companies typically run between $25 – $75 per month depending on the level of benefits you are wanting.

Most plans provide 100% coverage for preventive services such as routine exams, cleanings, and bitewing x-rays. For items that fall under basic care, such as fillings and simple extractions, many carriers will cover these benefits at 80%.

It is important to keep in mind that some plans do have a 6-month waiting period before they will cover these services.

Most plans cover major care at 50% with a possible 12-month waiting period for these services. Major services can include crowns, bridges, dentures, implants and more. You read that correctly, while Medicare does not cover dentures, a private dental plan can.

Final Thoughts

While we can always hope that one day we will be able to find a way for Medicare beneficiaries to have complete dental coverage, it is important to act and not wait until you are possibly burdened with thousands of dollars in out-of-pocket expenses.

Now you know that Medicare will not cover dentures, so it might be time to look at other options.

Give us a call today at (800)924-4727 to discuss your options.

Sources

Center for Medicare Advocacy: https://medicareadvocacy.org/medicare-enrollment-numbers/#:~:text=The%20Centers%20for%20Medicare%20%26%20Medicaid,are%20enrolled%20in%20Original%20Medicare.
Dentureliving.com: https://www.dentureliving.com/en-us/advice-tips/preparing-for-dentures/costs/how-much-do-dentures-cost

Is Medicare FREE at Age 65?

We would all love to hear that Medicare is free at age 65, but that is really not the case. Turning 65 is a significant milestone for many Americans. As you approach this milestone, you may be wondering about Medicare and how much it will cost you. There are many misconceptions about Medicare, but one of the most frequently asked questions is, “Do I have to pay for Medicare?” The answer is yes, but the amount you pay depends on your income, the type of Medicare coverage you choose, and when you enroll. This article will cover everything you need to know about paying for Medicare.

Is There A Monthly Fee To Have Medicare?

Yes, there is a monthly fee for Medicare Part B, which covers doctor visits, outpatient care, and medical equipment. In 2024, the standard monthly premium for Part B is $174.70. However, the amount you pay may be higher based on your income. If you have a high income, you may be subject to an Income-Related Monthly Adjustment Amount (IRMAA). If you are single and making above $103,000 or married filing jointly and making above $206,000 be sure to check out our IRMAA chart for additional premiums owed in 2024.

Is Medicare Free for US Citizens?

Medicare is not free for US citizens. While you may not have to pay a premium for Part A, which covers hospitalizations, Part B requires a monthly premium. Additionally, Medicare does not cover all expenses, and you may still be responsible for copayments, deductibles, and coinsurance.

Do You Have to Pay for Medicare at Age 65?

If you or your spouse paid Medicare taxes while working, you will be eligible for premium-free Part A when you turn 65. Now keep in mind that if you or your spouse happened to only work a part-time job for a year or so, that will not qualify you to receive premium-free Part A. To qualify for premium-free Medicare Part A you must have worked for 40+ quarters (10 years) and paid Medicare taxes. See the chart below for Part A monthly premium costs for 2024 below.

Quarters Paid In	2024 Monthly Premium
0-29	$505.00
30-39	$278.00
40+ (10 years)	$0.00

Part A Monthly Premiums

However, you will still need to pay a monthly premium for Part B. If you do not enroll in Part B when you are first eligible, you may be subject to a late enrollment penalty.

How Much Do I Have To Pay for Medicare When I Turn 65?

The amount you will pay for Medicare when you turn 65 depends on a few factors. If you or your spouse paid enough Medicare taxes while working, you will not have to pay a premium for Part A. The standard monthly premium for Part B in 2024 is going to be $174.70, but the amount you pay may be higher based on your income (IRMAA).

What Happens If You Don’t Enroll in Medicare Part A at 65?

If you are eligible for premium-free Part A and do not enroll in it when you turn 65, you may have to pay a penalty. The penalty is 10% of the Part A premium for every 12-month period you could have been enrolled but were not. The penalty lasts for twice the number of years you could have been enrolled but were not.

If you are not receiving Social Security benefits when you become eligible for Medicare, you will need to pay your premiums directly. You can pay your Medicare premiums online, by mail, or by phone. If you are enrolled in Medicare Advantage, a Medicare Supplement or a Medicare prescription drug plan, you may have additional costs.

In 2023, the standard monthly premium for Part B is $1640.90. Social Security withholds this premium from your benefit payments each month. Social Security will withhold for Medicare in 2024, but it will be about 3.5% ($5.80) higher at $174.70 per month.

How Do You Qualify For Free Part B Premium?

Some people may qualify for free Part B from Medicare if they meet certain income and asset requirements. The program is called Extra Help, and it is available to people who have limited income and resources. You can apply for Extra Help online, by mail, or by phone.

Is Medicare Part B Giveback the Same As Free Part B?

No! Medicare Part B giveback is found in certain states/counties where the reimbursement rates from Medicare to the private insurance companies offering those plans is higher. Some plans will credit the full Part B premium back to you and others might only credit a portion of the Medicare Part B premiums back to you.

It is important to understand that these plans are not available everywhere. In addition, you would need to be enrolled in a Medicare Advantage plan and not original Medicare.

Are Medicare Advantage Plans Free?

No! This is a huge misconception that many folks have. While some Medicare Part C plans may be $0 premium each month, you must continue to pay your Part B monthly premium. It is also very important to understand that Medicare Advantage plans ‘share’ the costs with you. This means that you will have co-payments and co-insurance to pay out of your pocket for each service. Now the good news is that Medicare Advantage plans must have an annual maximum out of pocket that sets a yearly cap on how much you would have to pay out of pocket. Some plans may have a $3,000 maximum whereas others may have a maximum of $7,500.

Conclusion

Medicare can be confusing, and the cost is an important factor to consider when deciding which coverage to choose. While Medicare is not free, it provides essential coverage and protection against high medical costs. Understanding the costs and requirements of Medicare will help you make informed decisions and plan for your future. There is no need to go at this alone! Call Senior Benefit Services, Inc. today at (800)924-4727 to get the help you deserve.

Can I Switch From A Medicare Advantage Plan Back To Original Medicare?

switch from Medicare Advantage to Original Medicare

Switching from a Medicare Advantage Plan back to Original Medicare might not be something you read about often, but it actually happens quite a bit. Medicare Advantage Plans have become increasingly popular among seniors over the years because of their affordability and additional benefits like vision, hearing, and dental coverage. However, some seniors may find themselves unsatisfied with their Medicare Advantage Plan or may want to switch back to Original Medicare. If you’re one of these seniors, you may be wondering if switching from a Medicare Advantage Plan back to Original Medicare is possible. This blog post will help answer your questions and guide you through the process.

When Can You Return Back to Original Medicare?

If you find yourself wondering if or when you can return back to original Medicare, it’s important to understand that there are specific times during the year when you can make changes to your Medicare coverage. The Annual Enrollment Period (AEP) runs from October 15th to December 7th each year, during which you can enroll in or switch your Medicare Advantage or prescription drug coverage. Additionally, if you’re already enrolled in a Medicare Advantage Plan, there is a separate enrollment period called the Medicare Advantage Open Enrollment Period (OEP) that runs from January 1st to March 31st each year. This period allows you to make changes to your Medicare Advantage Plan, including switching to a different Medicare Advantage Plan or switching back to Original Medicare. You can generally only switch outside these enrollment periods if you qualify for a Special Enrollment Period, which certain circumstances such as relocating to a new area may trigger.

Things To Consider When Leaving Your Medicare Advantage Plan

If you’re considering switching back to Original Medicare, it’s important to understand the differences between Original Medicare and Medicare Advantage. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), which are offered by the federal government. Medicare Advantage, on the other hand, is a private insurance option that covers the same services as Original Medicare, but may offer additional benefits like vision, hearing, and dental coverage. Original Medicare may have higher out-of-pocket costs, but it allows you the freedom to choose your own healthcare providers. Learn more about Medicare Supplement plans and stand-alone dental, vision, and hearing plans.

How To Switch From Your Medicare Advantage Plan back to Original Medicare?

To switch from a Medicare Advantage Plan back to Original Medicare, you’ll need to contact your Medicare Advantage Plan provider or call Medicare directly at 1 (800) MEDICARE. You can also enroll in a Part D prescription drug plan at this time if you’d like and it should automatically end the Medicare Advantage plan (as long as the plan has prescription drug coverage integrated into it). Once you’re back on Original Medicare, you’ll have the option to enroll in a Medicare Supplemental Insurance (Medigap) Plan, which can help cover your out-of-pocket costs like deductibles, coinsurance, and copayments. If you are switching out of a Medicare Advantage plan that has prescription drug coverage, you most definitely will want to enroll in a stand-alone Part D prescription plan.

Can I Get A Medicare Supplement Plan After Switching Back To Original Medicare?

If you decide to switch from a Medicare Advantage Plan back to Original Medicare and wish to enroll in a Medicare Supplemental Insurance plan, note that you might need to respond to health-related questions for eligibility. Keep in mind that if you turned 65 and initially enrolled into a Medicare Advantage plan and have been on that plan for less than 12 months then you can qualify for a special enrollment period (SEP). This SEP allows you to return to original Medicare and enroll in a Medicare Supplement plan with no underwriting. Your Trial Right is the name of this specific SEP. Learn more about other Special Enrollment Periods and how to qualify.

Final Thoughts

Switching from a Medicare Advantage Plan back to Original Medicare is possible, but it’s important to understand the enrollment periods and differences between the two options. If you’re thinking about making the switch, be sure to contact your Medicare Advantage Plan provider or call Medicare directly at 1 (800) MEDICARE. And if you decide to enroll in a Medigap plan, be sure to do so during your open enrollment period to ensure you get the best coverage and pricing. By understanding the process and timing, you can make an informed decision that best meets your healthcare needs and budget. If all of this still sounds confusing, then let one of our advisors help. Simply give us a call at (800)924-4727 and experience why Senior Benefit Services, Inc has so many satisfied clients. Remember, “We Make Medicare Easy!”

How Much Does Medicare Part C Cost?

Are you a senior citizen wondering how much Medicare Part C will cost you? You’re not alone! Many seniors have questions about the costs and plan options associated with this important part of their healthcare. In our 2024 guide to Medicare Part C, we’ll explain the sample premiums as well as other fees that go into determining your exact out-of-pocket expenses for these plans. We’ll reveal the services Medicare Part C covers and guide you to choose the plan best fitting your needs. Don’t worry; understanding the costs associated with your healthcare can be simple!

Examples of Monthly Premiums for Medicare Advantage Plans

Expect an average premium range with Medicare Advantage (Part C), though costs can vary based on location and specific plan. In many cases, beneficiaries can still find plans with $0 premiums. Although the average Medicare Advantage premium in 2024 is around $30 to $40 per month. For instance, Carrier 1 Medicare Advantage Plan using an HMO network offers a $0 per month premium, but it’s limited to certain counties within each state. A different plan, Carrier 2 using a PPO network has monthly premiums that start around $35. It’s essential to remember that a lower premium often means higher out-of-pocket costs when you need care and/or a more restrictive network. Therefore, it’s crucial to balance the monthly premium with other expenses such as deductibles, copayments, and coinsurance when choosing the right Medicare Advantage plan for you.

Overview of Medicare Part C – what it is and who can get it

Getting older comes with various challenges, including healthcare needs. That is where Medicare Part C comes into play. Also known as Medicare Advantage, Part C is an alternative to Original Medicare (Part A and Part B). It is a health insurance plan offered by private insurance companies approved by Medicare, which covers all of the benefits offered in Part A and B. On top of that, it can offer additional benefits, such as dental, vision, or hearing, at an affordable cost. Remember, only those enrolled in both Medicare Parts A and B qualify for Part C.

It’s essential to understand the fundamental difference between a Medicare Advantage plan (Part C) and a Medicare Supplement (Medigap) plan. While both are intended to help cover out-of-pocket costs of Original Medicare (Part A and Part B), they function in entirely different ways. A Medicare Advantage plan is an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. It often includes additional benefits such as prescription drug coverage, as well as dental, vision, or hearing services. On the other hand, a Medicare Supplement plan works in conjunction with your Original Medicare benefits. This is to help pay for the costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. You cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. It’s paramount to consider the differences, costs, and benefits of these options to make the best decision based on your healthcare needs and financial situation.

Understanding the different components of Medicare Part C coverage

Understanding Medicare Part C coverage is crucial for those who qualify for this program. Made available through private insurance companies, it combines the benefits of both Medicare Part A and Medicare Part B. Medicare Part A primarily covers inpatient hospital care, hospice care, and skilled nursing facility care. Medicare Part B, on the other hand, covers outpatient services, preventative services, and medical equipment. With Medicare Part C, you get an opportunity to customize your coverage by selecting a plan that fits your individual needs as well as budget. It can provide additional benefits, such as prescription drug coverage, vision, dental, and hearing care. By understanding the different components of Medicare Part C coverage, you can make an informed decision regarding which plan is right for you.

Factors that affect the cost of Medicare Part C

When it comes to Medicare Part C, many factors can influence the cost of coverage. The first thing to consider is the plan itself. Different Medicare Advantage plans have varying benefits, co-payments, and deductibles, all of which affect the monthly premium cost. Another factor is location. Insurance companies can charge different rates in various parts of the country, based on the cost of medical care in that region. Age, health status, and income level can also affect the cost, particularly for those who qualify for financial assistance. For those with a chronic health condition, there are plans designed just for those conditions. Some of these conditions include diabetes and heart complications. Ultimately, it’s essential to carefully evaluate all of these factors before choosing a Medicare Part C plan to ensure that you are getting the coverage you need at a price that fits your budget.

How to choose a plan based on your budget and needs

Choosing the right plan for your budget and needs can be overwhelming. With the help from an informed advisor it doesn’t have to be. First, assess your needs and priorities. Do you prioritize flexibility or a lower monthly cost? If provider flexibility is a priority, then a Medicare Advantage plan that uses a Preferred Provider Organization (PPO) network will allow you to see providers in and out of network. If your priority is cost then a plan that uses a Health Maintenance Organization (HMO) network will likely give you the lowest co-pays and premium costs. Next, take stock of your current health and lifestyle. Are you relatively healthy and rarely need to visit the doctor, or do you have ongoing medical needs? Once you understand your priorities and needs, your advisor can find a plan that aligns with them. This may include assessing factors like premiums, deductibles, and co-pays. Taking the time to choose the right plan can save you both time and money in the long run.

Common Misconceptions about Medicare Part C

Despite the widespread use of Medicare Part C, multiple misconceptions continue to circulate, which can make the decision-making process more challenging for individuals. One common misconception is that Medicare Advantage (Part C) plans are fully comprehensive and eliminate all out-of-pocket costs. Indeed, these plans often surpass Original Medicare in coverage, but they usually come with deductibles, co-pays, and other costs. Depending on things such as what state and county you reside in, you will hear about different Maximum Out Of Pocket (MOOP) costs. There are plans in some states and counties that have a $3,000 MOOP for a calendar year, but in another state and county that MOOP could be well over $7,000 for a calendar year.

Misconception 2

Another misconception is that all Medicare Part C plans are the same. In reality, plans can differ significantly, with various offerings, premiums, and out-of-pocket costs, depending on the insurance company and location. It’s crucial to investigate the specifics of any plan you’re considering to ensure it will truly meet your needs. Some plans offer a gym membership such as Silver Sneakers, but another may not. While some plans may offer dental benefits of up to $1,000 at no additional cost, another plan may offer $2,000. Now keep in mind that the Medicare Advantage plan offering the gym membership might only offer up to $1,000 in dental benefits. If you don’t need or want the gym membership but really want more dental benefits, then you would likely want to go with the plan that offers up to $2,000 in dental benefits. If you really want both the gym membership and the maximum dental benefits, you might want to consider getting the plan with the gym membership and adding on additional dental benefits with a stand alone dental plan.

Misconception 3

A third misconception is that Medicare Part C enrollees can see any healthcare provider. However, most Medicare Advantage plans are network-based, meaning your provider options may be limited. It’s important to make sure your preferred providers are in-network or be comfortable with the network providers before choosing a plan. As we discussed earlier, most plans will use either a PPO or HMO network. If you join a plan that uses an HMO network, then you MUST see only providers who participate in that plan’s network. If you go with a PPO plan then you will have the lowest out of pocket costs when going to a provider in their network, but you do have the option of seeing a provider who is not in that network. “Keep in mind, choosing an out-of-network provider often means facing a separate deductible and higher coinsurance payments.”

Misconception 4

Finally, some believe that once enrolled in Medicare Part C, they are locked in forever. The reality is, enrollees have the option to change plans during the annual enrollment period. This flexibility allows individuals to adapt their coverage as their healthcare needs evolve. Each year the annual enrollment period (AEP) begins October 15th and ends December 7th. During this time you can switch Medicare Advantage plans or leave Medicare Part C completely and return to original Medicare. Remember that if you return to original Medicare and want a Medicare Supplement you may be subject to underwriting. This means you will have to medically qualify for the Medicare Supplement. There are provisions for certain situations where you could obtain a Medicare Supplement plan without underwriting.

By dispelling common misconceptions, you can make informed decisions and maximize your Medicare Part C coverage.

Tips for saving money on Medicare Part C coverage

Medicare Part C can be a great way to get comprehensive health coverage. However, it can also be costly. If you’re looking for ways to save money on your Part C coverage, one option to consider is hospital indemnity insurance. This type of insurance provides additional coverage for hospital stays, which can be a major source of expense when it comes to healthcare. Did you know that daily hospital co-pays can vary from $200 per day to over $400 per day? At $400 per day a 5 day inpatient hospital stay would amount to a $2,000 exposure that would need to be paid out of pocket.

By adding hospital indemnity to your Part C plan, you can help avoid paying unexpected costs out of pocket. Learn how a hospital indemnity plan could pay your daily hospital co-pays for pennies on the dollar.

Indeed, Medicare Part C outshines regular Part A and B by providing coverage as a valuable alternative to original Medicare. It is important research your plan’s components and understand your monthly and out-of-pocket costs. There are a variety of options available from private companies, so it’s worth considering which one will cover your needs best. Doing this allows you to save time and money while finding the right plan for your situation. Additionally, there are several strategies you can use to save money on your out of pocket expenses. Learn more about Medicare Part C; call (800) 924-4727 to find the best plan.

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.

Fill Out This Form To Request A New Medicare Advantage Quote

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 in Maryland

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 how 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 premiums 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.

Choose The Right Medicare Plan For you! Compare Plans!

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.

Medicare Advantage Co-Pay and Co-Insurance

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.

Get Your FREE Customized Medicare Advantage Quote

Takeaway

Senior Benefit’s Hagerstown Office

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Cumberland, MD 21502

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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’.

Medicare Supplements vs Medicare Advantage Plans?

Trying to figure out everything you need to know to compare Medicare Supplements vs Medicare Advantage plans? Medicare Supplements and Medicare Advantage plans can be very confusing and most of the time we head to the internet for answers.

Well, guess what:

For an advisor Medicare Supplements vs Medicare Advantage plans are fairly easy to understand, but for someone doing it on their own there are usually many questions that might not get answered when you are searching the internet for coverage.

In this post we will answer some of the most asked questions on the internet and prepare you for how you can compare plans for your Medicare needs.

Medicare Plans — Medicare Supplements vs Medicare Advantage plans…which is right for you?

1. Who Regulates Medicare Supplement Plans?

In 1990 the federal government placed the Omnibus Budget Reconciliation Act (OBRA) into law which standardized all Medicare Supplement Policies.

Overall, Medicare Supplement plans are state regulated, but the above law made these policies subject to minimum federal requirements.

This law did things like standardizing plans so there isn’t any confusion about your benefits as well as requiring that Medicare Supplement plans are guaranteed issue when someone turns 65 years old during the first 6 months of their enrollment to Medicare Part B.

During this 6 month period they also can’t do things like charge you more because of any pre-existing conditions.

Outside of federal law, the states can also enact their own minimum standards like limiting insurance agents commissions to make sure they aren’t switching customers companies every year for a commission.

2. How Many Medicare Supplement Plans Are There?

There are a total of 12 Medicare supplement plans as of 2022, these plans are:

Plan A
Plan B
Plan C
Plan D
Plan F
High Deductible Plan F

Plan G
High Deductible Plan G
Plan K
Plan L
Plan M
Plan N

The best thing about Medicare Supplement plans is that they are standardized, this means that no matter what state you are in (outside of Massachusetts, Minnesota, or Wisconsin) all of the plans will offer the exact same benefit.

This also makes it easier to pick a company since no benefits will change, most companies can offer additional benefits, but can’t offer less benefits.

So, if you aren’t sure which option will be best, you can always go with price first, since every product is the exact same no matter the company.

Thrivent’s Plan A will be the same as Mutual of Omaha’s Plan A.

3. Which Of The Following Must Be Present In All Medicare Supplement Plans?

As I stated above, Medicare supplement plans are standardized in 47 states and on the most basic level, no matter what state you live in, they all have to cover some parts of:

Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits have been used up.

Medicare Part A hospice care coinsurance or copayments
First three pints of blood used in a medical procedure
Medicare Part B coinsurance or copayments

Depending on the plan that you choose, there are even more benefits.

For example:

Medicare Supplement Plan G, one of the most all-inclusive Medicare Supplement plans, has the following extra coverage benefits:

Medicare Part A deductible
Part B excess charges
Part B preventive care coinsurance
Skilled Nursing Facility (SNF) care coinsurance
Foreign travel emergency care

Some plans may include additional benefits like the Silver Sneakers Program.

The only states where the benefits are going to be different are Massachusetts, Minnesota, or Wisconsin.

Medicare Supplement plans in those states are different and you will probably want to speak with an agent to help you figure out exactly how they will work.

On the other side of things, a Medicare Supplement plan does not have to cover vision, dental, hearing aids, or long term care. These items can be covered with a separate dental-vision-hearing plan and a separate long term care plan designed to cover long term stays in a nursing home or provide long periods of home health care benefits. Keep in mind when shopping for plans to go along with Medicare in MD there are quite a number of choices and options to cover your future medical expenses.

4. When Can You Change Medicare Supplement Plans?

There is a part of the year known as the Medicare Open Enrollment Period which confuses many retirees since it is really called the Annual Election period or AEP.

This is the time period you can change your Stand-Alone Part D Prescription Drug Plan (PDP) or your Medicare Advantage Plan (MAPD) and it usually lasts from October 15th to December 7th every year. Understand that this period does NOT pertain to Medicare Supplements.

There is no specific period where you can change Medicare Supplement plans each year. In fact if you get a rate increase and want to shop your current plan, you can do so at any time. Keep in mind that to actually switch to another Medicare Supplement plan, the new insurance company will likely require you to answer health questions. Depending on your current health conditions, you may be declined from the new carrier, so never cancel your existing coverage before you have your new policy in hand.

In certain states there are special provisions that may allow a person to change their Medicare Supplement plan such as the birthday rule. States that have the birthday rule ensures that a consumer can switch to another carrier as long as they are getting the same coverage or less without underwriting. The birthday rule can be handled differently in each state that offers it. Right now the only states providing Medicare beneficiaries with the birthday rule provision are Oregon, California, Idaho, Illinois, and Nevada.

If you thinking about switching from a Medicare Supplement to a Medicare Advantage Plan or you have a Medicare Advantage plan and want to switch to a Medicare Supplement then you will be able to do so during the Annual Enrollment Period.

It is very important to do your research before your Annual Enrollment Period so that you know what could happen to your policy. Plans for Medicare in Maryland have many more options when looking at Medicare Supplements compared to a Medicare Advantage plans. In fact there are only several carriers offering Medicare Advantage plans in Maryland (and only in certain counties) compared to a large amount of carriers offering Medicare Supplement plans statewide.

For Instance:

If you are currently enrolled in a Medicare Advantage Plan and decide to switch to a Medicare Supplement plan, you could be denied coverage due to your current health. Also keep in mind that unlike a Medicare Advantage plan, a Medicare Supplement plan’s premium is based off your current age when you enter the plan.

If you are currently enrolled in a Medicare Supplement Plan but want to switch to a Medicare Advantage Plan, you can do so during the Annual Enrollment Period, but your coverage will not be effective until January 1st of the following year. This means that if you enroll in a Medicare Advantage plan on October 15th, do NOT immediately cancel your Medicare Supplement plan since you will need that coverage for the rest of the current year.

5. How Long Is An Open Enrollment Period For Medicare Supplement Policies?

Each person has their own 6 month time table for applying for a Medicare Supplement plan.

It is your personal Open Enrollment period and it starts on the first day that your Medicare Part B becomes active.

For Instance:

If your Medicare Part A and B starts on Jan 1st then your personal enrollment period will last until July 30th.

This usually happens when you turn 65 years old and start to receive your Medicare Part B benefits. In many states you can also purchase a Medicare Supplement up to 6 months in advance of when you are turning 65. The plan will not go into effect until your Medicare benefits do. This means that if you are in a state that allows advance purchase of 6 months and you are going onto Medicare effective August 1st, then you can purchase your plan in February. The Medicare Supplement plan will not go into effect until August 1st as well.

If you are wanting to purchase a Medicare Advantage plan when turning 65 you can enroll up to 3 months prior, during the month you are turning 65 and up to 3 months after you turn 65. This period for Medicare Advantage is known as the Initial Enrollment Period (IEP).

Keep in mind, if you continue to work after age 65 and have proof of comparable insurance coverage, your Medicare Supplement Open Enrollment period can be pushed back to later when you retire.

Can I purchase Outside Of My Open Enrollment Period?

Outside of your Personal 6 month enrollment period, you can actually purchase a Medicare Supplement plan at any time of the year.

However, you have to keep in mind that if you miss your 6 month window, or decide to look for more affordable coverage, you can be asked health questions.

There is a possibility, that based on your health, you won’t be able to switch products or if you missed your cut-off, you won’t be able to get a Medicare Supplement plan.

The best time to get a Medicare plan is going to be during your initial personal open enrollment for Medicare Supplements because you are guaranteed approval (no health questions), and during your Initial Enrollment Period for Medicare Advantage.

Here is where you have more flexibility with a Medicare Supplement. When comparing Medicare Supplements vs Medicare Advantage plans outside of your initial enrollment period, a Medicare Advantage plan does not have the flexibility to be changed anytime throughout the year.

6. Does Every State Have Medicare Supplement and Medicare Advantage Plans?

Every state has Medicare Supplement plans in some form or another, with the main differences happening in Massachusetts, Minnesota, or Wisconsin.

Each state; however, doesn’t have to offer the same plans. This means that State 1 could offer Plans A, B, N, and G and then State 2 could offer Only Plans N, G, F and B.

While each state can offer whatever Medicare Supplement Plans they choose, they can’t offer less benefits than another state.

Wisconsin Basic Medicare Supplement Benefits

If you live in Wisconsin, your basic Medicare Supplement Benefits are:

Inpatient hospital care: covers the Part A coinsurance
Medical costs: covers the Part B coinsurance
Blood: covers the first 3 pints of blood each year
Part A hospice coinsurance or copayment

Minnesota Basic Medicare Supplement Benefits

If you live in Minnesota, your basic Medicare Supplement Benefits are:

Inpatient hospital care: covers the Part A coinsurance
Medical costs: covers the Part B coinsurance
Blood: covers the first 3 pints of blood each year
Part A hospice and respite care cost sharing
Parts A and B home health services and supplies cost sharing

Massachusetts Basic Medicare Supplement Benefits

If you live in Massachusetts, your basic Medicare Supplement Benefits are:

Inpatient hospital care: covers the Part A coinsurance
Medical costs: covers the Part B coinsurance
Blood: covers the first 3 pints of blood each year
Part A hospice co-insurance or copayment
365 additional days of hospital care after Medicare coverage ends

While Medicare Advantage plans are available in all states, they are not necessarily available in all counties. When looking to compare Medicare Supplements vs Medicare Advantage plans, you will see that not every county has a Medicare Advantage plan available in it. This is a big difference in options that are available to state residents. The Medicare Supplement plans must be provided on a statewide basis since they are overseen by the state, but Medicare Advantage plans may pick and choose which counties they want to offer a plan in. When shopping Advantage plans to be your primary plan, you must reside in the county that the plan is available. If you reside in a county where there are no Medicare Advantage plans available then you will not be able to enroll in one. So in this particular case when we compare Medicare Supplements to Medicare Advantage plans….the Medicare Supplement is the clear choice.

7. Which Medicare Supplement and Medicare Advantage Plans Offer Silver Sneakers?

This is a great question and could be the determining factor in which company you finally decide to purchase coverage through.

If you don’t know what Silver Sneakers is, let me catch you up to speed.

The Silver Sneaker program encourages older adults to participate in physical activities that will help them to maintain better control of their overall health.

It is available around the country, and membership provides access to any gym that participates, including all amenities included with basic level access.

Think of it as a program that will help you stay fit both mentally and physically.

Some of the carriers that offer Silver Sneakers Are:

Blue Cross Blue Shield
Aetna
Humana
Kaiser Permanente
Mutual Of Omaha
United Health Care

While this can be a nice extra benefit, you must still weigh the value up against the cost of that carriers plan. If a Medicare Supplement carrier offering the Silver Sneakers benefit has a plan that is $40 or more per month over another carrier offering the same plan, you might be better off going with the lower priced plan (that offers the same health benefits) and buying your own gym membership since many offer discounts to those who are over the age of 65. If you are comparing Medicare Advantage plans that both offer Silver Sneakers it is best to take compare not only the plan’s premiums but also their co-pays and maximum out of pocket costs you are responsible for in a calendar year.

8. What Is The Average Cost Of Medicare Supplement Insurance?

There are many factors that go into the costs of a Medicare Supplement plan, and that is because health insurance companies can price Medicare Supplement plans in three different ways:

Community Rated

Community rated is when premiums are based on everyone currently covered, so it isn’t based on your individual age.

Issue Age Rated

Premiums rated based on issue age will be based on how old you were when you first purchased the policy.

Attained Age Rated

If your premiums are based on an attained age, this means as you get older your premiums will also increase. Most plans filed by insurance carriers in the state of Maryland are attained age rated.

Health insurance companies’ prices can vary by a large percentage, so always remember that there isn’t any difference in the base of the plan.

Below are some average rates (Age 70 year old female, non-tobacco user, resident of Maryland)

Medicare Supplement Plan	Average Monthly Premium
Plan A	$127.05
Plan B	$158.75
Plan C	$217.57
Plan D	$198.10
Plan F	$153.46
Plan G	$128.32
Plan K	$79.41
Plan L	$108.87
Plan M	$179.33
Plan N	$100.24

Keep in mind that these rates are an average of Supplement plans and should only be used when comparing plans for Medicare Supplements in Maryland. They can be more or less depending on your specific situation such as the state you are a resident of, whether or not you use tobacco, and what your age is.

9. What Is The Best Medicare Supplement Insurance Plan?

The most purchased plan used to be Medigap Plan F; however, the recent news of Plan F no longer being available to those new to Medicare after 2019, Plan G is quickly gaining popularity.

Medicare Supplement Plan G, also called Medigap Plan G, or Medsup Plan G, is one of the best health insurance products that is offered through private insurance companies.

These Medicare Supplement plans work in parallel with Medicare Part A (which is hospital insurance) and Medicare Part B (which is medical insurance)

The only difference between Plan F and Plan G is that Plan G doesn’t cover the Annual Part B deductible, other than that, the benefits are:

Medicare Part A hospital coinsurance
365 Hospital Reserve Days
Part A hospice care coinsurance or copayment
Part A deductible
Medicare Part B preventive care coinsurance coverage
Part B coinsurance or copayment coverage
Part B excess charges
First three pints of blood for a medical procedure
Skilled Nursing Facility (SNF) care coinsurance coverage
Foreign travel emergency coverage, up to the plan limit

Plan G is going to offer the most benefits when it comes to covering the gap of Original Medicare and in our opinion is going to be the best Medicare Supplement Plan.

No matter which company you choose, a Plan G is a Plan G, so if you hear a company name that you might not be familiar with, but it has the lowest monthly rate, don’t rule out that plan. At this time when folks are shopping for a Medigap plan they lean towards purchasing a Medicare Supplement Plan G due to very little additional out of pocket costs.

10. How Do Medicare Advantage Plans Work?

It is important that you understand that Medicare Advantage plans are not a supplement to Medicare. Medicare Advantage is actually Part C of Medicare and replaces your Original Medicare Parts A and B. Many times Medicare Advantage plans are referred to as cost sharing plans. This is because while the premiums are extremely low, you will have out of pocket costs on most services. An example would be a $20 co-pay each time you visit your primary care physician, maybe a $40 co-pay each time you visit a specialist, a hospital co-pay of $300 per day for the first 5 days, 20% co-insurance for lab work, and the list goes on.

Medicare Advantage plans in Maryland are limited to just a few carriers as of today such as Humana, Johns Hopkins, and Kaiser. With this limitation and comparing Medicare Supplements vs Medicare Advantage plans, the winner for Medicare choices is in favor of Medicare Supplements. In other states such as Virginia where there are many more Medicare Advantage plans and larger networks, the choice could be quite even.

11. What Is The Difference Between Medigap And Medicare Supplement?

The word Medigap is actually a play on how the Medicare Supplement Plans work.

These plans are made to cover the GAP’s that Original Medicare will not cover and that is where the name Medigap comes from. These names are used in all states and not just when shopping plans for Medicare in MD.

They have 2 different names, but they are the exact same thing.

So You Have Medsups, Medigap, and Medicare Supplement Plans.

12. What Is The Difference Between Medicare Advantage And Medicare Supplement?

These two words probably are the ones that get mixed up the most and this is one of the most commonly asked questions.

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.

Although, you are able to find some $0.00 premium Medicare Advantage plans in some states, other states have plans with premiums that range from $25 – $125 per month.

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

	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 $10,000 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.

Frequently Asked Questions (FAQs)

When can you change Medicare Supplement Plans? There is no set date during the year when you can change Medicare Supplement plans. There are a few things to keep in mind when deciding to change your Medicare Supplement plan before it comes up for renewal. If you pay your premium annually, you will need to wait until the new policy is issued and then you can apply for a refund of unused premiums from your current company. You should never cancel your existing coverage before your new policy has been approved.

Can you change Medicare Supplement plans with pre existing conditions? This is not a simply yes/no answer. Some Medicare Supplement insurance companies may look at a pre-existing condition as too severe and will not issue a policy, where another carrier may not view the pre-existing condition as un-insurable. Of course there are certain conditions that insurance companies are going to shy away from such as currently being treated for cancer, on kidney dialysis, or have a upcoming surgery planned. The best thing you can do is simply talk with an insurance advisor and let them see what all your options are.

What is the best Advantage plan for Medicare? The best Medicare Advantage plan is the one that covers your individual needs with the least amount of financial exposure. While Medicare Advantage plans have what are known as Star Ratings, this is only one way to measure which plan you should investigate further. You need to look at the network of providers to see if all your doctors and facilities participate. In addition, you need to make sure that all your prescriptions are being covered on the plan’s formulary list. Also, don’t get caught up in the low co-pays when seeing your primary care physician. While a $20 co-pay doesn’t seem like much, you need to be aware of the fact that this adds up when seeing your doctor multiple times a year. Throw in some visits to a specialist who has a $40 co-pay and the amounts start to add up. Speaking of co-pays, don’t forget that most Medicare Advantage plans have a daily hospital co-pay that can be upwards of $300 per day up to 5 days in the hospital. The good news is that a Medicare Advantage plan must offer a cap on what you can be out of pocket for in a calendar year. All the approved expenses that you pay out of pocket go towards this cap. It is important to be aware of what the plan’s maximum out of pocket amounts are each year. Some can be as high as $10,000 for a calendar year.

Taking Action

Now that your main questions about Medicare Supplements vs Medicare Advantage plans have been answered it is time to take the next step.

Feel free to give us a call toll free at 1.800.924.4727 or complete the form request here.

With all insurance products, the longer you wait the more complicated the outcome can get, so there is no need to wait.

Upcoming Medicare Annual Enrollment Period 2024: Part 1

Don’t panic, you still have about 3 months left before we enter the Medicare Annual Election Period. How will you know it is getting closer? Well, you will see an increase of Joe Namath and Jimmie Walker telling you all about the benefits you could be getting from Medicare. Don’t worry, in one of the later parts of this series I will touch a little bit more on the commercials and how they are not really what they appear to be.

What You Can Do During the Annual Election Period (AEP)

You can leave traditional Medicare and enroll into a Medicare Advantage Plan
You can disenroll from a Medicare Advantage Plan and return to traditional Medicare and get a stand-alone Part D Prescription Drug plan.
You can change your stand-alone Part D Prescription Drug plan to another stand-alone Part D Prescription Drug plan.
You can change your Medicare Advantage Plan to another Medicare Advantage Plan.

For a full list of what you can do during the different enrollment periods check out our article here.

Your Window of Opportunity to Make a Change

The dates for the Medicare Annual Election Period are set in stone. You can make any of the changes discussed above from October 15^th until December 7^th. If you decide on December 12^th that you need to change your stand-alone Part D prescription drug plan because a prescription you are taking will no longer be covered, then you will basically be stuck in that plan for another year

How do you know if there are going to be changes to your existing plan?

Medicare Advantage and Part D carriers are required to send out each year what is called an Annual Notice of Change (ANOC) packet to all their policyholders. The carriers must send the ANOC package in the mail to you by September 30^th.

I can’t tell you how many times we hear about folks either throwing these away or simply not even opening them. Don’t do this! While there is quite a bit of information in the packet, most of the major changes are listed on the first page. It is vitally important that you read over this prior to October 15^th so you will have time to contact your agent and book time to review any changes that need to be made to your current coverage when the Medicare Annual Election Period rolls around.

Start Preparing Now

Yes, even though we are 3 months away from the Medicare Annual Election, there are things that you can do now.

Make a complete list of your current medications. Be sure to include the full name of the prescription along with the dosage, quantity and strength on your list.
Make a note beside any prescription that your doctor has informed you that could be changing in the future.
Have this list with you when you meet with your agent during the Annual Enrollment Period.In Part 2 we will discuss what you should do if you have a Medicare Advantage plan or a Medicare Supplement plan during the Medicare Annual Enrollment Period. As promised we will also dive a bit into the commercials, we all see and how they can be a bit misleading.

What if I have questions now?

If you are already a client of Senior Benefit Services, then please contact your personal agent immediately. For those folks who are not a current client but wish to start receiving the personalized attention they deserve, simply call (800)924-4727 or click here and one of our friendly staff members will connect you with your own personal advisor.

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Quick and Easy Medicare Supplement Comparison

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Why would you need to change your current Medicare Advantage plan?

Do you need to change your current Medicare Supplement plan?

Are you required to make any changes during the Annual Election Period?

What if you decide that you want to switch from a Medicare Advantage Plan to a Medicare Supplement plan?

Wouldn’t I get more benefits if I call the 800# on the Joe Namath commercial?

<img loading="lazy" decoding="async" class="aligncenter size-medium wp-image-4495" src="https://seniorbenefitclient.com/wp-content/uploads/2022/07/joe-namath-medicare-commercial-300x161.jpg" alt="Joe Namath Medicare Advantage Commercial" width="300" height="161" />

Medicare Open Enrollment Period 2024…Get Ready…Get Set…GO!

So Why Is It Called The Open Enrollment Period?

What Can I Do During the Annual Election Period?

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

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

What If My Medicare Supplement Premium Went Up This Year?

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

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

What Are My Next Steps?

Understanding Wegovy: A Beacon of Hope in Obesity Management

How Wegovy Works

The Road to Approval

Medicare’s Monumental Decision To Cover Wegovy

What Medicare’s Approval Means for Seniors

Eligibility Criteria and Cost Coverage

Navigating Medicare Approval for Wegovy

Consulting Your Healthcare Provider

Verify With Your Medicare Part D Plan

Recording Your Efforts

Filing for Prior Authorization

The Impact of Wegovy on Senior Health

Frequently Asked Questions About Medicare’s Approval of Wegovy

Did Medicare Approve Wegovy for Weight Loss?

Are Medicare Part D Plans Already Covering Wegovy?

Will Medicare Advantage Plans Cover Wegovy?

How Do I Start the Process to Get Wegovy Covered Through Medicare?

Will Medicare Cover the Full Cost of Wegovy?

Final Verdict of Wegovy Now Being Covered By Medicare

The Beginning of Medicare Part C: The BalancedBudget Act

How they differ from Original Medicare

Pros of Medicare Advantage Plans

Lower out-of-pocket costs

Care Coordination

Cons of Medicare Advantage Plans

Limited provider network

Potential for higher costs in certain situations

Annual changes in plan coverage

Considerations for Seniors

Factors to consider when deciding on a Medicare Advantage plan

How to evaluate plan options

Comparing Medicare Supplement to Medicare Advantage

Frequently Asked Questions (FAQs)

So What Can We Conclude Regarding Medicare Advantage Plans?

The Scope of Medicare Dental Coverage

Will Dental Ever Be Covered Under Medicare?

Options for Dental Coverage Under Medicare

Self-Pay

Private Insurance

Final Thoughts

Is There A Monthly Fee To Have Medicare?

Is Medicare Free for US Citizens?

Do You Have to Pay for Medicare at Age 65?

How Much Do I Have To Pay for Medicare When I Turn 65?

What Happens If You Don’t Enroll in Medicare Part A at 65?

How Do You Pay for Medicare If You Are Not On Social Security Already?

How Much Will Social Security Take Out For Medicare in 2024?

How Do You Qualify For Free Part B Premium?

Is Medicare Part B Giveback the Same As Free Part B?

Are Medicare Advantage Plans Free?

Conclusion

When Can You Return Back to Original Medicare?

Things To Consider When Leaving Your Medicare Advantage Plan

How To Switch From Your Medicare Advantage Plan back to Original Medicare?

Can I Get A Medicare Supplement Plan After Switching Back To Original Medicare?

Final Thoughts

Examples of Monthly Premiums for Medicare Advantage Plans

Overview of Medicare Part C – what it is and who can get it

Understanding the different components of Medicare Part C coverage

Factors that affect the cost of Medicare Part C

How to choose a plan based on your budget and needs

Medicare Supplements