Medicare Advantage Archives

Q: Which Medicare Supplement and Medicare Advantage Plans Offer Silver Sneakers?

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.

Q: What Is The Average Cost Of Medicare Supplement Insurance?

The average cost of Medicare Supplement Insurance varies by state, age, tobacco use, and the pricing method of the insurance company (Community Rated, Issue Age Rated, Attained Age Rated). For example, average monthly premiums for a 70 year old female, non-tobacco user in Maryland can range from $79.41 for Plan K to $217.57 for Plan C.

Q: What Is The Best Medicare Supplement Insurance Plan?

The best Medicare Supplement Insurance Plan varies based on individual needs. Plan G is quickly gaining popularity as it offers comprehensive coverage similar to Plan F but requires beneficiaries to pay the Medicare Part B deductible. It is considered one of the best options for covering the gaps in Original Medicare.

Medicare Advantage Hospital Coverage

Person laying in hospital bed — Medicare Advantage hospital coverage can leave you with surprise bills.

Many folks wonder about how Medicare Advantage plan’s hospital coverage works.

Medicare Advantage plans are a great way to get health coverage for senior individuals and those on Medicare due to disability who qualify. But did you know that supplementing your Medicare Advantage plan with a hospital indemnity plan can provide even more comprehensive coverage? Let’s look at how this works and why it may be beneficial to you.

What is a Hospital Indemnity Plan?

A hospital indemnity plan is an insurance policy that pays out cash benefits for covered medical expenses due to illness or injury. This type of policy provides financial assistance for the costs associated with inpatient care and can also cover other related expenses such as medications, outpatient services, doctors’ visits, and more. It is important to note that these plans do not cover all medical expenses—that’s where Medicare Advantage comes in.

How Does a Hospital Indemnity Plan Supplement Medicare Advantage?

Medicare Advantage plans are designed to cover most of the same things as traditional Medicare Part A and Part B, but sometimes there are gaps in coverage. These gaps can include deductibles, copayments, coinsurance, or other out-of-pocket costs associated with health care services. That’s where a hospital indemnity plan comes in—it helps to fill those gaps in coverage by providing additional financial protection against unforeseen medical expenses.

For example, if you were hospitalized due to an unexpected illness or injury, your hospital indemnity plan would pay out cash benefits to help cover any out-of-pocket costs that your Medicare Advantage plan doesn’t cover. To better understand this, let’s take a look at the following case study combining a hospital indemnity plan with Medicare Advantage hospital coverage:

Medicare Advantage hospital coverage co-pay covered by hospital indemnity plan.

Jane is a 67-year-old female who has a Medicare Advantage plan that requires her to pay the first $300 per day that she is in the hospital. She must pay the $300 co-payment for the first 5 days she is an inpatient.

Jane is admitted into the hospital on March 2^nd due to an accident that has damaged her knee and shoulder. It is determined that Jane needs to have a full knee replacement done and will also need physical therapy for her shoulder. Jane spends 4 nights in the hospital before being sent to a skilled nursing facility to get rehab for her knee and shoulder.

Jane will owe the hospital $1,200 for her stay ($300 x 4 days = $1,200). The good news for Jane is that her insurance agent helped her obtain a hospital indemnity plan that will cover $300 per day for up to 10 days each calendar year for only $29.00 per month. This means that Jane will receive a cash payment of $1,200 that she can in turn use to pay for her hospital bill.

It Gets Even Better!

Here’s the great news…if Jane were to go back into the hospital during the same calendar year, she would still have 6 days of benefits left on her hospital indemnity plan. So even if her Medicare Advantage plan covered all the hospital expenses, her hospital indemnity plan would continue to pay cash benefits directly to her. That extra money could be used anyway that Jane wants.

Why Should You Consider Adding a Hospital Indemnity Plan?

Adding a hospital indemnity plan to your existing Medicare Advantage plan can provide peace of mind and greater financial security for a very small monthly premium. Having both types of coverage means that you will have more comprehensive protection against unexpected hospital expenses due to illness or injury—which can help save money in the long run. Plus, many hospital indemnity plans come with additional options such as ambulance trip coverage, skilled nursing facility coverage, and even outpatient surgical expense coverage—so adding one could be well worth the cost!

Conclusion:

Hospital indemnity plans can be an excellent way for individuals who qualify for Medicare Advantage to further protect their finances from unexpected medical costs due to illness or injury. If you are looking for additional peace of mind and financial security when it comes to health care costs and Medicare Advantage hospital coverage, then consider adding a hospital indemnity plan today! With its cash benefits, it could prove invaluable over time. To find out more about how a hospital indemnity plan could benefit you personally, call Senior Benefit Services at (800)924-4727.

Medicare Out of Network (Advantage Plan Confusion)

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

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

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

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 Supplement vs Medicare Advantage (Pros and Cons)

Medicare Advantage vs Medicare Supplement

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

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

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

Medicare Advantage

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

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

Is There A Free Lunch In There Somewhere?

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

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

Do You Want Flexibility?

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

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

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

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

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

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

Medicare Supplement Plans

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

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

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

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

What To Start With

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

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

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

Which Is Better?

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

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

Example 1

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

Example 2

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

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

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

The Last Word

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

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

Table of Contents

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.

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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.

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Takeaway

Senior Benefit’s Hagerstown Office

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(800) 924-4727

580 Northern Ave
Hagerstown, MD 21742

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

Senior Benefit’s Thurmont Office

We are here to help. Contact us today!

(301) 271-4040

112A E Main St
Thurmont, MD 21788

Hours :

Monday – Firday : 8am – 4pm EST
Sat & Sun: Closed

Senior Benefit’s Cumberland Office

We are here to help. Contact us today!

(301) 722-1414

309 Willowbrook Road, Suite 1
Cumberland, MD 21502

Hours :

Monday – Firday : 9am – 5pm EST
Sat & Sun: Closed

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.

What are Medicare Flex Cards? Flexcard for Seniors: Who Qualifies?

What is a Medicare Flex Card?

If you have spent any time in front of the television, you have likely seen a commercial or two about a Medicare Flex Card. While you might not remember the actual term being used, you likely do remember the advertisement of getting around $2,800 pre-loaded on a ‘debit’ type of card that can be used to pay for certain medical expenses. While this sounds like a windfall of money for seniors, the advertisements gloss over quite a bit of important information.

So…what the heck is a Medicare Flex Card anyway? To make this as easy as possible to understand, this money does not come from the federal government. The money is part of a benefit that can be paid out by a private insurance company. Furthermore, the card is not available to folks on a Medicare Supplement plan, but rather must be enrolled in a Medicare Advantage plan. That caveat alone knocks out the majority of seniors who could qualify for the money. On a Medicare Advantage plan that offers a flex card, the funds can be used for such things as:

Prescriptions
Durable Medical Equipment
Other medical expenses such as dental, vision, and hearing
Plan Deductibles and Copayments

You may be saying to yourself, “I am already on a Medicare Advantage plan, so how do I get a flex card?” This is where it gets even a bit more interesting. Not all Medicare Advantage plans offer a flex card as a benefit. While the commercials don’t point this out, the reality is that even if a carrier does offer a flex card as a benefit, they don’t have to offer it on all their Advantage plans and can even limit it to plans in specific zip codes. In addition, a number of insurance companies limit this benefit to those individuals who qualify for a Dual Eligible plan, which means that you must have a low enough income to qualify for both Medicare and Medicaid.

Even When Things Fall Into Place….There Is Still No Guarantee

Let us play devil’s advocate here and say that an individual happens to live in a zip code that has one of these plans available and it is not a Dual Eligible plan. This means that you could sign up for this plan and get a quick extra $2,800!? Not necessarily. You have to understand that since it is not Medicare providing this benefit but rather the private insurance company, the amounts can be up to $2,800. Don’t you just hate that phrase…’up to’? One insurance company might offer $300 while another offers $400, and then another might offer $500.

Should You Enroll in a Medicare Flex Card plan?

First things first. Do you understand the difference between a Medicare Advantage Plan vs a Medicare Supplement plan? If not, then the answer is definitely hold off until you do. Let’s say you do know the difference between these types of plans, then the next thing you need to do is look at the plan’s prescription drug formulary. A formulary is the complete list of covered prescriptions and also what tier they will fall into (the tier determines how much your co-pay or coinsurance will be). If the plan does not cover all your prescriptions, then it might very well be a bad choice. After checking your prescriptions, you are going to want and make sure your doctors are part of the plan’s network. If not, you might have to make the decision to switch doctors or pay the full bill out of your own pocket. Last but not least, you are going to want to compare the plan’s other benefits to determine how much your different co-pays, co-insurance, and even maximum out of pocket costs are going to be.

The Final Word

Instead of trying to figure this out all on your own or take the word of a possible misleading commercial, you can simply reach out to Senior Benefit Services where we will put you with your own personal advisor that can give you all the information that you need to make an informed decision. Feel free to call us at (800)924-4727 or click here to request an advisor to contact you directly.

Medicare Advantage and Diabetes

Are you a diabetic who is turning 65 and going onto Medicare? You may want to rethink getting a Medicare Advantage plan. A recent study found that Medicare beneficiaries who were enrolled in a Medicare Advantage plan were more likely to receive older generic diabetes medications rather than newer and more expensive medications.

What Are Your Options

If you are a diabetic and looking at a Medicare Advantage plan, then the first thing you will want to do is make sure that your current prescriptions are covered in the plan’s formulary. If the prescription is covered, then you want to make sure that there are no additional conditions that would impede the prescription being covered immediately. Some plans require that you do what is called step therapy. This basically means that the plan wants you to try other lower costing drugs before they approve the more costly one that you are on. If this is the case, you may want to look at another option.

A Medicare Supplement plan with a separate Part D prescription drug plan might just be a better option for you. By going this particular route, you are able to be covered under traditional Medicare and select a Prescription drug plan that covers all of your current prescriptions if one is available. In addition, there may be multiple plans that cover your current prescriptions, so you will want to make sure that you select one with not only solid star ratings, but also that do not require step therapy.

To do all this research on your own can be quite daunting. Instead of putting yourself through all of this aggravation, you can simply contact Senior Benefit Services, Inc. and let us do all of the work for you! Our advisors will show you all of the best options to fit not only your medical needs, but also your budget. Feel free to give us a call today at (800)924-4727.

When And Why You May Need A Hospital Indemnity Plan

If you or someone you love have ever received hospital care, the chances are that you understand how overwhelming the costs of medical services can be. It is crucial to your financial well-being to understand your options regarding insurance coverages of hospital medical expenses. Many folks who have a Medicare Advantage plan will opt to purchase a low costing hospital indemnity plan to offset those costs.

Hospital Indemnity Plans

Hospital indemnity plans are a type of insurance policy that covers certain unpaid costs left by your essential healthcare. Depending on the indemnity plan you choose, the insurer pays a designated amount either per visit, per day, week, or month that you are in the hospital for medical care.

These plans are considered supplemental insurance coverage that can’t stand alone as your primary basic healthcare coverage. As indemnity plans aren’t counted as minimum essential coverage, they are intended to complement your essential coverage by aiding in costs left unpaid.

Why Hospital Indemnity Plans Are Important

Unfortunately, many people are currently struggling to pay back medical bills left unpaid by insurance companies. Medical debt causes undue stress on families, some of whom are forced to take money from retirement, college, or other long-term savings to pay back exorbitant hospital services fees.

Hospital stays are expensive, and costs quickly add up the longer and more intensive your care becomes. Many retirees will purchase a indemnity plan to cover the daily hospital co-pays that their Medicare Advantage plans leave them exposed to. Many Medicare Advantage plans have daily co-pays of $300 per day for up to a certain amount of days. If you happen to have an Advantage plan with a cost sharing expense of $300 per day for the first 5 days in the hospital, then your exposure is $1500 for that stay. Hospital indemnity plans allow you to put that financial exposure onto the insurance company. In essence you are buying dollars of coverage for pennies.

Other Benefits Of Hospital Indemnity Plans

Indemnity health insurance offers other benefits as well. Since the plan is an indemnity, it will pay in addition to any other coverage that you might have. Benefits are paid directly to the policyholder and not the hospital. In addition, many plans now offer optional riders that cover such expenses as ambulance services, skilled nursing, outpatient surgery, and even cancer benefits.

Depending on your medical situation, indemnity hospital plans can help you manage the maximum costs you may be responsible for after a hospital stay.

Choosing Medicare Insurance Plans

What are the best Medicare plans for Prescription drugs, hospital costs, doctors and surgeon costs – all of it seems complicated to a lot of Americans.

Most of us know that people sign up for Medicare at the age of 65, but for many of us, that’s where our knowledge of Medicare basically ends. Now you need to choose the best Medicare plan for your own personal needs and budget. In fact, you may not be aware, but it is also a good time to look for additional coverage such as dental, vision, and hearing coverage.

You may have heard it called a government entitlement program, but a better way to describe Medicare is that it’s public insurance that helps to cover American seniors. Since most people of advanced age are retired and not on their employer insurance, Medicare provides that coverage they need to be able to afford healthcare services. What Medicare doesn’t provide is the massive amount of instructional time it would take to make every American family masterful or even literate on the complex ins and outs of the insurance industry and what the terms in their contracts mean.

Medicare Advantage and Specialized Plans

Here’s one example: in addition to simple Medicare with its part A and part B coverage, many seniors select Medicare Advantage plans to help cover costs. When selecting an Advantage plan, keep in mind that you must continue to pay your Part B premium each month in addition to any monthly premiums the Advantage plan may charge. Many folks opt to purchase a hospital indemnity plan to help offset co-pays not covered by their Advantage plan. These co-pays can include daily hospital expenses, ambulance expenses, skilled nursing and even outpatient surgery co-pays and co-insurance. To find out more about why a hospital indemnity plan may be a very good option for you, see our article here.

All of this takes work and attention to detail. So how do you figure out the labyrinth that is Medicare coverage?

We can help.

At Senior Benefit Services, Inc., we provide assistance with that elaborate process of securing your chosen Medicare insurance coverage. We are not a government agency or an insurance company. Instead, we operate sort of as a clearinghouse, where we work with carriers to get you access to the information you need to make choices. When you call, you ultimately get a response from a licensed agent who can help you get access to policies and government insurance options. Get quick quotes for supplemental coverage through our website, and you can get closer to knowing what you need to know about something that is a fact of life, but not really on most people’s radar until their 65th birthday, or later.

Medicare Parts & How They Work

Figuring out the parts of Medicare can be both intimidating and time-consuming, especially if you have been confusing the different Medicare parts with Medicare plans.

But, it doesn’t have to be:

You can actually learn about the different parts of Medicare without pulling out all your hair and that once you have learned each part, they will pretty much always be the same.

In this guide today we will go over how each part works, why they are different, and how to know which parts you do or don’t need.

See Current Costs for Part A and Part B

What Is Medicare

The program was established in 1965 as a federal government program that offers health insurance if you are 65 or older, under 65 and received Social Security Disability Insurance or people who are under the age of 65 and have End-Stage-Renal Disease, also known as ESRD.

A federal agency, known as CMS or (Centers for Medicare & Medicaid Services is who is responsible for running the program.

Program benefits are being funded by Social Security and Medicare taxes that you pay on your income, from premiums that people pay who have Medicare and as part of the budget of the federal government.

Once you become eligible to enroll, you will start hearing about different parts of Medicare which we discuss below.

The Different Medicare Parts

There are four main parts, and as we discussed earlier, they can be confusing.

Each part will play its own role in your journey and understanding the differences can save you both money and heartache.

In some instances, it makes a lot of sense to also consider purchasing separate Medicare Supplement Plans aka Medigap Plans to fill in the gap where Medicare does not.

Medicare Part A (Hospital)

The first part is Part A, which is your hospital insurance.

Your hospital insurance will cover things like the cost of hospice, home health care, skilled nursing facility stays or even semi-private room for stays.

Part A will also cover blood transfusions requiring more than 3 pints of blood.

And guess what:

If you have worked for at the least 10 years in the United States, this benefit is usually free.

When you think about anything revolving around a hospital stay, think of Part A.

Nursing Home Coverage

If you have a qualifying hospital inpatient stay then Part A will cover a skilled nursing facility stay (SNF).

In order to qualify for the SNF care, your stay has to be a minimum of three days and must be provided at a Medicare-certified facility.

Approved charges for covered skilled nursing care covers, but is not limited to:

Skilled nursing services
Semi-private room
Medical social services
Meals
Rehab services, if they are medically necessary to treat your illness
Medications received while in SNF care
Medical supplies and equipment used in SNF
Ambulance transportation to the nearest provider
Dietary counseling

Remember, your doctor has to certify that you need daily skilled care that you cannot receive at home.

Hospice Coverage

If you have been diagnosed with a terminal illness and only given six months or less to live, you can get hospice care.

The primary focus of the hospice is to make you as comfortable as possible while you are dealing with your illness, there is no focus on curing your disease.

Before a hospice stay is covered, you must meet all of the following conditions:

You must be enrolled in Part A.
Your doctor must certify that you are terminally ill and have six months or less to live.
You must agree to give up curative treatments for your terminal illness.
You must receive hospice care from a Medicare-approved hospice facility.

Part A hospice care is usually received in your home and it may include:

Doctor services
Nursing care
Pain relief medications
Social services
Durable medical equipment
Medical supplies
Hospice aide services
Homemaker services
Physical and occupational therapy
Dietary counseling
Short-term inpatient care
Short-term respite care

If you are under hospice care, Part A will sometimes cover some costs that Medicare normally does not include, like spiritual and grief counseling.

Inpatient Care

Inpatient care can be covered for places like

Participation in a qualifying clinical research study
Critical access hospitals
Inpatient rehabilitation facilities
Long-term care hospitals
Mental health care
Acute care hospitals

Keep in mind that Part A does not cover a private room unless it is considered medically necessary.

Home Health Care

You also have home health care benefits that are covered when considered to be medically necessary and get ordered by your doctor.

These home health care services can include:

Physical therapy
Speech-language pathology services
Part-time or intermittent skilled nursing care
Part-time or intermittent home health aide services
Occupational therapy
Medical social services

Keep in mind that Part A of Medicare will not cover any type of 24-hour home care, meals, or homemaker services if they aren’t related to your treatment.

It also won’t cover things like help with bathing and dressing, if that is the only care that you need.

Your home health care must be provided by a Medicare-certified home health agency, and a doctor must certify that you are home-bound.

The Three Most Commonly Asked Questions About: Medicare Part A

Medicare Part B (Medical)

The next part of Medicare is going to be Part B, this part is responsible for your doctor’s visits.

It is going to mainly be used for outpatient services that are considered to be medically necessary.

It is going to include coverage for things like doctor office visits, preventative care, lab tests, chemotherapy, ambulance rides, diagnostic imaging surgeries or even kidney dialysis.

Medicare Part B is just as important as Part A and together they make up coverage for both at the hospital and outside of the hospital.

Part B Premiums

There is definitely a chance that your Part B Medicare premiums may go up every year and there is no way to figure out by how much.

For 2022 the standard monthly premiums for Part B will be $170.10 and if you have Social Security benefits it will be deducted from your benefits automatically. Keep in mind that if you are a higher income earner, then you will pay more for your Part B premiums. You can check to see if you fall into the higher income earner category here.

Part B Coverage

There are a ton of things that you are covered for under Medicare Part B so we put together a list of the items.

Remember that you need to look at the specifics of how each benefit will work when you sign up for your Part B coverage.

Ambulance Services

Cardiac Rehabilitation

Chiropractic Services

Diabetes Self Management Training

Diabetes Supplies

Durable Medical Equipment

Emergency Room Services

Eyeglasses

Hearing & Balance Exams

Kidney dialysis services and supplies

Mental health care (outpatient)

Occupational therapy

Outpatient medical and surgical services and supplies

Physical Exams

Physical Therapy

Prescription Drugs (limited)

Prosthetic and orthotic Items

Pulmonary rehabilitation

Rural health clinics and free or low-cost health clinics

Screenings (tests and scans)

Second surgical opinions

Shots

Smoking cessation (help to quit smoking)

Speech therapy

Telehealth

Transplants and immunosuppressive drugs

Urgently needed care

3 Questions You Should Ask About Medicare Part B

Medicare Part C (Medicare Advantage)

So, Part C of Medicare is different than Part A & Part B in that it is actually you obtaining your Medicare benefits through private insurance companies.

Part C is most known as Medicare Advantage.

These Advantage plans are basically private health plans that you can sign up for instead of Original Medicare.

You will still get Parts A & B of Medicare, and some of them come with Part D as well, all from one private insurance company.

These Advantage plans usually offer a few more benefits than original Medicare; however, some of them will carry an additional monthly premium.

If you are considering an Advantage plan, then you should also think about if you would prefer a Medicare Supplement plan as well.

Types of Medicare Advantage Plans

Knowing the different types of Advantage plans are important, so, below we put together a list of the different types:

HMO (Health Maintenance Organization Plan)

Lets you see doctors and other health professionals who participate in its provider network. If your doctor is already in network, it could be a good option because you tend to pay less out-of-pocket with in-network doctors.

PPO (Preferred Provider Organization plan)

Covers both in- and out-of-network providers, giving you the freedom to choose any doctor that accepts Medicare assignment, which can work if you prefer that kind of flexibility.

PFFS (Private Fee-for-Service plan): The plan determines how much it will pay providers and how much you must pay when you get care. The treating doctor has to accept the plan’s payment terms and agree to treat you. If the doctor doesn’t agree to those terms, then the PFFS plan will not cover services through that doctor.
SNP (Special Needs Plans): Are especially for people who have certain special needs. The three different SNP plans cover Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions such as diabetes, End Stage Renal Disease (ESRD), or HIV/AIDS. This type of plan always includes prescription drug coverage.
HMO-POS (Health Maintenance Organization – Point of Service plan): Covers both in- and out-of-network health services, but at different rates. You pay less out-of-pocket when you go to in-network doctors, labs, hospitals, and other health care providers.
MSA (Medical Savings Account plan): Includes both a high deductible and a bank account to help you pay that deductible. The amount deposited into the account varies from plan to plan. The money is tax-free as long as you use it on IRS-qualified medical expenses, which include the health plan’s deductible.

Medicare Part D (Prescription)

The last part of Medicare is going to be Part D, this is going to help cover and lower the cost of your prescription drugs.

Unlike Parts A & B, you don’t enroll in Part D through Social Security, instead, you will go through a private insurance company for your prescription plan.

Each plan will function differently depending on the insurance company, and once you sign up for coverage you would be considered enrolled in Part D.

These plans are optional and will come with an additional monthly premium that you will have to pay the insurance company directly.

If you are taking any prescriptions it is probably worth it to have a plan that will help you with co-pays in regards to prescriptions.

Keep in mind that new legislation passed in 2022 will start to lower your overall out of pocket costs even more over the next few years.

Medicare Parts vs Medicare Plans

The most confusing part of Medicare can come from trying to figure out Parts vs Plans.

This is because Parts and Plans are both Letter Based.

To clear things up, just remember that there are only 4 parts to Medicare and that Medicare Plans are actually Medicare Supplement Plans also known as Medigap plans.

Medicare Supplement Plans are offered through private insurance companies and are Supplement to Original Medicare.

They basically pickup in areas when Medicare falls short in coverage.

You still have to be enrolled in Part A & Part B of Medicare to qualify for enrollment into a Medicare Supplement plan.

Below we show how Original Medicare (Parts A & B) work with Medicare Supplement Plans:

Taking Action

Now you know the different parts of Medicare and how they work differently from Medicare Plans.

It should be much easier to navigate your way around Medicare and all of its different workings.

If you are turning 65 this year or have already turned 65, get enrolled as early as possible because the longer you wait, the more costly getting enrolled can become.

Getting the correct combination of coverage will be essential when it comes to living your best life and staying healthy.

To ensure you make the most informed and beneficial choices regarding your Medicare coverage, reach out to Senior Benefit Services, Inc., where experienced professionals can guide you through the intricate details and help tailor a plan that best fits your individual needs.

Medicare Open Enrollment is Fast Approaching

When Does Open Enrollment Begin?

Open Enrollment begins on October 15th and ends on December 7th this year.

So what exactly should you be doing during the Open Enrollment Period (Medicare OEP)?

Make sure that you review your current Part D prescription drug plan!
Keep in mind that your current drug plan might change the prescriptions covered on its formulary.
You want to make sure that all of your current prescriptions are covered once again for 2019.
Check to see what your co-payments will be for 2024 so that you do not have any surprises that you weren’t planning for.

What If I Am Covered By Medicare Advantage?

If you are covered by a Medicare Advantage plan, you will want to review any changes that might occur with the renewal for next year.

Plans are required to send you a Plan Annual Notice of Change (ANOC) in September to give you ample time to review any changes that might be occurring and decide whether your current plan will continue to meet your individual needs for next year.

Things that have typically changed over the years include (but not limited to):

Maximum Out of Pocket Limits – how much you are exposed to paying out of pocket in a plan year.
Copays for hospitals and doctors
Copays for prescription drugs
Plan formularies for prescription drugs

If you are in a PPO or HMO plan, then always make sure that your doctors are planning on accepting the plan benefits during 2024.

Medicare Supplement Plans Not Affected

As you may have noticed we did not mention anything about Medicare Supplement plans above.

The reason is that the upcoming Open Enrollment period does not affect your existing Medicare Supplement plan.

Some individuals are under the impression that they can switch Medicare Supplement carriers with no health questions during the upcoming Open Enrollment period, but this is not the case.

Does this mean that you can’t see if there is a plan that might offer you the same benefits at a lower price?

Of course not! Simply keep in mind that you will have to qualify for the new carrier’s plan.

Open Enrollment Video Overview

The following short 1 minute video from CMS also provides a quick overview of the Open Enrollment period and how it relates to Medicare Health and Drug plans.

While this article is designed to give you some helpful hints of things that can be done during the Open Enrollment period, please keep in mind that this is not a complete list of items/areas that you should have reviewed.

Takeaway

The open enrollment period can be very confusing to many folks. Senior Benefit Services, Inc. can help make it is a simple as possible. Feel free to contact us at (800)924-4727 to be connected to your own personal advisor.

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1. Who Regulates Medicare Supplement Plans?

2. How Many Medicare Supplement Plans Are There?

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

4. When Can You Change Medicare Supplement Plans?

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

Can I purchase Outside Of My Open Enrollment Period?

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

Wisconsin Basic Medicare Supplement Benefits

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

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

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9. What Is The Best Medicare Supplement Insurance Plan?

10. How Do Medicare Advantage Plans Work?

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

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

Medicare Advantage

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Frequently Asked Questions (FAQs)

Taking Action

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

Your Window of Opportunity to Make a Change

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

Start Preparing Now

What if I have questions now?

What is a Medicare Flex Card?

Even When Things Fall Into Place….There Is Still No Guarantee

The Final Word

Medicare Advantage and Diabetes

What Are Your Options

What Is Medicare

The Different Medicare Parts

Medicare Part A (Hospital)

Nursing Home Coverage

Hospice Coverage

Inpatient Care

Home Health Care

Medicare Part B (Medical)

Part B Premiums

Part B Coverage

Medicare Part C (Medicare Advantage)

Types of Medicare Advantage Plans

HMO (Health Maintenance Organization Plan)

Medicare Supplements