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If you went on Medicare after January 1st of 2020 then you cannot buy a Medicare Supplement Plan F. What is the best alternative for Medicare Supplement Plan F? Research you may have conducted on your own has likely returned results on Medicare Supplement Plan G. 

Prior to January 1, 2020 the most popular Medicare Supplement plan being sold was Plan F.  This plan was considered by many to be ‘Cadillac Coverage’ since the policyholder had no deductibles, co-pays, or co-insurance payments that they would be paying out of pocket.

If you went onto Medicare prior to January 1, 2020 you can still get a Plan F, but many choose to switch to a Plan G since it is typically lower priced than Plan F.  If you went onto Medicare January 1, 2020 or later, then you are not allowed to purchase a Plan F so this is another reason why the Plan G has risen to be the most popular Medicare Supplement right now.

So, what does a Medicare Supplement Plan G cover?

Let’s start with Part A of Medicare and how the Plan G works with this part.

If you go into the hospital as an inpatient Medicare says that you will be responsible for the first $1600. This amount is the Part A deductible for 2023.  After you meet the deductible, Medicare will cover for the first 60 days of your semi-private room and board, general nursing and miscellaneous services and supplies.  Medicare Supplement Plan G will cover that Part A deductible for you.  Keep in mind that the Part A deductible is not a calendar year deductible. It is very possible to incur that same deductible again if you were to go back into the hospital during the same calendar year.  If this happens, then the Plan G will cover the Part A deductible again.

Blood

If you were to need pints of blood while in the hospital, Medicare says that you are responsible for the costs of the first 3 pints. Keep in mind that you can have blood donated directly to you.  The Plan G will pay for those first 3 pints and Medicare will cover all amounts above that.

Skilled Nursing Facility Care

Many folks become a bit confused when it comes to receiving Skilled Nursing Facility benefits.  Medicare says that if you spend 3 days in the hospital then need rehab that they will cover the first 20 days in a Skilled Nursing Facility.  It is important to keep in mind that your date of discharge does not count towards the 3-day minimum requirement.  The easiest way to keep track of this is to understand you really need to spend at least 3 nights in the hospital as an inpatient.  After Medicare covers the first 20 days, it will now pay all but the first $200 per day for days 21 through 100.  The Medicare Supplement Plan G will cover those 80 days of co-pays in full for the policyholder.

What About Medicare Excess Charges?

Another area that sets the Plan G apart from other Medicare Supplement plans is that it covers excess charges.  In fact, with Plan G covering 100% of the excess charges, it is a perfect alternative for Medicare Supplement Plan F. So, what are excess charges?  Excess charges are amounts that a provider can charge you in addition to what Medicare approves. They can only do this if they don’t participate in the Medicare Assignment program. 

“A non-participating physician does NOT accept what Medicare approves as full payment.”

Let us look at an example of this.  You go to a physician who does not participate in the Medicare Assignment program. He/She bills you $500 for a specific service and Medicare only approves $400 for this.  Years ago, the physician could bill you for the full $100 that Medicare did not approve, but that is no longer the case. 

Excess Charge Limits

The maximum a provider can bill you for can be no more than 15% above the amount that Medicare approves.  This means that the physician could charge an additional $60.  Medicare Supplement Plan G will cover 100% of the excess charge amount.   It is important to keep in mind that around 95% of today’s providers participate in the Medicare Assignment program. This means they do NOT charge excess charges.

What’s Not Covered

The final area of benefits that we are going to touch on is the Part B deductible.  Currently in 2023 the Part B deductible is $226.  This amount is a calendar year deductible. Medicare Supplement Plan G does not cover the Part B deductible.  This one area is the only difference between Plan F and Plan G.  The Plan F covers the Part B deductible whereas the Plan G does not.

The good news is that with current policy pricing the Plan G is typically at least $226 per year less in cost than the Plan F.  This means that your premium savings are more than enough to cover the Part B deductible for the year.

When you see how close in benefits the Plan G and Plan F are to one another, it is easy to see why the Plan G has now become the most popular Medicare Supplement for complete coverage.

So 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 premium for those folks who live in what are known as high Medicare usage areas.  This means that if you happen to live in a zip code where Medicare typically pays more in claims, then you will pay a higher premium for the exact same plan as someone who lives in a lower usage area.

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 Prices in Maryland

If we are comparing a particular plan for a specific age, you will find that many times the monthly rate is within a dollar or less 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 2022 the rates are close to one another.

• ACE Property and Casualty – $128.17
• Sbli USA Life – $129.83
• Allstate Health Solutions – $129.84

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 2022.

• Allstate Health Solutions – $94.04
• Sbli USA Life – $96.73
• ACE Property and Casualty – $97.92

 

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

 

Medicare Advantage in Maryland

Unlike Medicare Supplements there really are not many carriers offering Medicare Advantage in MD.  In addition, Medicare Supplement plans are standardized which makes it much easier to shop for your health insurance.  Medicare Advantage plans are not standardized and can vary quite a bit on out-of-pocket costs.

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

1. What is the Maximum Out of Pocket Costs (MOOP)? In Maryland the MOOP ranges anywhere from $6,700 – $7,550 for 2022.
2. 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.
3. 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.
4. 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.

 

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, but it does mean that there are fewer choices and far less competition among them.

Takeaway

Choices for Medicare in MD can be overwhelming, so don’t try going at it alone.  Contact Senior Benefit Services, Inc and we will not only discuss all your options but explain how each one would work for you.  Call us at (800)924-4727 and you will see how ‘We Make Medicare Easy’.

 

So How Much Will Medicare Cost in 2023?

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

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

 

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

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

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

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

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

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

Traveling Abroad With Medicare

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

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

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

 

 

 

How To Prepare

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

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

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

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

 

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

 

Take Away

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

When we are in our very young years, we have the notion that we are invincible.  As we age, it becomes quite clear that we are not.  Once we are approaching our golden years it is imperative to understand how frequent doctor visits can benefit senior citizens.

As you reach retirement age, several changes will happen in your life. As you get older, you will have to work harder to maintain good health. Establishing a good relationship with a doctor you trust is crucial when trying to remain healthy as you get older. 

The average senior citizen will visit the doctor around four times a year. One of the main things you need to focus on when trying to stay healthy is scheduling frequent appointments with your doctor. These appointments provide you with an opportunity to express concerns about health changes and get some information about your existing health problems. Scheduling frequent doctor visits is beneficial as you get older and here are some reasons why.  

Get Help With Pain Management

As you get older, you might start to experience problems with things like degenerative joint disease or arthritis. When left unmanaged, these common health problems can cause lots of pain and discomfort. Living your life in severe pain can limit mobility and rob you of your joy. Instead of suffering in silence, you need to visit your doctor regularly to get help. 

During an appointment, your doctor will review the conditions that are causing you pain. Once they have an idea of what your ailments are, they can review a few different treatment options. Severe pain can also be an early warning sign of things like herniated discs, gallbladder disease and even spinal tumors. If these problems are diagnosed early on, you have a better chance of beating them and returning to a sense of normalcy. 

Your Doctor Can Help Monitor Your Blood Pressure

Every time you visit your doctor, they will check a few basic things. One of the first things most doctors will check during your visit is your blood pressure. The older you get, the more common high blood pressure issues will become. High blood pressure can be life-threatening if it is coupled with other serious ailments like heart disease or diabetes. 

The only way to have this condition identified is by routinely checking it. If your doctor discovers that your blood pressure is high during a check-up, they can prescribe medications to help you control it. However, if you skip an appointment with your doctor, this condition will only get worse. This is why you need to view attending these appointments as a priority. 

Addressing Cognitive Issues

Having cognitive problems can severely diminish a senior citizen’s quality of life. In most cases, cognitive problems will be caused by underlying problems like elevated blood sugar levels, infections and even brain lesions. The only way to find out the cause of your cognitive issues and get the appropriate treatments is to work with a trusted medical professional. If your doctor feels like your issues are something they can’t diagnose or treat, they may refer you to a mental health professional. 

Instead of trying to pay for the cost of doctor visits on your own, you need to find the right Medicare policy. With this insurance policy, you can get the care you need without going broke.

Often, people dream about how they will spend their retirement and never stop to consider the intricacies involved in living after leaving a career. As you are approaching retirement, you must plan for demands that may be placed on your budget. Unwelcome surprises are simply part of the realities of life, but these challenges can be reduced with the proper planning. 

Let’s take a look at some of the challenges that may arise during your retirement that you can ease the burden of by planning for them now. 

Longevity

Thanks to continuous advances in medical treatments and preventive medicine, people are living longer than ever before.  In addition folks today are living a healthier lifestyle which is proven to add years to your life.   

Living longer is something we don’t want to complain about, but we do want to plan for it.  By not taking this into consideration, we may outlive our savings. You don’t want to be fortunate enough to live longer yet not afford your lifestyle. 

Living Beyond Your Budget

We all tend to live a little beyond our means, especially when we first enter retirement. However, disaster can strike if we go too far outside our budget for a consistent period. Your budget should cover your current monthly expenses, but also be sure to plan for unexpected expenses. 

It may be difficult at first to admit if you are living well beyond your means.  Consider that you want to be comfortable in retirement and simply reduce your spending when possible. Your life will change when you retire, and you will have more time to enjoy travel, hobbies, or helping with grandchildren.  By simply decreasing your spending now, before approaching retirement, you can ensure you’ll have the funds necessary to cover these things. 

Costs Of Healthcare

Healthcare costs, therapies, wellness supplies, prescriptions, and surgeries have escalated in recent years with no end in sight. As these necessities continue to climb in price, medical costs for retirement years could multiply if you or someone in your household experiences a medical crisis.

Choosing the right Medicare Supplement  can significantly benefit you in your retirement. As you prepare and plan for this next chapter of your life, consult with a Medicare specialist to ensure you receive the right benefits for you and your financial future.