Selecting the Right Medicare Plan

You desire Medicare coverage that fits the method you live and helps you achieve your health goals. With the ideal instructions, choosing your Medicare plan can be very easy. Ask us to assist you in finding the coverage that fulfills your total health requirements.

Summary:

In a nutshell, below are some tips for choosing the best Medicare Supplement (Medigap) to prepare for your needs.

• Comprehend your coverage requirements and budget plan
• Register throughout the Medigap Open Enrollment Period
• Explore any potential discounts
• Know when you might have guaranteed-issue rights

Five questions to help you choose the best Medicare plan

What do additional benefits, such as vision, dental and hearing coverage, pertain to reaching my health objectives?

Always consider your existing and future requirements as you sift through your coverage alternatives:

• Initial Medicare (Parts A and B) doesn’t provide thorough vision, dental or hearing coverage. You’ll need to pay for those services ultimately, with a few exceptions. If you have the Original Medicare and want vision, oral and hearing benefits, you’ll need to buy a separate plan to cover them.
• Lots of Medicare Advantage plans include vision, dental and hearing coverage. They’re offered through personal insurance providers. Coverage and expenses vary, so you’ll need to examine whether you require regular care (like cleansings and screenings) or coverage for treatments and materials (like oral implants and contact lenses). Discover more about the differences between Original Medicare and Medicare Advantage here.
• Some Medicare Supplement plans may likewise use extra advantages like dental, hearing, and vision. Find out more about how to supplement your Original Medicare coverage here.

Do I want the versatility to see any medical professional?

Here’s what you require to know:

• Medicare Advantage HMO plans need you to remain in the network and get referrals to see professionals. There are some exceptions for emergency care situations or out-of-area urgent care. These plans might have lower copays and regular monthly premiums.
• Medicare Advantage PPO plans might have higher month-to-month premiums but will provide you more versatility to see physicians beyond the network without recommendations.

Do I plan to take a trip outside the United States?

• Some Medicare Supplement plans might cover medical services or materials that you get outside the U.S. if you get care within the first 60 days of your trip.
• Medicare Advantage plans may cover emergency medical treatment outside the U.S. Not all plans are the same, so talk to your plan agent before you leave the country.

Do I require prescription drug coverage if I’m not taking a great deal of medication?

When picking any of these plans, here are some things to consider:

• What drugs does my plan cover? Just how much will they cost? Each Medicare drug plan has its list of covered drugs, known as a formulary, that places various prescriptions into price tiers.
• What takes place if my plan doesn’t cover my medication? In many cases, your medication will not be on the formulary. Your physician can request the plan for an exception to add it to the list. If the plan approves the exception, you’ll generally pay the most outstanding prices tier.
• Can I use the drug stores I desire? All Part D plans have their network of drug stores that you can utilize to fill your prescriptions. Some plans have a list of preferred pharmacies where you can save much more.

Do I need to manage numerous Medicare plans?

Medicare Advantage plans, used by private insurance providers, combine your health center coverage (Part A) with medical coverage (Part B). Many plans include prescription drug coverage and deal coordination of care through their networks. One thing you’ll need to consider, however, is whether you need to pick a Medicare Advantage plan that’s structured:

• Like an HMO, where you can see medical professionals in a select network and might require referrals.
• Like a PPO, where you’ll have more flexibility to see physicians outside the network at a more significant expense.

Six suggestions for picking Medicare drug coverage.

If you’re questioning how to select a Medicare drug plan that works for you, the best way is to begin by taking a look at your top priorities. Check if any of these apply to you:

I take specific drugs.

Look at drug plans that include your prescription drugs on their formulary (a list of prescription drugs covered by a drug plan). Then, compare costs.

I want extra defense from high-cost prescription drugs.

Look at drug plans offering you coverage in the covered area, and after that, consult those plans to ensure they cover your drugs in the area.

I want my drug expenditures to be balanced throughout the year.

Take a look at drug plans with no or a low deductible or with extra coverage in the coverage gap.

I take various generic prescriptions.

Look at Medicare drug plans with “tiers” that charge you nothing or low copayments for generic prescriptions.

I do not have many drug expenses now, but I desire assurance and avoid future charges.

Take time and look at Medicare drug plans that have a low monthly premium for drug coverage. If you want/need prescription drugs in the future, all plans will still cover most substance abuse by people with Medicare.

I like the extra advantages and lower expenses offered by getting my healthcare and prescription drug coverage from one plan. I’m ready to pick a drug plan with constraints on medical professionals, healthcare facilities, and other healthcare providers I can choose.

Have a look for a Medicare Advantage Plan (Part C) that has prescription drug coverage.

Get Someone in your corner with Medicare.

If you have been asking yourself: Who can help me select a Medicare plan – look no more!

Our firm can help you recognize which plan is ideal for you and how much your area’s monthly premiums cost. Working with us can be extremely valuable to get all the statistics you need before you choose. We have access to data like rate trend history and monetary ratings for numerous Medicare-related insurance coverage providers.

We’ll get you the information you need to choose. We assist our customers with discovering plans that are accepted by their important doctors and that are also affordable for their budget plan.

We then supply free claim assistance for the life of your policy, so you are never alone in handling Medicare. Submit the form to get help from a friendly, low-hassle agent today.

This has been one of the main topic discussions between agents and Medicare beneficiaries in 2020. According to legislation from the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), insurance companies would no longer be able to offer Medicare Supplement plans F and C starting on January 1st of 2020. Does that mean that beneficiaries can no longer enroll in those plans? The answer is yes, and no!

Before we answer that question, let us talk a little more in-depth about Medicare Supplement part F. Besides being one of the most popular Medicare Supplement plans, it was also the most comprehensive coverage Medicare beneficiaries could purchase.

After Medicare paid its part, typically 80% of hospital and medical cost, Medicare Supplement plan F, would pay the remaining of the expenses, leaving its members with no

deductibles or copays related to their hospital and medical expenses. When you get a Medicare Supplement Plan, your Medicare is Primary Insurance, and Supplement becomes secondary. There is no network restriction with MediGap Plans. You can see any Dr who accepts Medicare. 

Medicare Supplement Plans work entirely different from Medicare Advantage Prescription Drug (MAPD) plans! It is very important not to confuse them! 

Related Post: Medicare Supplements vs. Medicare Advantage: 4 Point Guide

Can Medicare beneficiaries still enroll in plan F?

Yes, if their Medicare effective date was prior January 1st of 2020, and no if they became eligible for Medicare after the 01/01/2020. This congress decision was based on several issues from Medicare government spending, on how much providers were getting reimbursed and many other reasons, basically ensuring the newly eligible Medicare beneficiaries pay at least the Medicare Part B deductible, which is $198 in 2020. Now with that, all said, what are the options left on the table for those that can still enroll on plan F and for those that do not? For Medicare beneficiaries that were already previously enrolled in the program, they could even enroll in a Plan F, or if they were already registered on plan F, they have the option to continue their coverage as long as they keep paying their premium. Now, on the other hand, newly Medicare beneficiaries, those that became part of the program after January 1st of 2020, are no longer eligible to enroll in Plan F, but can they still enroll in a comprehensive Medicare Supplement plan that could limit their out-of-pockets significantly? The answer is yes!

Private insurance companies offer Medicare Supplements, and several different plans provide different levels of coverage. Those plans are labeled by a letter, and the level of coverage of each letter that labels the plan, are standardized, in other words, a Medicare Supplement plan “F” or “G” will offer the same coverage whether you are in New York or California, or whether you enroll on company A or company B. The only difference will be in the cost of the premium, which generally will be different depending on the insurance company, that’s where working with an Independent Broker could be helpful, as Independent brokers represent typically multiple carriers and could help the prospect understand the difference among all the Medicare Supplement in their area and also help candidates compare the different rates offered by different insurance companies to assist the prospect to make the right choice.

Now, what are those options?

For those members that could no longer enroll in a Medicare Supplement plan F, another option that could offer a similar comprehensive coverage would be what’s called Medicare Supplement plan G. The main difference between plans F and G, is that with plan G, the beneficiary would have to meet their Medicare Part B deductible, which is a yearly deductible of $198 in 2020. Once that deductible is met, there will be no copayments for the beneficiary enrolled on plan G for any medical and hospital costs that are covered under original Medicare. Plan G is then an alternative to enroll into a comprehensive coverage for those that can no longer enroll on the plan F. Another type of Medicare Supplement that is also very popular and could be an alternative for those members is called the Medicare Supplement Plan N. Similarly, to plan G, Medicare Supplement plan N, also has a yearly Medicare Part B deductible of $198 in 2020. After the member satisfies that deductible, there will be a copay for doctor visits, which is up to $20 an appointment, and a copay for emergency visits, which is up to $50 a visit. Medicare excess charges are not covered under Medicare Supplement Plan N. Medicare excess charges could mean a surprise doctor’s bill. Medicare Part B excess charges are the difference between how much a doctor charges for a treatment or procedure and how much Medicare has agreed to pay for it. Doctors who accept “assignment” have decided to accept the Medicare-approved amount as full payment for services rendered. Doctors who do not accept “assignment” may overcharge the Medicare rate for a particular service by a maximum of 15%.

That is another alternative where the beneficiary can have comprehensive coverage for a lower cost in terms of premium. This is a general overview of some of the popular options that could be an alternative to Medicare Supplement plan F. However, and it is essential to note that there are other options available when it comes to Medicare Supplements. Every individual prospect has different needs, so it’s always very important to do a full need analysis with your agent before accepting any recommendation and making any decision.

Our dedicated team can help you make a decision and compare all plans available for you in your area. There is no fee for our service.

Related Post: Why Medicare Beneficiaries Need a Licensed Agent?

It is important to note that Medicare and Medicare Supplement plans do not provide you with Medicare Creditable Drug Coverage. They do not provide you with any Drug Coverage. Every Medicare Beneficiary must have a Prescription Drug Plan (PDP). They are offered through private insurance companies. If you miss your enrollment period or choose to opt-out on the Drug Coverage, you may have an LEP (Late Enrollment Penalty) when you finally decide to purchase a drug plan. 

Related Post: Prescription Drug Coverage for Medicare recipients

Got Medicare Questions?

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The #1 question we get from clients new to Medicare or retiring, and are looking at options for secondary insurance is, what is the difference between a Medicare supplement (aka Medigap policy) and a Medicare Advantage Prescription Drug plan (aka Part C) plan?

Minor differences will exist in each regional market, but here we will discuss the general pros and cons of Medicare supplements vs. Medicare Advantage plans.

Network

With Medicare supplements, you generally have greater freedom with choosing your doctors, hospitals, or facilities. When you get Medicare Supplement Plan, your Medicare card (Original Medicare) is a primary insurance and Medigap is secondary. 

By design, supplements cover you anywhere Medicare is accepted, this means any doctor or hospital that participates in Medicare, in all 50 states and US territories, without a referral. This access can be valuable for patients with rare or complex conditions, for example, as they may require a specialty doctor located on the other side of the country. The same goes for specialty hospitals.

• Relevant post: Memorial hospital and Medicare

On the other hand, Medicare Advantage plans; usually, an HMO or PPO managed care plan, are defined by 1) a service area, typically your county or city, and 2) a provider network, doctors or hospitals who have contractually agreed to accept this insurance at contracted rates. In this case, providers must be in your area AND be in your plan network for you to access. There are exceptions to this, such as PPOs, but those will be discussed separately.

When you chose the Medicare Advantage plan, it becomes primary, and you use only one card for your convenience. Lots of people, for some reason, think that by enrolling in the MAPD plan, you lose you Medicare. That is the wrong theory. MA plans must cover all benefits covered under original Medicare. 

Despite this limitation in their service area and network, the good news is, more Medicare Advantage plans now are offering coverage during travel outside of local service areas. All Medicare Advantage plans cover Emergency rooms all over the world. As a specialist in NY state, we have programs that offer coverage outside of our state. Aetna and UnitedHealthcare are two insurers covering domestic travel at select states under some of their Medicare Advantage plans, making Medicare Advantage much more viable for frequent travelers or seniors with a second home in Florida. Aetna Medicare Advantage Prescription Drug Plans has a seamless network, which means you can visit Dr’s in the states where Aetna is Available. UHC has a Passport program, and you should contact their customer service if you are a member and turn on the passport program. With UHC MAPD plans, you can be in another state for nine months. Humana is also having benefits for Medicare beneficiaries that allows you to take the MAPD plan to another state and use it there. As a broker specializing in Medicare plans in Brooklyn, Queens, Manhattan, Staten Island, and Long Island, it is not very common we enroll our prospect in Humana plan just because of a bad network in NY. For some people, Humana may be a great fit, but for many people, it is not. 

Cost

So far, we have discussed freedom and access, and Medicare supplements look attractive. But freedom and access come at a price, which for many seniors may be equally if not more critical consideration.

In the downstate New York area, the most popular Medicare Supplement plans cost $80-$310 monthly, before adding in prescription coverage, which will cost an additional $14 – $100 monthly. So, in total, expect to pay $220-$550 per month for your hospital, medical, and prescription coverage. Medicare Advantage plans, on the other hand, range from $0 an up monthly in this area, including prescription coverage. That is a significant savings in upfront premiums.

Lots of our clients ask us why an insurance company would cover us for FREE? The answer is simple. All MAPD plans are contracted with CMS. In simple language, the program does not cost you, but it cost Medicare, who pays the lump sum every month for you to have it. CMS pays Private Insurance Company, and the company covers you.

For someone in good health, who sees their doctor once or twice per year, does their routine preventive screenings (colonoscopy, mammography, etc.), and has few conditions requiring a specialist, Medicare Advantage makes a lot of sense. You will save a lot in monthly premiums, and not incur as much copayment as someone with many medical issues. Basically, with the MAPD plan, you pay as you go.

On the other hand, if you do see many doctors, or had a recent event such as hospitalization or rehabilitation, it pays to sit down and do some math. Copayments can add up quickly, for example, if you require skilled nursing rehab, or have frequent bouts of hospitalization.

Here at First Manhattan, we can do that math with you (at no cost to you!) when you book an appointment to see one of our experienced agents. We will examine your needs and budget, and revisit with you every year during the Annual Enrollment Period to reassess your plan because we know that life doesn’t stay the same, and insurance plans don’t stay the same. 

Additional Benefits

So far, we went over the top two distinctions between Medicare supplements and Advantage plans: network and cost. But no less significant for many seniors, are benefits such as dental, vision, hearing—all considered “additional benefits” not covered by Medicare.

As a rule, Medicare supplements will not cover anything not covered under original Medicare. This means no dental, routine vision/eyewear, hearing test/aids, and. In contrast, many Medicare Advantage plans now offer some dental, vision, etc., to make Medicare Advantage plans more attractive to consumers. Typically, the coverage is minimal, but it is a step up from no coverage at all. 

Rx

As briefly mentioned above, all Medicare supplements do not come with prescription coverage. Beneficiaries must purchase a Stand-Alone Prescription Drug Plan (Part D if they choose a Medicare supplement.

Many Medicare Advantage plans, on the other hand, do include prescription coverage, making it an all-in-one solution in many senses.

Conclusion

We hope this post has been enlightening about Medicare supplemental insurance without being overwhelming. We summarized the four most significant distinctions between Medicare supplements and Medicare Advantage plans, the source of many confusions among seniors looking for suitable coverage to supplement Medicare. 

The great news is you don’t have to do it alone! Our agents here at First Manhattan are ready to guide you via the office, home, or phone appointments. Give us a call or send a request.