Medicare Basics

Q:Where is my Medicare Supplement accepted?
A: Any Medicare Supplement carrier is accepted at any doctor that accepts Medicare patients.

Q:Who decides what is approved on my doctor visits and hospital procedures?
A: Medicare has private companies that work for Medicare that approve visits and medically necessary procedures, not the insurance company.

Q: Are all Medicare Supplements the same?
A: Yes, Medicare Supplements are standardized plans with same benefits that are provided by all carriers. The only difference is the premium you are charged.

During open enrollment, a period of 6 months prior and 6 months after starting part B of Medicare, you can choose to take original Medicare or transfer your Medicare benefits to a private insurance company called Part C or Medicare Advantage Plan. A Medigap or Medicare Supplement helps pay the 20% Medicare doesn’t pay. On a Medicare Advantage plan you share all costs with the private insurance company up to your max-out-of- pocket costs. Max-out-of-pocket costs range anywhere from 4000- 8000 dollars a year. The main difference between these two plans are the cost per month. Most Medicare Advantage plans cost very little to no premium but with any major medical expenses can end up costing you more per year than a Medicare Supplement. Supplement plan G, cost 90-120$ a month for a 65 year old with only 183$ deductible a year. Premiums vary from state to state and Male and Female.

Open Enrollment is a term used for someone who is new to Medicare just aging in at 65 or just starting Part B of Medicare at a later age. Guaranteed Issue is a situation where someone is losing employer coverage or losing a Medicare Advantage plan no fault of their own and they have a right to plans A,C, and F with no health questions asked.

Age-in Open Enrollment- 6 months before and after the 1st day of the month you turn 65. SEP( Special Election Period)- If you start Medicare Part B at a later age because of employer or spousal coverage you will have a special election period to start your part B and Medicare Supplement. AEP- Annual Election Period – October 15th- December 7th This is a time where someone who is on a Medicare Advantage plan can choose to opt out of their advantage plan and go back to original plan or change their prescription drug plan. These changes will take place January 1st of the following year.

Plan F currently is the most comprehensive plan in Medicare. Plan F, with any medically necessary event at any doctor or hospital where Medicare is accepted, will cover the full 20% for you that Medicare doesn’t pay and your only responsibility is your monthly premium. Plan G, being the second most comprehensive plan in Medicare, has become more popular than plan F with most clients because of the savings it provides. The coverage with plan G is identical except you are responsible for your part B deductible of 183$ a year. The difference in premium usually ranges from 220-400$ a year resulting in total lower costs with plan G vs plan F.