fbpx

Ashford Insurance

Lake Worth Medicare Supplements

Medicare Supplements Made Easy

Lake Worth Medicare Supplements

What is a Medicare Supplement plan?

A Lake Worth Medicare Supplement (also known as Medigap) plan is a supplemental insurance plan sold by a private company. This kind of insurance helps cover the costs that Original Medicare doesn’t, like deductibles, copayments, or coinsurance.

How do Medicare Supplement plans work?

Once you enroll in both Part A and Part B, then you have the option to add a Medicare Supplement plan to give yourself additional coverage. Medicare Supplement plans work in addition to your existing Medicare coverage, so the benefits of the Medigap plan kick in once coverage from Part A or Part B ends.

Additionally, the federal government regulates which benefits are provided by each plan. The plans themselves provide the same benefits no matter which company sells them. This means that no matter which company you purchase a Plan F (one of many Medigap policies) from, the benefits must all match the Plan F benefits set by law.

It’s worth noting, however, that premiums for a plan can vary widely from one company to the next.

Warning:

It’s quite easy to get Medicare Supplement plans confused with Medicare parts because some of them share names. Keep in mind, that they are not the same.

Medicare Part A, Part B, Part C, and Part D are all sections of Medicare. Medicare Supplement Plans A, B, C, D, F, G, K, L, M, and N are Medigap policies that supplement your Original Medicare coverage. The plans supplement coverage for the parts.

Here’s another way to think of it: Medicare Part A is a part of Original Medicare. Medigap Plan A is a plan to supplement Original Medicare.

Typically covered benefits

Note coverage depends on which supplement you chose.
 

1. Part A coinsurance and hospital costs

Remember the example from the beginning, about the person who stayed in a hospital longer than 90 days? This benefit is great for those worst-case scenario hospital stays. Under Medicare Part A, a hospital stay past 60 days (until day 90) will cost you coinsurance payments. Days 90 and beyond are far more expensive. The Part A coinsurance and hospital benefit remedies these potentially high costs, kicking in for up to a full year, once your Original Medicare benefits are used up.

2. Part B coinsurance and copayment

This covers the coinsurance or copayments doctors, and other providers typically charge you under the Part B umbrella.

3. Blood (first 3 pints)

Under Original Medicare, you must pay for every pint of blood you receive until you hit four pints in a calendar year. You’re covered for the first three pints you get in a year with this benefit.

4. Part A hospice care coinsurance and copayment

Medicare Part A covers hospice care, but there can be a few copayments. For instance, with just Original Medicare, you must pay $5 per prescription drug. And if your hospice facility needs to temporarily move you to another facility, like a nursing home, you’ll have to pay 5% of respite care costs. With Part A hospice care copayment coverage, all these copayments would be taken care of, so hospice would essentially be free.

5. Skilled nursing facility care coinsurance

At a Skilled Nursing Facility (SNF), you receive care from skilled nursing or therapy staff. These facilities can be part of a nursing home or even a hospital and are registered as SNFs by Medicare. Treatment in SNFs includes physical therapy, audiology, occupational therapy, and others.

Although Original Medicare covers treatment from an SNF for up to 20 days, after day 20, you face daily coinsurance fees (currently $176 per day in 2020).1 Those fees are completely covered if you purchase a plan with the SNF care coinsurance benefit.

6. Part A deductible

Medicare Part A will cover your first 60 days in a hospital, but only after you meet your not-so-small deductible in your benefit period ($1,408 in 2020).2 A plan with this benefit covers your Part A deductible completely.

7. Part B deductible

This is a significant benefit, covering your deductible for any Medicare-approved Part B service. With this deductible covered, you can go to the doctor without any up-front cost.

The Part B deductible benefit is slightly controversial, however—so much so that Congress will no longer allow plans covering the Part B deductible (Plan F and Plan C) to be sold past January 1, 2020. Newly eligible beneficiaries after 2020 will not be able to buy Plan F or Plan C, but anyone who already had either of these plans before can keep them.

8. Part B excess charge

If you go to a doctor who doesn’t accept “assignment” (another way of saying the doctor agrees to the Medicare-approved amount for a service), they can legally overcharge you for the service. These pesky excess charges are paid for with the Part B excess charge benefit.

9. Foreign travel coverage

In general, Original Medicare doesn’t cover emergency services outside the US. There are a few rare exceptions, such as traveling through foreign countries to US territories (e.g., driving through Canada to go to Alaska). So, if you enjoy foreign travel, foreign travel coverage is a useful benefit to consider.

10. Out-of-pocket limit

A benefit many are typically used to with private insurance, the out-of-pocket limit applies only to Plans K and L. When you reach your Part B deductible and the out-of-pocket limit for your plan, your Medigap plan pays for 100% of your covered services until the end of the year.

When should I enroll in a Medicare Supplement plan?

You should enroll within six months of signing up for Medicare Part B.

Besides picking a plan that suits your needs best, timing is everything when purchasing a Medigap plan. For anyone 65 and over, within a six-month window of signing up for Medicare Part B, federal law guarantees the following protections:

  • You cannot be refused a Medicare Supplement policy that is offered in your area.
  • You cannot be charged higher premiums based on pre-existing health conditions.
  • You cannot be required to undergo a waiting period before your coverage begins.

Federal law assures these protections (called guaranteed issue rights) within that six-month window. But once that window is up, Medigap providers can deny you a policy, charge you more based on your health, or force you to wait longer for coverage to begin.

If you are considering a Medigap plan, do your absolute best to get your policy during the time frame when you have guaranteed issue rights. To see other situations where these protections may apply, see the full list on Medicare.gov.

Things to know about Medigap policies

  • You must have Medicare Part A and Part B.
  • A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
  • You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
  • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  • You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
  • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy if you pay the premium.
  • Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D). If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.
  • It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan unless you’re switching back to Original Medicare.

Medigap policies don’t cover everything

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

If you need assistance navigating Medigap policies, contact Ashford Insurance at 817-952-3153.