Medicare Plans Made Easy

We understand that navigating through the complexities of Medicare can seem overwhelming at times. With various plans and options, each carrying its unique features and benefits, it's natural to have questions or need clarification.

In this section, we have collated a list of the most frequently asked questions about Medicare, aiming to simplify this vital topic. These questions cover everything from the basic understanding of Medicare to specific details about different Medicare plans. Our goal is to help you become more informed and confident in making decisions about your healthcare coverage. Whether you're new to Medicare or considering changes to your existing plan, the following answers should provide the clarity you need.

What is Medicare Supplemental Insurance (A.K.A. Medigap)

Medicare Supplement Insurance, also known as Medigap, is private insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles.

Who is Eligible For Medicare Supplemental Insurance?

Medicare Supplement Insurance, also known as Medigap, is available to those who meet the following criteria:

Enrolled in Medicare: You must be enrolled in Medicare Part A and Part B to be eligible for a Medigap policy.

Residency: You need to reside in the state where the Medigap policy is offered. Medigap policies are standardized differently in Massachusetts, Minnesota, and Wisconsin.

Not Enrolled in a Medicare Advantage Plan: Individuals cannot use Medigap policies with Medicare Advantage Plans. If you have a Medicare Advantage Plan but are planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends.

One Person per Policy: Medigap policies only cover one person. If both you and your spouse want Medigap coverage, you'll each have to buy separate policies.

It's important to note that the best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. This period automatically starts the month you're 65 and enrolled in Medicare Part B. During this period, an insurance company can't use medical underwriting, refuse to sell you any Medigap policy it offers, charge you more for a Medigap policy because of your health condition, or make you wait for coverage to start (except in some cases for pre-existing conditions). If you try to buy a Medigap policy outside this window, there is no guarantee that you'll be able to get coverage. If you do get covered, it may cost more.

When Can I Sign Up For Medicare Advantage?

There are specific times when you can sign up for Medicare Advantage, also known as a Medicare Part C plan. These include the following periods:

Initial Enrollment Period (IEP): This is when you first become eligible for Medicare. It starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. If you qualify for Medicare due to disability, your IEP starts three months before your 25th month of disability and ends three months after your 25th month of disability.

Annual Election Period (AEP): Also known as Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, this takes place from October 15 to December 7 every year. During this period, you can switch from Original Medicare to Medicare Advantage, change from one Medicare Advantage plan to another, or switch back to Original Medicare. Changes made during AEP will take effect on January 1 of the following year.

Medicare Advantage Open Enrollment Period: This takes place from January 1 to March 31 each year. During this period, if you already have a Medicare Advantage plan you can change during this period.

Special Enrollment Periods (SEPs): In certain situations, you may be eligible to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. These situations include, but aren't limited to: moving out of your plan's service area, losing your current coverage, having a chance to get other coverage, or your plan changes its contract with Medicare.

Remember, if you're enrolling in a Medicare Advantage plan, you must meet the basic eligibility requirements for Medicare: you must be 65 years old (or qualify through disability), be a U.S. citizen or legal resident, and you must be enrolled in Medicare Part A and Part B.

What Is Medicare Advantage Insurance?

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B). Medicare Advantage Plans are offered by private insurance companies approved by Medicare. These plans must provide at least the same level of coverage as Original Medicare, but many offer additional benefits.

Key features of Medicare Advantage include:

Coverage: Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if the plan determines that a service is medically unnecessary, it may not cover the costs.

Additional Benefits: Most Medicare Advantage Plans offer prescription drug coverage, and many provide additional benefits such as dental care, vision care, hearing aids, and wellness programs, which are not covered by Original Medicare.

Costs: Medicare Advantage Plans often have lower out-of-pocket costs than Original Medicare. However, they also typically have a network of providers, and you may pay more if you use out-of-network care.

Network Restrictions: Unlike Original Medicare, which allows you to see any doctor or use any hospital that accepts Medicare, Medicare Advantage Plans often use a network of doctors and hospitals. The plan may not cover services received outside of this network, or it may cover them at a higher cost.

Enrollment: To enroll in a Medicare Advantage Plan, you must already have Medicare Part A and Part B. You must also live in the service area of the Medicare Advantage Plan you want to join.

It's important to note that not every Medicare Advantage Plan works the same way, so before you join, take the time to find and compare Medicare health plans in your area. When comparing plans, consider the costs, the additional benefits, and the network of providers.

Who is Medicare Supplement Recommended For?

Medicare Supplement insurance, also known as Medigap, can be an excellent choice for certain people, depending on their healthcare needs, financial situation, and personal preferences. Here are some scenarios where a Medigap policy might be recommended:

Frequent Use of Healthcare Services: If you frequently visit doctors or specialists, or have a condition that requires regular medical attention, a Medigap plan can help cover your out-of-pocket costs, such as copayments and deductibles, associated with Medicare Part A and Part B.

Predictable Costs: Medigap policies come with monthly premiums, but they can make your healthcare costs more predictable. This can be beneficial if you prefer to know upfront what your healthcare expenses will be, rather than facing potentially high costs when you need care.

Travel Coverage: If you travel frequently, particularly overseas, you may benefit from a Medigap policy. Some Medigap policies offer coverage for emergency care received outside of the United States, which Original Medicare does not typically cover.

Freedom to Choose Providers: With a Medigap plan, you can go to any doctor or hospital that accepts Medicare, without needing a referral. This might be ideal if you want more freedom in choosing your healthcare providers.

Financial Peace of Mind: If you can afford the monthly premium, a Medigap policy provides financial security by capping your out-of-pocket medical costs.

It's essential to compare the benefits of a Medigap policy with other coverage options, such as a Medicare Advantage plan, before making a decision. Each type of plan has its advantages and disadvantages, and the best choice depends on your individual health needs, budget, and lifestyle. Consulting with a trusted insurance advisor or a senior services organization can be beneficial when deciding which plan is the right fit for you.

Where Do I Purchase Medicare Insurance Plans?

Medicare insurance plans can be purchased through various means, and the best avenue depends on the type of Medicare coverage you're seeking:

Original Medicare (Part A and Part B): Enrollment for Original Medicare is typically handled through the Social Security Administration. You can apply online at the Social Security website, in person at a local Social Security office, or by calling Social Security.

Medicare Advantage (Part C): Medicare Advantage plans are sold by private insurance companies. You can purchase these plans directly from the insurance company, through a licensed insurance agent or broker, or you can use the Medicare Plan Finder on the Medicare.gov website to compare and choose a plan.

Medicare Prescription Drug Plans (Part D): Like Medicare Advantage plans, you can purchase Medicare Part D plans from private insurance companies or through the Medicare Plan Finder on the Medicare.gov website.

Medicare Supplement Insurance (Medigap): Medigap policies are also sold by private insurance companies. You can purchase these policies directly from the insurer or through a licensed insurance agent or broker.

Before purchasing a plan, you may want to compare all the available options in your area. The Medicare Plan Finder on Medicare.gov is a good resource to start with, as it provides a comparison of the Medicare Advantage, Part D, and Medigap plans available in your area.

Remember, enrollment in different parts of Medicare is subject to certain eligibility criteria and specific enrollment periods. It's a good idea to understand these details before you begin the process.

IMPORTANT: How To Save On Your Medigap Plan.

Saving money on a Medigap policy involves a combination of timing, shopping around, understanding pricing methods, and maintaining good health. Here are some strategies that can help you save on your Medigap plan:

Enroll During Open Enrollment: The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. During this period, you have a "guaranteed-issue right" which means insurance companies can't use medical underwriting to decide whether to accept your application, charge you more due to pre-existing conditions, or make you wait for coverage to start.

Compare Plans: All Medigap policies are standardized, meaning plans of the same letter (A through N) offer the same basic benefits, regardless of which company sells the plan. Therefore, it pays to shop around and compare costs for the same plan type among different insurers.

Understand Pricing Methods: Insurance companies set prices (premiums) for Medigap policies in one of three ways: community-rated, issue-age-rated, or attained-age-rated. Understanding these pricing methods can help you choose a plan that will be cost-effective for you in the long run.

Healthy Lifestyle: Maintaining good health can also help you save money on healthcare costs in general. Regular exercise, a healthy diet, and routine check-ups can prevent health issues from arising or escalating.

Consider High-Deductible Options: If you're in good health and willing to pay a higher deductible, you might consider high-deductible versions of certain Medigap plans. These often have lower premiums, but you must meet the deductible before the policy pays anything.

Check for Discounts: Some insurers offer discounts for women, non-smokers, married people, or those who pay annually. Some also offer a discount if you set your premiums to be automatically deducted from your bank account.

Work with a Trusted Advisor: Consider working with an insurance advisor who specializes in Medicare. They can guide you through the process, help you compare plans, and identify any potential savings.

Remember, the most inexpensive plan is not always the best option if it doesn't meet your health care needs. Consider both your current and future health needs when choosing a Medigap policy.