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Created in 1965, Medicare is the federal health insurance program available to seniors and the elderly in the United States. In addition to being open to those over the age of 65, sometimes others can get Medicare, such as those with certain disabilities, end-stage renal failure, and ALS (Lou Gehrig’s Disease). According to the Kaiser Family Foundation, over 60 million Americans now enjoy the benefits of Medicare.1 And many of those individuals choose to expand their coverage through the use of supplemental plans, which fill in the “gaps” in coverage, such as covering deductibles and coinsurance costs.
Understanding Medicare’s various parts and the supplemental plans can be confusing. Here’s a guide to navigating them, as well as understanding the various plan options and when you can enroll.
Medicare Part A and Part B
You are probably most familiar with Medicare Part A and Part B. Here’s what each one of them offers and what the costs are, according to the Centers for Medicare and Medicaid Services:
· Part A includes coverage for skilled nursing care, inpatient hospital stays, home health care, and hospice. The cost to you depends upon how many days you spend in a hospital or skilled nursing facility (like a nursing home or a rehabilitation center). The deductible for this coverage was $1,600 in 2023; the monthly premiums are usually nothing, as these are covered by the money you paid into Medicare during your working life. But if you didn’t contribute enough over your lifetime, the premiums can be up to $506 per month.
· Part B pays for more “everyday” events, such as visiting your healthcare providers, as well as getting imaging tests and labs, such as x-rays or bloodwork. Premiums and deductibles change annually but are generally affordable; in 2023, the monthly premium was $164.90 and the annual deductible was $226. After the deductible is met, Medicare pays 80% of the costs, while you pay the other 20%.2
Medicare Part C and Part D
These are the two common coverage options most people have heard about.
· Part C is often known as Medicare Advantage. This isn’t actually a supplemental plan. These are HMO and PPO plans that can take the place of supplemental plans for a lower cost.
· Part D can be easily remembered by “D” is for “drugs.” This is the plan that offers prescription coverage.
Remember: “Part” refers to a certain part of Medicare, while “Plan” refers to the supplemental options.
Medicare Supplement Plans
There are currently 10 supplemental plans from which to choose. Sometimes known as Medigap plans, they are designed to fill in the “gaps” in the coverage offered by Part A and Part B.
If your health situation means that you need a particular service or addition to your coverage, you can get it through supplemental plans. According to Medicare.gov, every supplemental plan will provide coinsurance and hospital costs up to 365 days after Medicare runs out. That means if you use up all your Medicare benefits within six months, the supplemental plan will kick in and cover you for the next six months, until the benefits reset and you begin with a new year.
Every plan provides this particular benefit, but after that, things begin to differ. Here’s what to expect from each:3
· Plan A provides coinsurance or copayment for Part B, the cost of the first three pints of blood, and the coinsurance or copayment for hospice care under Part A.
· Plan B covers all this plus the Part A deductible.
· Plan C covers all of the above as well as the Part B deductible and the coinsurance for a skilled nursing facility. It also covers 80% of the cost of medical care necessary during foreign travel.
· Plan D offers the same coverage as Plan C, minus the Part B deductible.
· Plan F is the most robust supplemental plan. It covers all the things listed in the plans here, as well as the Part B excess charge. (The excess charge occurs when a doctor charges more than Medicare will cover, leaving you with a bill for the excess. Plan F covers that difference so you don’t have to pay it.)
· Plan G covers all of the things Plan F covers, with the exception of the Part B deductible.
The plans beyond this provide limited coverage but will also have a lower premium. For instance, Plan M covers quite a bit of the same things that the above-listed plans do, but only 50% of the Part A deductible. Plan N doesn’t cover the Part B deductible or excess charges, but does cover the majority of the points listed above.
If you are looking for something that will limit your out-of-pocket spending on healthcare, that would be:
· Plan K. Though it provides only 50% coverage for blood units, skilled nursing facility coinsurance, and the other points listed by the plans above, it caps your out-of-pocket costs at $6,940 (in 2023). This can be a great option for those who have very high medical expenses for things that Medicare doesn’t cover.
· Plan L. This boosts the coverage to 75% for those things covered under Plan K, but it also caps your out-of-pocket expenses at $3,470 (in 2023). Again, it’s a good option for those who have high medical expenses and can handle the higher premiums but want to cap the amount they must spend over the course of a year for certain treatments or tests.
Points to Ponder About the Plans
As with everything else in life, there are exceptions. For example, only those who turned 65 before January 1, 2020 can get Plan F or Plan C (unless some special circumstances exist). The benefits and exceptions are standardized across the nation – except in certain states.
For instance, Massachusetts, Wisconsin, and Minnesota have state-standardized plans that might differ from the plans listed here. And since plans can change from year to year, other states might move to standardized plans at some point.
And as with any insurance plan, prices can change every year. The premiums you pay for the supplemental plans vary among plans, insurance companies, and states. According to U.S. News and World Report, the average cost for Plan G ranges from $170 to $250 per month, depending upon where you live.4
That’s why it’s so important to talk to an insurance advisor about Medicare, the various parts, and the plans that you can get to cover the gaps in coverage. An experienced expert can walk you through the options and help you choose the one that’s right for you. Remember that there is no cost to consult an insurance agent.
While you’re doing that, it’s a good idea to do what you can to stay healthy and safe, so that you hopefully never have to use the supplemental plan at all. A personal alarm button for senior safety can help you do that. When you are safe from the dire consequences of accidents, falls, and medical emergencies, you can help ensure that your medical costs stay as low as possible.
Can You Be Denied Supplemental Plan Coverage?
While you cannot be denied Medicare coverage, you can be denied supplemental plan coverage.
Let’s say you got Plan G a few years ago, when you were in better health. But now the premiums have gone up to a point where it’s too much of a squeeze on your wallet. When you try to switch to a different plan, the insurance provider might ask you to answer health questions to determine whether you qualify or not.
If you don’t qualify, they will turn you down for coverage. You can still keep your original Plan G and pay the higher premiums.
Reasons for denial might include certain medical conditions, such as uncontrolled diabetes, Parkinson’s disease, Alzheimer’s disease, chronic heart disease, and a recent diagnosis of cancer.
If you are denied a supplemental plan, it’s more important than ever to have a medical alert bracelet or wristband on you at all times. Though it’s vitally important to get the help you need at any time, day or night, it’s especially helpful if you can use a medical alarm to reach out for help the moment something happens. That’s because the sooner you get medical attention for any emergency, the better your long-term outcome can be. Getting help during the “golden hour,” as it’s called, can eventually save you a great deal of time, pain, worry, and of course, money. Protect yourself and your wallet by looking into an affordable Alert1 medical alert system today.
What About Guaranteed Issue?
You can switch plans if you have guaranteed issue rights. This means that no matter what your pre-existing condition is, as long as you already have a supplemental plan in force, they can’t deny coverage when you switch plans and they can’t charge you a higher rate because you have a pre-existing condition. Here are some ways in which guaranteed issue rights apply:
· You sign up during the Medigap Open Enrollment Period.
· The insurance company that provides the supplemental coverage shuts down or goes bankrupt.
· You are moving out of the state or area your current plan covers.
· Your Medicare Advantage plan will no longer cover where you live.
· Your state rules prohibit insurers from denying coverage.
However, there is sometimes a catch: some insurers require a six-month waiting period before your new plan will kick in, even with guaranteed issue. That means that the plan will cover many things but will not cover anything that they can tie to your pre-existing condition for the first six months you’re on the plan.
When Can You Change Plans?
What’s your birthday month? On the first day of that month after you turn 65, your Medigap Open Enrollment Period begins. As long as you are signed up for Medicare Parts A and B, you can choose a supplemental plan during this time. When you do enroll during the open period, you can get a policy without the insurance company asking any questions about your health.
The most difficult part of changing plans is figuring out which plan you want to get. Once you do that, you will need only your Medicare identification number, your social security number, the date that your Medicare went into effect, and the address and name of your primary care physician.
Remember that it’s important to think ahead when choosing the right plan for you. That’s because while you might be healthy right now, there could come a day when you won’t be – and if your health gets worse, your odds of getting a supplemental plan drop. Getting it while you are healthy is the best way to ensure that you have the coverage you need, when you need it.
The same principle applies to choosing the right medical alert system with fall detection. Far too many seniors and elderly adults suffer a fall and subsequent injury and then wish they had chosen a medical alert device to protect them. Obtaining a panic button alarm right now, before you actually need to use it, is the best way to ensure you will have 24/7 assistance in the event of falls, accidents, and other emergencies (police, fire, EMT, etc).
As you consider your supplemental plan coverage, consider affordable med alerts from Alert1 to go along with it. There’s nothing so satisfying as peace of mind!
