Training 8: Choosing a Medicare Plan – Medigap vs Medicare Advantage

Training 8: Choosing a Medicare Plan – Medigap vs Medicare Advantage

https://youtu.be/t5AHkhkOu_g

Top things to consider when choosing between Medicare Advantage and Medigap

Eligibility

There are a couple things related to eligibility that may be beyond your control.

You may not be able to buy a Medicare supplement in some States if you are under 65 even if you are Medicare-eligible. Individual States govern insurance law and some States do not require insurance companies to offer Medicare supplements to people under 65.

If you find your self in this situation, you can either insure through original Medicare plus a stand-alone Part D plan or enroll in a Medicare Advantage plan if you qualify.

If you are not in your Medigap Open enrollment Period or do not qualify for Guaranteed Issue Rights, you will usually be subject to medical underwriting. Although most companies have fairly liberal guidelines, there are still times when a preexisting condition will stop you from buying a supplement.

Money

The amount of money you can budget towards premiums will be an over-riding factor.

Many people with lower budgets will gravitate towards a Medicare Advantage plan because:

  • Medicare supplement premiums are generally much higher than Medicare Advantage premiums
  • If you buy a supplement, you will also need to enroll in Part D and will pay a separate premium

Plan Coverage

Medicare Advantage plans generally offer some benefits not included as part of original Medicare. Some companies offering supplements will also include some extras, but those benefits are normally not as numerous or benefit rich.

If you desire extras like dental, vision, hearing, gym memberships and transportation you may need to enroll in a Medicare Advantage plan.

Your General Philosophy

If utilizing a provider network seems to limit your freedom or doesn’t work well with your life style, you may want to consider a Medicare supplement if your budget allows.

Additionally, if the idea of having to navigate an annual enrollment period seems like a hassle you may also want to consider a supplement.

Plan Availability

Medicare Advantage plans are available County by County and is some less populated Counties you may have very few plans to choose from and often times those plans will predominately be Private Fee-for-Service plans.

You may by default need to consider a Medicare supplement if your choice of Advantage plans is limited.

Drug Coverage

Part D plans all include a Formulary which is the list of drugs covered by a specific plan. There are two types of Part D Formularies: Basic and Enhanced.

A Basic Formulary will normally include the most popular drugs prescribed to Medicare beneficiaries. An Enhanced Formulary will often include the less common (read more expensive!) drugs as well.

Most Medicare Advantage plans with drug coverage include a Basic Formulary and if you drugs are not covered by the plans Formulary, it may become necessary to buy a supplement and enroll in a stand-alone Part D plan with an Enhanced Formulary.

 

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Training 7: Times When You Can Buy Medigap Insurance

Training 7: Times When You Can Buy Medigap Insurance

Medigap enrollment periods overview

You have more flexibility related to times you can buy a Medigap policy than you do for times that you can enroll in a Medicare advantage plan.

But there are still enrollment periods and times that are better than others to buy a supplement.

Medigap Open Enrollment Period

Your Medigap Open Enrollment Period is the best time to buy a supplement.

During this time an insurance company cannot:

  • Refuse to sell you any Medigap policy that it sells
  • Make you wait for effective coverage (Some exceptions apply)
  • Charge you a higher premium due to a health condition

Your Medigap Open Enrollment Period lasts for 6 months and begins on the first day of the month that you are both 65 and enrolled in Part B.

This could be when you are aging into Medicare or after you have aged in if you did not elect Part B initially due to being covered by your employer or union group insurance coverage.

You can submit your application once you have received your Medicare card or receive notice of your Part B effective date if you waited to elect that coverage.

Submitting your application a month or two early will make it likely that your supplement will be in place when your Medicare or Part B becomes effective.

Guaranteed Issue rights

There are times when you have a change in your circumstances that trigger your right to buy a Medicare supplement guaranteed without regard to preexisting conditions.

Some common times when you have these rights include:

  • Your Medicare Advantage plan is leaving Medicare
  • You are enrolled in Medicare and your employer group insurance is ending, including COBRA
  • You have a Medicare Select Policy and move out of the service area
  • You joined Medicare Advantage when first eligible and are in your first year
  • You dropped a Medigap policy to enroll in an Advantage plan or Medicare select policy and it’s been less than a year
  • Your Medigap insurance company goes bankrupt

You may be limited as to which plans you are able to purchase.

Other times when you can buy a Medicare supplement

You can submit an application anytime you are enrolled in Medicare. But, keep in mind that you cannot be enrolled in an Advantage plan and have a supplement at the same time.

Also, buying a Medicare supplement will not cancel a Medicare advantage plan if you have been in Medicare Advantage more than a year.

If you have been enrolled in an Advantage plan more than a year you will have to wait until your Medicare Advantage Annual Election Period to submit an application for Medigap.

Once your policy is issued you can dis-enroll from your Advantage plan (January 1st – February 14th) or notify your Advantage plan while still in the election period (October 15st – December 7th).

In any case make sure your policy is issued prior to leaving your Advantage plan unless you would rather return to original Medicare.

If you are not in your open enrollment period or don’t have guaranteed issue rights you may not have a policy issued due to health conditions.

If you are enrolled in a Medicare Advantage plan, submit your application for a supplement early so you will know whether or not a policy will be issue so you can keep your options open.

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Training 6: Supplement charts

Training 6. Supplements Charts.

Comparing Medicare supplement plans

The following Medicare supplement benefits chart includes all Medigap plans.

Expect that the more of your Medicare-covered expenses that a plan covers, the higher the monthly premium.

But, keep in mind that the monthly premium can vary greatly from company to company. In fact, premiums for the same plan may vary by more than $100 per month.

PlanPrescriber is a national insurance brokerage company that represents many top rated companies. Comparing plans is simple.

You can compare plans online or speak with a representative by calling (888) 310-0376.

Since some insurance companies do not offer enrollment online, you will be able to compare more plans by calling.

 

Medicare Supplement Plans Benefit Checklist
A
B
C
D
F*
G
K
L
M
N
Basic Plan (Part A Coinsurance up to an additional 365 days)
x
x
x
x
x
x
x
x
x
x
Basic Plan (Part B Coinsurance/ Co-payment; 1st 3 Pints Blood; Part A Hospice Care Coinsurance/ Co-payment)
x
x
x
x
x
x
50%
75%
x
100% except up to $20 co-pay for office visits and $50 co-pay for ER visits
Skilled Nursing Co-payment ($148/day for days 21 – 100 for 2013)
x
x
x
x
50%
75%
x
x
Part A Deductible ($1,184 for 2013)
x
x
x
x
x
50%
75%
50%
x
Part B Deductible ($147 for 2013)
x
x
Part B Excess Charges (additional 15% for providers not accepting Medicare assignment)
x
x
Foreign Travel Emergency
x
x
x
x
x
x
Out-of-Pocket Maximum
$4,660
$2,330

* Plan F includes a high deductible option where $2000 is required before benefits are paid.

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How to Use the Medicare.gov Website to find Providers

How to use the Medicare.gov website to find Providers

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Training 1: What is Medicare Advantage

What is Medicare Advantage

Training 1. Medicare Advantage facts

  1. Medicare Advantage plans are part of Medicare. You do not leave Medicare when you enroll in a Medicare Advantage plan.
  2. Benefits are provided by a private insurance company and may be an HMO or PPO.
  3. Medicare drug benefits are usually included in an Advantage plan.
  4. A Medicare Advantage plan is not a Medicare supplement.

All Medicare Advantage plans must include Medicare Parts A and B. You can usually receive your medical and drug benefits from one plan.

Advantage plans often include extra benefits beyond what is available from original Medicare.

It’s not uncommon that a plan may include some of the following benefits:

  • Dental
  • Vision
  • Hearing
  • Silver Sneakers Gym Membership
  • Transportation to and From Medical Visits.

 

Additional Resources

Medicare Advantage vs Medigap: Follow These 5 Simple Steps and Get the Best Medicare Plan… Guaranteed!  – 59 page eBook.

This eBook is available on Amazon. My goal was to write a straight-forward easy to read guide to help you choose between Medigap or Medicare Advantage.  You do not need a Kindle to read this book… just download the free app on the book’s sales page and read right on your computer.

Medicare Plan Review You Tube Channel – Dozens of videos on:

  • Medicare Advantage
  • Medicare Supplement Insurance
  • Part D

Subscribe to be notified when new videos are added.

Medicare & You Handbook – A Medicare publication. 140 page pdf.

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Mini-Course Part 2: Medicare Advantage Plan Eligibility And How Plans Work

Mini-Course Part 2: Medicare Advantage Plan Eligibility And How Plans Work

Facts About Medicare Plan Eligibility

In order to be eligible to join a Medicare Advantage plan you must:

  1. Be enrolled in Medicare Part A and B
  2. Live in the plan’s service area
  3. Not have end-stage renal disease

You must also continue to pay your Part B premium which is normally deducted from your Social Security income.

How Plans work

Medicare Advantage plans must follow rules set by Medicare but plans can differ  in:

  • Monthly premium amount
  • Plan benefits
  • Your share of cost sharing to use the plan

Premiums

Advantage plan premiums may range from $0 to over $100 per month.

Premiums can be mailed, deducted from your Social Security earnings or be debited from your checking account.

Cost Sharing

Cost sharing can be in the form of:

  • Deductibles
  • Copayments
  • Coinsurance

Deductibles, if required, generally relate to the Part D drug coverage included in the plan.

If you have a PPO or HMO-POS and can receive services out-of-network, expect that you will pay more in cost-sharing amounts to do so.

If you are uncertain about what a procedure or service may cost, the easiest thing to do is to call the member services phone number on your card and speak with a plan representative.

Your due diligence can pay off

Prior to joining a plan:

  • Research the provider network
  • Know how much you will pay to use your plan
  • When you can switch or cancel your plan

As it relates to the network, don’t stop exploring after you have determined that your primary care provider is included. Check to be certain that your preferred specialists, ancillary providers and hospitals are in network as well.

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Training 3: Types of Medicare Advantage Plans

Training 3: Type of Medicare Advantage Plans

  Plans that you may have available

  • Preferred Provider Organization (PPO)
  • Health Maintenance Organization (HMO)
  • HMO-POS (Point of Service)
  • Private Fee-for-Service (PFFS)
  • Medical Savings Account (MSA)
  • Special Needs Plan (SNP)

PPO vs HMO

Many of the plans that you may have available will be HMO or PPO plans. Here are some differences:

  • A PPO will allow you to receive services out-of-network and an HMO will not
  • You will generally need a referral for a specialist when enrolled in an HMO
  • AN HMO may have lower cost sharing amounts

HMO-POS

A point of service plan is almost a PPO / HMO hybrid. You can receive some services out-of-network at specific locations. expect that you will pay more out-of-network.

PFFS

Private Fee-for-Service plans are not as popular as they once were.

These plans allow you to use any provider that will accept the plan’s terms and conditions. The downside to this freedom is that providers ncan accept the plan on a visit-by-visit basis.

Some rural area may only have this type of plan available.

Medical Savings Account

The least popular type of Medicare Advantage plan, this plan consists of two parts: a high deductible health plan and a savings account.

Part D is never included in this type of plan and you will need to enroll in a stand-alone Part D plan separately.

Special Needs Plan

Special Needs Plans are distinguished by who is eligible to join.

There are three types of plans for beneficiaries that qualify:

  • Dual-Eligible Plans (Having both Medicare and Medicaid)
  • Chronic Illness Plans
  • Institutional Plans (Nursing home)

These plan offer a high level of coordinated care and usually include Part D.

A Word about Part D

If you enroll in a PPO, HMO or HMO-POS plan that offers medical benefits only, you will not be allowed to join a stand-alone Part D plan.

Only join a Medical-only plan if you have other creditable drug coverage.

Medicare Special Needs Plan

Watch This “Medicare Special Needs Plan” Video on YouTube

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Training 4: Enrolling in Medicare Advantage: Enrollment Periods

Training 4 Medicare Advantage election period overview

 

Times when you can enroll in, switch or drop plans are strictly regulated by Medicare. If you do not have an election period available, you will either not be able to enroll, or if you are enrolled in a plan, you will be locked in until the end of the calendar year.

Initial Enrollment Period

Once you become Medicare-eligible your initial enrollment period lasts 7 months and includes:

  • 3 months before the month you turn 65
  • The month you tun 65
  • 3 months after the month you turn 65

If you are becoming Medicare-eligible due to a disability you also have a 7 month window which includes:

  • 3 months prior to your 25th month of disability
  • Your 25th month of disability
  • 3 months after your 25th month of disability

It’s in your best interest to submit an application prior to the month that you get Medicare. You want your Medicare Advantage plan and Medicare to begin at the same time.

Annual Election Period

You can enroll in, switch or drop a plan during the Annual Election Period.

This election period begins on October 15th and continues through December 7th.

Companies can make their plans publicly available and begin marketing on October 1st, although they cannot accept an application until October 15th.

Submitting an application early in the enrollment period will increase the likelihood that you will have your card by the time your plan becomes effective on January 1st.

Special Enrollment Periods

Normally you must remain enrolled in a plan for the calendar year, but there are some times when you can make plan changes. These time are considered to be Special Enrollment Periods and are generally triggered by your special circumstances.

Some common Special Enrollment Periods include:

  • You move out of the plan’s service area
  • You are enrolled in your State’s Medicaid program
  • You receive extra help (Part D subsidy)
  • You live in a nursing home

Enrollment period time frames vary depending on the reason for the Special Enrollment Period.

5 Star Special Enrollment Period

Medicare rates all plans from 1 to 5 stars. From December 8th through November 3oth you are able to enroll in a 5 star-rated plan.

You are allowed to make one change per year.

Medicare Annual Dis-Enrollment Period

If you have enrolled in a Medicare Advantage plan and feel that the plan will not suit your needs (or for any reason) you are allowed the opportunity to cancel that plan.

The dis-enrollment period begins on January 1st and continues through February 14th.

If you exercise this option you will return to original Medicare. You cannot choose another plan at this time.

You can enroll in a Part D plan and submit an application for a Medicare supplement policy if you choose.

You will more than likely be subject to Medical underwriting and there is the possibility that you will not qualify.

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Training 5: What is Medigap and How to Shop for It

Medigap important points

In Part 1 we indicated that Medigap is a separate type of plan from a Medicare Advantage plan.

Medigap is the official name for a Medicare supplement. Indeed, Medigap, Medicare supplement, supplemental and most commonly, supplement mean the same thing.

Here are the important points contained in the definition.

  • Sold by Private Companies

  • Doesn’t Work with Other Insurance

  • Fill the Gaps by Paying Your share of Cost for Covered Services

http://affordablemedicareplan.com/mini-course-part-5-what-is-medigap/

Medicare basics – your share of expenses

To understand how a Medigap policy helps fill the gaps in original Medicare we first need to look at your share of the costs for covered services.

Medicare requires you to pay:

  • Part A Deductible & Coinsurance
  • Part B Deductible
  • Part B Coinsurance – 20%

These costs can add up to a lot of money and there is no annual out-of-pocket maximum.

Medigap Facts

  1. Medigap plans are standardized. Basic benefits will be identical for all plans designated by the same letter (i.e. Plan F or Plan G). The only difference between plans is how much the premium is for basic benefits. There is an exception for plan available in Massachusetts, Minnesota and Wisconsin. Those States have their own version of standardized plans.
  2. You can choose your own providers and are not usually subject to network restrictions. The exception is with a Medicare select policy where network usage is required.
  3. You cannot be cancel due to your claims or a change in your health. You will be canceled if you stop paying your premiums. Other than that the only other time is if the company ceases to offer plans.
  4. Part D is not included. You will need to enroll in a stand-alone Part D plan.

Additional, plans will generally only pay for services that are covered by original Medicare. Some plan will include some extras, normally a discount for vision or gym memberships generally offered through a membership like AARP.

You should choose a plan on how well it will pay for your share of Medicare-covered expenses, how much the premium is and put less emphasis on any extras.

One thing is for sure… shopping for plan is easy. Much easier than shopping for a Medicare Advantage plan. Medigap standardization really simplifies finding a plan.

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Selling Medicare over the Phone

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