Fraudsters can make a lot of money off of Medicare fraud, which poses a big problem for Medicare enrollees and taxpayers alike. If thieves get their hands on your Medicare number, they can be worth a lot of money. With these numbers Medicare can be billed for services that never even happened. Then the thieves keep the money for themselves. And taxpayers are the ones that pay. The more money that goes towards false health care claims, the less money there is for real health care needs. In the long run, this can lead to higher premiums and stricter rules for Medicare enrollees. So, to help you avoid these scams let’s look at the most common scams and how to avoid them.
Billing Scams
These scammers network with crooked medical professionals who will bill Medicare for services or medical equipment that they never gave. Scammers can also pretend to be a hospital or medical office and send you a fake bill. They count on the chance that you will pay any bill you get without double checking it against your medical records. So, it’s important to keep track of how you use your Medicare. If you have Original Medicare (Parts A and B), every 3 months you will receive a Medicare Summary Notice (MSN). Or if you have Medicare Advantage, you will get a monthly Explanation of Benefits (EOB).
The MSN and EOB are not bills, instead they are an itemized list with information about Medicare services charged under your Medicare number during those time periods. Specifically, they include how much Medicare paid for your care and how much you owe. If you get a bill that doesn’t match your MSN or EOB, or if the MSN and EOB show services you didn’t receive it could be a scam and you need to contact Medicare to report it.
In-Person Scams
Sometimes these scammers will come directly to your home pretending to be from Medicare or a healthcare company working for Medicare. Be wary! They might try to sell you a service or offer “free” services to get your attention. This is just an attempt to get your personal information. Medicare will never send someone to your house to sell you anything.
Any home health services covered by Medicare will be scheduled ahead of time. Things like nursing care and physical therapy will always be scheduled, you will be expecting them. They will also never ask you about your finances or any personal information as their company will already have all of your information on file.
Phone Scams
Medicare will never call you unless you’ve specifically requested a phone call. If the Social Security Administration needs more information to process your Medicare application they will first send you a letter to set up a time to talk to you on the phone. Other than that the only calls you can expect from Medicare are ones you have personally set up by either requesting a call in writing or by calling 1-800-MEDICARE (1-800-633-4227).
Even when you do get a formal Medicare call (which is rare), they will never ask for credit card or banking information. Scammers will typically try to get you to share this information, as well as your Social Security and Medicare numbers. Don’t share this information with anyone. To keep yourself safe, make sure you know who is calling you. To be extra sure, you can tell the caller that you will call Medicare directly to handle whatever the problem is. This way when you call you know the number is actually Medicare.
Marketing Scams
Medicare Open Enrollment runs from October 15th to December 7th every year. Seniors will get a lot of mail about different Medicare plans at this time of year. Some of this information may be legitimate, but some can also be scams. It’s important to separate fact from fiction. If you are new to Medicare, the best way to make sure that you’re getting real information is to use the Medicare Plan Finder. This is the official government site that has all the information about available MEdicare plans.
An even better way to confirm all the information is real is by working with a licensed agent, such as EZ. You can make sure they are real by checking credentials with the National Association of Insurance Commissioners, and remember, never give out information to anyone calling unsolicited.
Email Scams
Spam emails are another way that people try to get your Medicare number or other personal information. The email might say it comes from a doctor’s office, a state or local health agency, a hospital, or the Centers for Medicare and Medicaid Services. The email scam could come in many different forms, such as a request for personal information because you need a new Medicare card or because changes to Medicare mean you should get money back.
No matter what the reason, it’s not right. Nobody from the government, a service provider, or an insurance company will ever send you an email asking for your Medicare number, bank account information, or other personal information. Again, the best thing to do is to close the email without replying or clicking on any of the enclosed links. If you want to know if the email is legitimate, you can call 1-800-MEDICARE or the number on the back of your card.
Tips To Avoid Medicare Scams
There are a handful of ways to avoid Medicare scams. We’ve briefly mentioned them above but here’s a full look at tips to keep you safe.
1.Protect Your Medicare Card
Your Medicare card is just as important as your Social Security Card. Just like you’d never keep your SS card out, do the same with your Medicare Card. Never give your Medicare number out to anyone who isn’t your doctor or an authorized Medicare agent.
2. Be Wary Of Phone Calls
If a government agency or insurance company needs to confirm information, especially sensitive information like a social security or Medicare number, they will send you a letter. Uncle Sam doesn’t make phone calls to people who haven’t asked for them. The Social Security Administration, the IRS, or Medicare will only call you if you have already talked to them and given them permission to call you again. And if Medicare really does call you back, they already have your Medicare number and other personal information on file.
3. You Don’t Need To Activate Your Medicare Card
Scammers often pretend to be from Medicare to get you to “activate” your Medicare card for a fee. Your Medicare card is not a debit card. There is no activation needed to use it and you’ll never have to pay to use your Medicare card.
4. Medicare Reps Are Not Salesmen
Medicare will never contact you trying to sell your services or plans. Your Medicare is something you seek out on your own; they do not try to sell you specific services. The only people that should recommend medical services or products is your doctor.
5. Analyze Medicare Statements
Medicare or your private insurance company sends you claims summary statements with information about the health care you have received. Pay close attention. It’s important to make sure you get all the services and goods that are provided. Report anything you think might be a mistake.
Reporting Medicare Fraud
If you think something is wrong with a Medicare bill, you should first call your doctor, provider, or the facility to see if there was a mistake. You might also want to talk to the people in charge of billing. If you have Original Medicare and are still worried, you can talk to the Medicare Administrative Contractor (MAC). Your Medicare Summary Notice (MSN) has information about the MAC, which is the company that handled your Medicare claim. You can also call 1-800-MEDICARE (1-800-633-4227).
If you are still worried and have a Medicare Advantage Plan, you can talk to your plan directly. The phone number for your plan should be on the back of your benefit card and on your EOB (Explanation of Benefits. To report fraud, call 1-800-MEDICARE (633-4227), the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477). If you don’t want to, Medicare won’t use your name in an investigation.
Let EZ Help
Medicare is great, but sometimes it can be hard to understand. Even after signing up, you’ll still have to make some decisions about your health care. Don’t worry. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you. EZ can help you enroll, buy a Medicare Supplement Plan, or just think about your options. Our insurance agents work with the best firms in the country. You can get a free comparison of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our licensed agents at 877-670-3602 to get started.
Does Medicare cover assisted living? The simple answer is no. Medicare does not fund assisted living, which provides housing and custodial services including laundry, cooking, medication management, and other daily living activities for older people or those with disabilities eligible for Medicare. However, it will cover some services such as skilled nursing facilities and some home health care services.
As you get older, you may need help doing things like taking a shower or getting ready. A study showed that 1 in 5 people over the age of 85 in the U.S. need or get extra help with everyday chores. If you find it hard to live on your own, you might want to look into an assisted living center. Different from nursing homes, these facilities give older people the personalized care they need and let them keep their own living area. If you have Medicare, it’s important to know what your plan covers and how much money you may have to pay out of pocket.
What Is Assisted Living?
Assisted living is a place to live for older people or people with disabilities, such as amyotrophic lateral sclerosis (ALS) or end stage renal disease(ESRD), who need help with some daily tasks and access to medical care when they need it. People in this situation or their families may choose assisted living homes so that they can get help from professionals. People who live in assisted living may need ongoing medical care and skilled nursing services.
Assisted living is a step below a nursing home or skilled nursing facility in terms of the amount of care it offers. State rules, which vary from state to state, govern them. Assisted living usually gives people more freedom and costs less than care in a nursing home, but it is more expensive than a place for independent living. Assisted living is more like a home than a hospital, while a nursing home is more like a hospital. People who can’t live on their own but want to keep as much freedom as possible can benefit from assisted living.
The Difference Between Assisted Living and Skilled Nursing
Assisted living communities are more like homes, whereas skilled nursing facilities and nursing homes are more clinical like hospitals. Skilled nursing facilities provide a higher level of medical care and, in some cases, may be covered by Medicare. Most assisted living communities focus on giving personal care rather than medical care like helping you bathe, eat, and get dressed.
As long-term care assisted living centers are not covered by Medicare because they are considered custodial care, but Medicare will pay for any health care costs that add up while the person is living in an assisted living home. These health care bills that can be covered include things like medicine and medical equipment. Most of the time, Medicare will only fully pay for skilled medical care or short stays in a skilled nursing facility. Hospital insurance is covered by Part A of Medicare. For example, if you need care while healing from surgery and it’s not the only thing you need, it will be covered.
In some cases, the same company might run both an assisted living community and skilled nursing facility in the same building or on the same property. How Medicare pays for your care depends on what kind of care you are receiving in one of the hybrid facilities and if you meet certain criteria.
Skilled Nursing Criteria
For Medicare to cover skilled nursing care:
You must have just come out of a hospital stay of at least 3 days and still have covered hospital days left in your benefit period.
Your doctor has to prescribe this level of care.
The reason you are in skilled nursing is because of the same condition you were in the hospital for or the condition stems from being in the hospital, such as you picked up an infection while in the hospital.
The skilled nursing care has to be considered medically necessary.
If you meet all of these criteria, Medicare will fully cover your first 20 days of residential care. From days 21 to 100, you would have to pay up to $200 a day in coinsurance. If you have Medicare Supplement, your share of the costs could be covered for up to 100 days instead of 20. Either way Medicare will not cover any part of this care after 100 days.
Will Medicare Advantage Cover Assisted Living?
Medicare Advantage has to cover at least as much as Original Medicare. However, Medicare Advantage is bought through private health insurance companies so any extra policy benefits will vary. Some Medicare Advantage plans do include benefits for home care services, but they don’t usually cover assisted living or other long-term custodial care. However, if you move to an assisted living community, Medicare Advantage will continue to pay for eligible medical costs like medications, surgeries, and appointments, just as it would if you were living at home.
Cost Of Assisted Living
In 2023, the average cost of living in an assisted living home is $4,774 per month or $57,288 for the year. The total cost of assisted living can be different based on the following:
How many hours of care you need, such as 24/7 or just a few hours a day.
What time of day you need care
Where the assisted living community is located
Which facility you choose
If you need additional services depending on your health
Generally, assisted living communities have varying levels of care. The more independent you are and the less care you need the cheaper it will be. Depending on the facility here are the costs associated with assisted living communities:
Rent
Medication management, or nursing care services
Special meal plans
Transportation
Events or activities
Move-in fees
Housekeeping
Laundry services
Unless you have long-term care insurance, you will have to pay for all of the costs of assisted living out-of-pocket. If you have long-term care insurance your policy may cover some assisted living costs if you meet certain requirements. Additionally, if you have access to Veterans Affairs benefits, check your plan to see if long term custodial care is covered and for how long.
Other Care Options
Medicare Part A pays for skilled nursing care, but only under certain circumstances and for a short time. With a few cases, it must be given less than seven days a week or less than eight hours a day for no more than 21 days. Some of the other types of care that Medicare might pay for are:
Home Care – Such as part-time or occasional help from a home health worker. Medicare does not, however, pay for care at home 24 hours a day, 7 days a week. It also doesn’t pay for maid or custodial services like cleaning, bathing, or putting on clothes if those are the only things you need.
Hospice or respite care – Both of which Medicare pays for. Hospice cares for and supports people who are nearing the end of their lives. Respite care is a short stay in a hospital for hospice patients that gives their nurses a break.
PACE – Also known as programs of all inclusive care for the elderly. It is a Medicare/Medicaid program that helps people get the health care they need in their own communities so they don’t have to go to a care center. It pays for prescription drugs, doctor visits, help getting to and from the doctor’s office, home care, and if needed, stays in a nursing home.
Working With EZ
As you get older, you need to be able to take care of yourself. An assisted living center may be a good choice if you need extra help with everyday tasks. The cost of assisted living varies on many things, like the type of care you get, how long you need care, and where you live. Original Medicare and Medigap (supplemental insurance) does not pay for personal care in an assisted living facility, but they may pay for other medically required services. A Medicare Advantage plan may cover more services, such as personal care, than a regular Medicare plan.
Since Medicare won’t usually cover the costs, you should think ahead and find other ways to pay for assisted living. Medicare is great, but sometimes it can be hard to understand. After you sign up, you’ll still have to make some decisions about your health care. Don’t worry about asking questions. Talk to an EZ person who can tell you what you need to do and explain everything to you. EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our certified agents at 877-670-3602 to get started.
Original Medicare does not have an annual limit on out-of-pocket costs, and 4.5 million Medicare recipients are expected to spend more than $5,000 each on out-of-pocket health care costs in 2023. This lack of financial protection, combined with the fact that Original Medicare doesn’t cover all medical costs, has led to a lot of people buying Medicare Supplement Plans. This is because Medicare Supplement Plans fill in those gaps in coverage and financial protection. But how do private health insurance companies determine your premium? Insurance companies who offer Medicare Supplement Plans use three different pricing methods: attained-age, issue-age, and community-rated. Knowing how these prices work, can help you compare Medicare Supplement Plans and find the one that works best for you.
The Pricing Methods
The method a company uses for pricing has a significant impact on the overall cost of a policy. These 3 ratings are each based on different factors. First, we have attained age rating, which is based on the age you are when you sign up for your plan and will increase as you age. Next is issue-age rating, this method also uses your age when you enroll to determine your premium, but it will not increase as you get older. Finally, there is community-rated, which isn’t based on your age but instead is based on where you live. Below we’ve detailed each of these plans and how they work.
Community Rating
The costs of community-rated Medicare Supplement plans depend on where you live. No matter someone’s age, everyone pays the same premium for the same Medicare Supplement plan within their region, which is decided by the insurance company it can be by city or county. So, if you and your neighbor buy the same Medicare Supplement plan, your monthly premium will be the same even if you are 70 and your neighbor is 80.
Only a few states offer Medicare Supplement plans that are rated by the community. Maine, Vermont, Massachusetts, Connecticut, New York, Arkansas, Minnesota, and Washington are some of these states. States that don’t offer community-rated plans may charge you a higher premium based on your age, depending on whether they offer attained-age or issue-age-rated plans at enrollment. Most of the time, community-rated plans have the least expensive premiums, but rates may be different depending on where you live, whether you live in a city or a rural area, among other things.
What States Have Community-Rated Medicare Supplement Plans?
In these eight states, the monthly premiums for Medicare Supplement policies must be based on the community rating:
Arkansas
Connecticut
Massachusetts
Maine
Minnesota
New York
Vermont
Washington
Issue Age Rating
The premiums for issue-age-rated plans are based on how old you are when you sign up for coverage, similarly to attained age but they do not incrementally increase with age. For example, if you sign up for a plan at 65 your initial premiums will be less than if you signed up at 75. Most of the time, issue age plans also raise rates every year, but the rate increases are not based on your age like attained-age premiums are. Instead, they raise based on inflation and other factors that affect health costs.
If you sign up for this type of plan when you first become eligible to buy a Medicare Supplement plan, it costs less in the long run than plans for people who are older. But you should be aware that issue-age-rated plans start with higher premiums than attained-age-rated plans.
The issue-age method is used to rate Medicare Supplement insurance policies in the following states:
In these states, however, carriers may opt to use community ratings instead through an appeals process.
Attained Age Rating
Most of the time, Medicare Supplement insurance companies use attained-age rating models. The age when you sign up for the plan is used to figure out how much your premiums will cost. The younger you are when you enroll the lower your premiums will be. But these premiums are not locked in for life, as you age they will increase. For example, if you’re 65 years old, the premium for a certain Medicare Supplement plan might be $130, but if you’re 75, the same plan might cost $170. Generally, rates go up by a small amount each year or at a designated time. These rate increases are generally decided by state health insurance agencies.
Some states, like Massachusetts, Minnesota, and Wisconsin, have different rules for coverage as well as different Medicare Supplement Plans available. While those states have different plans they do all offer the same benefits they just operate in slightly different ways and have different names. If you live in one of these states, you can look at our state-by-state Medicare Supplement guide to find out exactly how your plans will be priced.
States that Offer Attained-Age Medicare Supplement Plans
No state requires carriers to offer Attained-Age Medicare Supplement plans. However, any state that is not required to specifically use a certain method is allowed to offer attained-age plans. There are many states that offer this pricing method but they can also offer any of the other methods as well. These states are:
Choosing Between Attained Age, Issue Age, and Community Rating
When choosing between attained-age, issue-age, or community-rated plans, there are a few things to think about, such as:
Your medical needs as a whole
Costs and benefits of the plan
Your age
The plan provider’s reputation
Premium cost rate projections
Different states have different levels of protection for Medicare recipients who want a Medicare Supplement plan. One such right to be on the lookout for is ‘guaranteed issue’ protections. With these rights, a Medicare Supplement insurance company can’t turn you down if you meet certain requirements. Such as, you suddenly lost a group health plan that covered your Medicare cost-sharing, You disenrolled from Medicare Advantage within 12 months of enrolling, or if your previous insurer no longer offers your Medicare Supplement Plan or commits fraud. They also promise to cover pre-existing conditions and won’t raise your premiums too much because of your health.
The easiest time to join a Medicare Supplement plan is during your six-month Medicare Supplement Open Enrollment Period, which starts when you sign up for Medicare Part B. After this initial enrollment period, Medicare Supplement plan providers can turn you down for coverage if you already have a health problem.
For example, if you drop your Medicare Supplement attained-age-rated coverage because it’s too expensive, you might not be able to buy another Medicare Supplement plan unless your state has continuous guaranteed issue rights or you meet other requirements. The states that have continuous guaranteed issue rights are Connecticut, Maine, Massachusetts, and New York. Continuous guaranteed issue rights mean that all Medicare Supplement providers must sell policies at least once a month or all year long.
Before you sign up for a Medicare Supplement plan, it’s important to know the rating category so you can figure out how much your long-term premiums will cost.
What Else Affects Medicare Supplement Plan Costs?
Medicare Supplement premium prices can be affected by a number of other things. Rates can be affected by things such as the rate of inflation, the state you live in, the cost of health care, and your lifestyle. Lifestyle factors can include choices like smoking or drinking.
The plan benefits that you want to include will also affect the price of your plan. The cost of the plan will be higher if it has more benefits. Your premiums will be less if you choose a plan with a higher deductible. In order to choose the best plan, you should carefully look at your health care needs and how much each plan will cost in the long run.
How To Lower Medicare Supplement Plan Costs
There are other ways to lower your Medicare Supplement premiums besides researching your options and comparing different insurance companies, such as:
High deductible plans – This could be a good choice if you are in good health and think you could pay more for the few claims you make.
Getting a plan for your partner – Some companies give a Medicare Supplement Household Discount to couples who both buy Medicare Supplement policies from them.
Bundling – Companies may lower the cost of your Medicare Supplement premiums if you buy another type of insurance from them, like life insurance.
It’s important to understand your pricing plan, whether you’re signing up for Medicare Supplement for the first time or you already have a policy. As a customer, if you know how companies charge for their services, you can make better decisions about what to buy. Be sure to do your research, and you might be surprised by how much you can save.
Working With EZ
If you are in the market for a Medicare Supplement Plan, one of the most important things you can do is compare the various plans’ premiums and benefits. This can require a significant amount of research, which can take a notable amount of time because you will need to call a number of different insurance companies in order to get quotes.
However, if you collaborate with an EZ agent, you can reduce the amount of time it takes to compare prices by 50%. When you work with a licensed agent, you gain access to a centralized resource where you can compare the Medicare Supplement Plan offerings of multiple insurance companies.
In addition to providing you with price comparisons, your agent can also explain the distinctions between the various plans. Your insurance agent will be able to assist you in comparing the out-of-pocket costs to the monthly premiums so that you can select the strategy that will save you the most money in the long run. Give us a call at 877-670-3602 to get started with your search for a Medicare Supplement Plan.
If you are a Medicare recipient or are about to become one, you may have noticed that Original Medicare (Parts A and B) does not cover all of your medical costs. Therefore, you will likely need a Medicare Supplement Plan to help cover out-of-pocket expenses. The good news is, you have plenty to choose from, there are 10 different plans available all with different levels of coverage. However, Plan G and Plan N are currently the most popular. Choosing between these two plans can be hard because they do have a lot in common, in fact they have more similarities than differences. It is essential to understand what each plan covers. Being misinformed can leave you with extra unnecessary out-of-pocket costs. So, let’s compare these plans so you can get an idea of which one fits you better.
What Both Plans Cover
Medicare Part A deductible– In 2023, if you are hospitalized for inpatient care, you have to pay the Part A deductible of $1,600 per each 60-day benefit period. The Benefits period restarts after you have been out of the hospital for 60 consecutive days. This is not an annual deductible, you could end up paying this deductible more than once in a single year. Having these plans cover this deductible means it’s not coming out of your pocket.
Part A hospital care and coinsurance – Part A partially covers hospice care leaving you copays or coinsurance. Certain prescription drugs will also have a copayment. However, you will be responsible for all of these copayments without a Medicare Supplement Plan that covers them.
Part B coinsurance – Medicare Part B requires a coinsurance payment for each covered service. Meaning Part B will pay 80% of the Medicare-approved amount for each covered service. Leaving you to pay the remaining 20% as your coinsurance payment (after you meet your annual Part B deductible). Plans N and G will both cover 100% of the Part B coinsurance.
Blood – If you need a blood transfusion for any reason, Original Medicare will only start covering the pints of blood after you have already paid for the first 3. Plans G and N will cover those first 3 pints for you so you’ll never have to pay for blood.
Skilled Nursing Facility Care – Medicare Part A will require you to pay a daily coinsurance if you are admitted for more than 20 days. As of 2023, your coinsurance could reach up to $200 a day. Thankfully, Plans G and N cover this coinsurance entirely.
Foreign Travel Emergencies – Typically, Original Medicare does not cover any medical care that you receive outside of the U.S. Plans G and N will both cover 80% of the costs of qualifying emergency medical care if you need it outside of the country.
What Neither of Them Cover
The only benefit that both of these plans will not cover is the Part B deductible. This is because of the Medicare Access and CHIP Reauthorization Act, or MACRA. This law altered Medicare with a modification to regulations that say plans are not allowed to offer any first-dollar coverage. This is also why Plans C and F are no longer available to new Medicare beneficiaries because both plans offered the Part B deductible coverage.
The Coverage Differences
Now that we know what benefits these plans both have in common, let’s look at the differences between them.
Benefits
Doctor Visit Copays – While Plan G will cover 100% of doctor visit copays, Plan N will not. With Plan N you will still have a $20 copay for each doctor’s visit. Therefore, if you visit your doctor fairly often this could really add up over the course of the year.
Emergency Room Copay – First, keep in mind that visiting the emergency room and being admitted are two different things. Just coming to the emergency room and then being released will cost you a $50 copay with Plan N. However, with Plan G there are no additional costs or copays for an emergency room visit.
Medicare Part B excess charges – Doctors and other healthcare providers can sign an agreement to accept “Medicare Assignment”. Which is essentially a fee schedule between Medicare and the provider saying that Medicare believes services should cost a specific amount and the doctor agrees to accept those prices. If the healthcare provider does not sign this agreement then they are allowed to charge up to 15% more than the Medicare-approved amount. That 15% is what is known as the Part B excess charge. Excess charges are one of the most significant coverage differences between Plan N and G as it could leave you with significantly higher medical expenses if it’s not covered. Plan G covers 100% of these excess charges whereas Plan N doesn’t cover them at all.
Costs
Cost is another difference, obviously even though the coverage differences are slight any plan with more benefits will be more expensive even if it’s only by a small margin. The price of Medicare Supplement Plans vary based on your location, age, and smoking status. In areas with higher costs of living, monthly premiums are generally more expensive. In general, Medicare Supplement Plans are priced in three ways: community-rated, issue-age-rated, and attained-age-rated.
Community-rated
Everyone, regardless of age, who has the same Medicare Supplement Plan pays the same monthly premium under this pricing structure. Your premiums may increase due to inflation and other factors but never due to your age.
Issued-age-rated
With this structure, your Medicare Supplement Plan premium is baked on your age at the time you purchase it. The younger you are the lower your premiums will be, and they will not increase with your age. Just like with community-rated, these plans will only ever become more expensive due to inflation and other outside factors but not your age.
Attained-age-rated
This type of pricing will calculate your premium based on your current age and does increase as you get older. Your premiums will be lower when you’re younger, but will steadily rise with your age. Increases can also happen due to inflation and other factors as well as your age.
Having Said that Plan G premiums range between $100 and $300 on average. Now, if you’re interested in a Plan G plan but the premium is a bit too expensive there is an alternative. Plan G also has a high-deductible version that offers all the same benefits with a lower premium. In exchange for the lower monthly cost you have to meet a higher deductible than you would with the standard Plan G. As for Plan N the average premium is between $120 and $180 as of 2023. When you factor in all the variables that can affect your premium Plan N can cost as low as $70 or be as expensive as $400.
So Which One Is Better?
The answer to this all depends on you. But in our opinion Plan G is the most valuable. Compared to Plan N, it provides the most coverage and saves you a significant amount of money. However, if you don’t need to visit your doctor frequently, you may easily be better off with Plan N. Overall if you’re a healthy person on a tight budget Plan N does have fantastic benefits. Although, even if you only visit the doctor a few times a year, Plan G does offer that extra bit of protection for only a little bit more money. With Plan G the only out-of-pocket Medicare cost you have to worry about is the $226(2023) Part B deductible.
How To Enroll
The best time for you to enroll is during your Medicare Supplement Open Enrollment Period. This is because if you enroll during this time you automatically receive guaranteed issue rights. Meaning you can’t be denied coverage or charged more due to your health or any pre-existing conditions. You only get one Medicare Supplement Plan Open Enrollment Period, so it is important to make use of it while you have it. The Medicare Supplement OEP begins once you turn 65 and enroll in both Medicare Part A and Part B; it continues for 6 months.
Need Some Help?
Financial planning and figuring out which benefits you need and don’t need can be time-consuming and frustrating. That’s what EZ.Insure is here for. A Medicare agent can do all of that research and compare plans for you. As well as take the time to get to know your budget and explain everything that will affect you personally. This means you’ll have professional help ensuring you get the best coverage. EZ.Insure provides you with your own personal agent. You’ll never have to worry about bouncing from agent to agent, yours will always be there to answer your questions, compare plans, and enroll you all for no extra cost. They can even help you after you’ve enrolled by reviewing your coverage annually or helping submit claims. To get started with your agent today simply enter your zip code in the bar below or give us a call at 877-670-3602.
Medicare Supplement Insurance fills in the “gaps” left by Original Medicare by paying for things such as copayments, deductibles, and coinsurance. A high deductible choice is available with some Medicare Supplement policies. The premiums for high-deductible Medicare Supplement Plans are lower than those for regular plans, but the coverage threshold is higher. If the premium difference between the high-deductible and the standard plan is small, then the high-deductible plan may be more cost-effective.
Which High Deductible Medicare Supplement Plans Are Available?
Both Plan F and Plan G have a version with a high deductible. Beneficiaries who became eligible for Medicare after 2020 will no longer be able to get Plan F, or its high deductible option. But anyone can sign up for Plan G with a high deductible.
The only exception is in Massachusetts. Massachusetts is one of 3 states who standardize their Medicare Supplement Plans differently than the rest of the country but they do have the same benefits. In Massachusetts there are only 3 plans available and none of them are high deductible plans.
How Do High Deductible Medicare Supplement Plans Work?
In the majority of states, residents can choose from one of 10 different Medicare Supplement Plans designated by letters. The government sets the benefits for each type of plan. High-deductible options are limited to Plans F and G. The only difference between the standard and high-deductible versions of these Medicare Supplement Plans is the date on which coverage will begin. While standard plans pay for their benefits right away, high deductible plans don’t begin paying for them until the annual deductible is met.
What Do High Deductible Medicare Supplement Plans Cover?
The high deductible versions of Plan F and Plan G cover the same things as their standard counterparts. Plan F is the most popular Medicare Supplement plan and has been for a long time, even though it is unfortunately discontinued. Your only out-of-pocket expense with this plan is the monthly premium for Plan F, as it covers everything else. It covers:
Deductibles for Medicare Part A and Part B
Medicare Part A and Part B coinsurance or copayments
Medicare Part B excess charges
Skilled nursing facility coinsurance
Foreign travel emergency expenses up to plan limits
Since Plan F was discontinued, Plan G has become extremely popular among Medicare beneficiaries and is now among the most widely selected Medicare Supplement Plans. Plan G is the most affordable Medicare Supplement plan and helps fill in the gaps that Original Medicare doesn’t cover. Plan G covers:
Medicare Part A deductible
100% of hospice copayments and coinsurance
Additional foreign travel emergency benefits
100% of Medicare Part B excess charges
How Much Do High Deductible Medicare Supplement Plans Cost?
With a high-deductible Medicare Supplement Plan, you are responsible for both the premiums and the deductible. In 2023, the deductible for high-deductible Plan G and Plan F is $2,700, however it changes yearly. The plan’s premiums vary from person to person. According to Medicare.gov, the premiums for Medicare Supplement Plans are determined by private health insurance providers and can vary depending on a person’s age, gender, geographic location, tobacco use, and health history.
The premiums for high-deductible Medicare Supplement Plans are lower than those for standard Medicare Supplement Plans because members are responsible for paying the deductible before the plan begins paying for covered services. A new Medicare beneficiary of age 65, for instance, may be charged $105 per month for the standard version of Medicare Supplement Plan G, while the high-deductible version may cost only $35 per month from the same insurer. As you get older, the premium gap between the regular and high deductible plans can widen. A Medicare recipient who is 85 might pay $195 per month for Medicare Supplement Plan G, with a low deductible and $60 per month for a high deductible version of the same plan.
Advantages and Disadvantages of High Deductible Plan G
The best thing about a high-deductible health plan is the low monthly premium. People who think they will only need preventive care can save a lot of money. Also, once the deductible is paid, the benefits are the same as with plan G.
A disadvantage of the High-deductible Plan G is that you have to pay the Part B deductible for Medicare for non-hospital care. Also, you don’t get insurance benefits until you’ve paid your annual deductible. Every year, these deductibles start over and usually go up. And, you’ll have to pay the Part B coinsurances until your deductible is met.
Advantages and Disadvantages of High Deductible Plan F
Unfortunately Plan F is no longer available to anyone you became eligible for Medicare on or after January 1st 2020. This is because the Medicare Access and CHIP Reauthorization Act of 2025 included a change that says Medicare Supplement Plans can not cover the Part B deductible. However, if you were eligible before that date or already had Plan F you are still able to keep or purchase it.
As with any option with a high deductible, the main benefit of a high deductible is a lower premium. Once the deductible is paid, the benefits are the same as Plan F. The biggest problem is that if health problems worsen, they can lead to an increase in medical bills. Also, the deductible can change every year, which makes it hard to plan for medical costs in the future.
Is A High Deductible Medicare Supplement Plan Worth It?
When the combined cost of your premiums and deductible is less than the premiums for a standard Medicare Supplement plan, the high-deductible plan makes more financial sense. There are three things you’ll need to consider.
1. If You Can Meet The Deductible
If you’ll spend enough on coinsurance, copayments, and deductibles to meet the Medicare Supplement deductible for a high-deductible Medicare Supplement plan, you should compare quotes to see which one is the most cost-effective. For the high-deductible version to cost less than the standard option, the lower premiums must be more than enough to cover the extra cost of meeting the deductible- remember you have a high deductible. In 2023, the deductible for Medicare Supplement plans will be $2,700, which equates to $207.50 per month. For you to spend less on a high-deductible plan overall, its monthly premiums would have to be at least $207.50 less than those of a standard plan.
2. If You Can’t Meet The Deductible
When you are reasonably confident that you will not be able to meet the deductible, selecting a Medicare Supplement plan with a high deductible is not the best option for you. If you have expenses that are lower than the deductible, the plan will not pay for any of the services that you receive. You are, in all respects, not compensated in any way for the premiums that you pay.
3. If You’re Unsure If You Can Meet The Deductible
If this describes your situation, one way to figure out whether or not a high-deductible Medicare Supplement plan is right for you is to evaluate your current financial standing. Then determine how much money you have available to pay for out-of-pocket medical expenses. When you do not end up meeting the deductible, you will not only be responsible for the cost of the premiums, which are typically quite affordable. But you also run the risk of losing coverage that is available with a standard Medicare Supplement plan. If you are able to meet the deductible, you will be covered from that point. Which will help you limit the amount of money you will have to pay out of pocket in the event that you face unexpectedly high medical costs.
Alternative Options
Another choice for Medicare Supplement coverage that could help you save money on your monthly premiums is the Medicare Supplement Plans K and L. A cost-sharing benefit and out-of-pocket spending caps are included in these plans. A Plan N could be beneficial to you if you want more coverage than what is offered by those two options. In exchange for a few copayments, participants in Plan N pay a premium that is marginally lower than the standard Plan G or Plan F premium.
One more alternative to consider is enrolling in a Medicare Advantage plan. Because the monthly payments are so much more affordable. On the other hand, considering the ongoing out-of-pocket costs that come in the form of copayments and coinsurance, a Part C plan might end up being more expensive in the long run.
Sign Up With EZ
Whether you’re looking for a high-deductible plan or something else, we can help you choose the right policy. We’re here to make it easy for you to weigh your options and choose the most beneficial arrangement possible. Working with an EZ agent will cut down time spent shopping around. You can compare and contrast numerous Medicare Supplement Plan providers and plans by working with a licensed agent. In addition to providing you with cost comparisons, your agent can explain the nuances between the various plans. Furthermore, your agent can assist you in comparing premium costs to out-of-pocket expenses to help you choose the most economical plan. Get started on your search for a Medicare Supplement Plan by calling us at 877-670-3602 right away.
Medical underwriting is a process health insurance companies use to decide how risky you are to insure and how much your premium should be. If you’re eligible for Medicare and want to also add a Medicare Supplement Plan to your Original Medicare coverage, the private insurance company you choose may require you to go through underwriting before you can buy your policy.
Underwriting can be complicated, and each insurance company handles it differently. To help you understand we will go into detail about why companies underwrite, how it works, and when it applies. We’ll also talk about health conditions that will get your application turned down so you know what steps to take if you are.
Underwriting Basics
Underwriting is how insurance companies find out about your health and decide if they want to take on the financial risk of insuring you. It requires a thorough look at your health history, both on the application and in a follow-up phone interview. If a company thinks you have too many expensive health problems, they can refuse to cover you, limit your coverage, or raise your rates.
Insurance companies underwrite people to keep premiums and risks as low as possible and maintain stability. However, limiting access to Medicare Supplement Plans could mean that the people who need the extra coverage the most don’t get it. Logically, if a company takes on more people with expensive health problems, it will have to pay out more money for claims. To make up for the difference, the insurance company would either charge higher premiums or not let those people on the policy at all.
The federal government sets standards for the different types of Medicare Supplement plans and gives enrollees some protections in the form of guaranteed issue (GI) rights, but they have no control over how insurance companies decide who to accept as a customer. Carriers don’t always agree on what makes an applicant uninsurable.
What Triggers An Underwriting Process
If you want to switch from one Medicare Supplement Plan to another, or switch from Medicare Advantage to Original Medicare and you’re not eligible for IEP, then you’ll trigger the underwriting process. You’ll have to answer a lot of questions about your health. The insurance company can also send you to a doctor or nurse for a medical exam to get a better picture of your current health.
You can change from one Medicare Supplement Plan to another any time of year, but you’ll have to be in good enough health to pass underwriting. To return from a Medicare Advantage (MA) plan to Original Medicare with a Medicare Supplement Plan, you’ll have to wait until the Medicare Annual Enrollment Period, from October 15 to December 7, and pass underwriting.
Underwriting Timeline
Underwriting takes time, so we recommend sending in applications two to three weeks before the date you want the policy to start. This will give the underwriter time to look over the application and talk to you on the phone. We’ve found that the underwriting process takes, on average, between seven and ten days, but it could take as little as one day or as long as thirty days. If underwriting takes longer than expected and your application doesn’t start on the first of the month you asked for, the insurance company will either backdate it to the original start date or move it to the first of the next month automatically. If this happens, you should check in with the carrier in case you need the original start date, but the carrier automatically moves it to the next month.
Some companies have started using an auto-accept or auto-reject feature in their online applications, but this only works for clear-cut cases where there is no room for confusion. To get an automatic acceptance, an applicant would have to say “no” to every health question and be in great health. Applicants whose answers lead to a “maybe” will have to talk to an underwriter over the phone for further explanation and complete the underwriting process.
How Underwriting Affects Your Premiums
Depending on the carrier, the results of underwriting can cause premiums to increase. Some companies have less strict rules for underwriting, which means they accept applicants with worse health conditions but raise the premium to make up for it. Applicants with more health problems may be put in another pricing tier called “class” or “level.” Companies use this system to try to find a good balance between keeping premiums from going up too much and giving a lot of people access to the policy.
What Conditions Can I Be Denied For?
Companies that offer Medicare Supplement insurance are more likely to charge you a higher premium than to turn down your policy. However, they can still turn down your application. No matter which company you choose, you may not be able to get Medicare Supplement insurance if you have a certain health condition.
Some medical conditions that often lead to a denial are:
AIDS
Activities of daily living assistance
Alzheimer’s
Atrial fibrillation
Any history of cancer
Cirrhosis
Certain cognitive conditions
Certain medications
COPD
Congestive Heart Failure
Diabetes not under control with medications
End Stage Renal Disease
Heart attack
Implantable cardiac defibrillator
Kidney failure
Multiple Sclerosis
Nebulizer use
Parkinson’s disease
Organ transplant
Osteoporosis
Supplemental oxygen use
Stroke
It’s important to remember that each company has its own rules for underwriting. If one company turns down your application, another may be willing to take on the risk. Working with one of our licensed insurance agents can help you find a “guaranteed issue” policy or a company that will accept your application even if you have health problems.
How To Avoid The Underwriting Process
During certain times when you have guaranteed issue (GI) rights, you will be able to sign up for a Medicare Supplement Plan without having to go through underwriting. During a GI period, insurance companies must sell you a policy without considering your health or any pre-existing conditions. Your Initial Enrollment Period (IEP) is the first seven months after you turn 65, this is when you can sign up for Original Medicare without being penalized.
Your Medicare Open Enrollment Period (OEP) is usually part of your Initial Enrollment Period (IEP). This is when you have a GI right to sign up for a Medicare Supplement Plan. The OEP starts on the first day of the month that you start getting Medicare Part B. It lasts for six months, during which time you can sign up for any Medicare Supplement Plan letter with any insurance company, no matter how healthy you are.
In rare cases, you may be eligible for a Special Enrollment Period, which also gives you the right to a Guaranteed Issue, where you can change your policy without having to go through the trouble of underwriting. There are also parts of the underwriting process you can avoid such as the medical exam. Some states let you change your Medicare Supplement plan without having to go through a medical exam:
Guaranteed Issue is always the case with Medicare Supplement plans in Connecticut. In this state, you have to use community rating methods. But Connecticut is one of the states where Medicare Supplement costs the most.
Beneficiaries in Maine can switch to plans with the same or less benefits during the month of June without having to go through an underwriting process.
There is an anniversary rule that lets people change companies without having to go through underwriting for 62 days. Instead of your birthday, the time is based on the date of the policy.
beneficiaries in Washington state can switch from one policy to another at any time (except for Plan A).
Does Medicare Use Underwriting?
Original Medicare doesn’t use underwriting. The federal government gives this insurance to people over 65 or who have been on Social Security disability for at least 24 months. Underwriting is not used for Medicare Advantage plans or Medicare Part D drug plans. Anyone can sign up for these insurance plans. Keep in mind you can’t have both a Medicare Advantage plan and a Medicare Supplement plan at the same time.
Comparing Plans With EZ
When looking for a Medicare Supplement Plan, it’s important to compare the costs and benefits of each one. That means you’ll have to do a lot of research, which can take a long time since you’ll have to call numerous insurance companies to – receive price quotes. But if you work with an agent from EZ, you can compare prices in half the time. Working with a licensed agent gives you access to many Medicare Supplement Plan carriers and plans in one place.
In addition to giving you price comparisons, your agent can tell you how each plan is different. Also, your agent can help you compare out-of-pocket costs with premium costs to figure out which plan will save you the most money over time. Call us today at 877-670-3602 to start looking for a Medicare Supplement Plan.
The answer to this all depends on you. But in our opinion Plan G is the most valuable. Compared to Plan N, it provides the most coverage and saves you a significant amount of money. However, if you don’t need to visit your doctor frequently, you may easily be better off with Plan N. Overall if you’re a healthy person on a tight budget Plan N does have fantastic benefits. Although, even if you only visit the doctor a few times a year, Plan G does offer that extra bit of protection for only a little bit more money. With Plan G the only out-of-pocket Medicare cost you have to worry about is the $226(2023) Part B deductible.
California
New York