Original Medicare, which is made up of Medicare Parts A and B, pays for a portion of the health care services you may need. However, it does not cover the cost of everything, and you may have to pay some things out of pocket. Thankfully, Medicare Supplement plans can help with this. These plans fill in some of the “gaps” in Original Medicare and will help you save money in the long run by paying for certain Medicare deductibles, copays, coinsurance, and other costs. Two of the most comprehensive Medicare supplement plans are Plan F & Plan G. In order to decide if one of these plans might be a good fit for you, you will need to explore what they cover and how much they cost.
Medicare Supplement Plan F
Medicare Supplement Plan F is one of the most popular Medicare Supplement Plans because it offers the most coverage out of all of them. But unfortunately, it’s no longer available to everyone on Medicare.
When compared to the other Medicare Supplement Plans that are currently available, Medicare Supplement Plan F has the most benefits and fills the coverage “gaps” left by Medicare Parts A and B best. For a low monthly premium, this plan lets you go to a doctor’s office or hospital, get approved treatment, and leave without paying anything out of pocket.
Plan F also covers other Medicare-approved expenses that aren’t related to Parts A or B. This includes coverage for emergencies that happen while you’re traveling abroad and coinsurance for skilled nursing facilities. Plan F is also notable because it is one of only two plans that covers Medicare Part B excess charges.
Plan F can only be bought if you had qualified for Medicare before December 31, 2019. Anyone who has become eligible after that date is unable to purchase Plan F. Even if you qualify, it can be a lot more expensive than other Medicare Supplement Plans, so you may end up spending more than the value of the extra coverage you’d get.
What Plan F Covers
As was said above, Medicare Supplement Plan F covers all of the services that Medicare Parts A and B cover, but with less out-of-pocket costs. If your doctor accepts Original Medicare and it is your main insurance, Medicare Supplement Plan F will cover everything that Original Medicare doesn’t. That includes:
Part A hospital deductible and coinsurance
Hospital costs up to an additional 365 days after Medicare benefits are exhausted
Part A hospice care coinsurance or copayment
Blood (the first 3 pints)
Other Medicare-approved expenses associated with Part A hospitalization
Medicare Part B 20% coinsurance and copayments
Medicare-approved doctor’s office fees
Part B deductible
Medicare Part B excess charges
Other Medicare-approved expenses associated with Part B coverage
Plan F Costs
Medicare Supplement Plan F may have higher premiums than other Medicare Supplement Plans, but that’s because it has the most benefits compared to the plans. Medicare Supplement Plan F costs about $230 per month on average, but premiums can be anywhere from $150 to $400 per month or more. This is because many things can affect the price of your premium, such as your zip code, gender, age, whether or not you smoke, and so on.
Medicare Supplement Plan G
Plan G is one of the best options for people who don’t qualify for Plan F. Medicare Supplement Plan G is a top choice for anyone who has Medicare. If you choose Medicare Supplement Plan G, your out-of-pocket costs will usually be a fraction of what they would be if you only had Original Medicare, since you will only be paying one low premium price. Then, once you’ve paid your annual Part B deductible, the rest of your health care costs for the rest of the year will be covered in full.
What Plan G Covers
Medicare Supplement Plan G covers a wide range of services and helps you save money when you use Medicare-approved medical services. As previously mentioned, one of the best things about Plan G is that it pays for all Medicare-related costs after your Part B deductible has been met. Many other Medicare Supplement Plans, on the other hand, require you to pay more out-of-pocket costs after you’ve paid your Medicare Part B deductible.
All of this means that because Medicare Supplement Plan G covers a great quantity, it helps you keep your out-of-pocket costs low. Here’s a breakdown of exactly what’s covered:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part A deductible
Part A hospice care coinsurance or copayment
Part B coinsurance or copayment
Part B excess charges (if a provider is permitted to charge more than Medicare’s approved amount and does so)
Blood transfusion (first 3 pints)
Plan G Costs
Plan G costs different amounts depending on where you live, your age, whether or not you smoke, and your gender. For example, the monthly premiums for Medicare Supplement Plans are usually higher in places where the cost of living is higher. So, the monthly premiums for Medicare Supplement Plan G are usually between $100 and $300.
How They Compare
Plan F and Plan G are two of the most popular Medicare Supplement plans that people who qualify for Medicare can choose from. Both plans cover costs in addition to what Original Medicare does, but there are some differences between them that you should think about when deciding which one is best for you. Looking above you’ll notice they cover a lot of the same things:
Part A deductible
Part A coinsurance
Part B coinsurance or copayment
The first three pints of blood used in a transfusion
Skilled nursing facility coinsurance or copayment costs
Hospice care coinsurance or copayment costs
Medicare excess charges (up to 15% more than the amount Medicare says a service is worth)
Foreign travel emergencies
Plan F covers the annual Medicare Part B deductible, but Plan G does not. This is the main difference between the two plans. Even though Original Medicare Part B deductibles are getting more expensive over time, it may still make financial sense to choose Plan G because it usually has a lower monthly premium than Plan F.
Plan F and Plan G have similar coverage, but Plan G is the most complete Medicare Supplement plan for new Medicare recipients. This is another important difference between the two.
Plans F and C are no longer available to new Medicare recipients because of new laws passed by the federal government. You can still apply for Plan F if it’s available where you live and if you were eligible for Medicare before 12/31/19. You are able to keep using Plan F if you obtained it before 2020.
Pros and Cons
As with all insurance options, Plan F and Plan G come with both advantages and disadvantages. So let’s take a look at what these are.
The pros:
Plan F is the best Medigap plan because it covers more Medicare-approved costs at 100% than any other plan. It also gives you the option of choosing a high deductible, which lets you pay lower premiums while still being covered for all approved costs once you’ve met your deductible.
Plan G covers almost all of the same approved Medicare health care costs as Plan F, except for the annual deductible for Medicare Part B. Before your insurance pays for Part B, you will have to pay for it out of your own pocket. Still, the premiums may be cheaper than Plan F, depending on where you live and how much coverage you want. Plan G also has a version with a high deductible that usually has even cheaper monthly premiums.
The cons:
Unfortunately, both plans don’t cover prescription drugs. Original Medicare recipients can add a Medicare Part D prescription drug plan, which only covers prescription drugs, or they can sign up for a Medicare Advantage plan (also called Medicare Part C), which covers their Original Medicare health benefits and may cover prescription drugs.
If you choose the version of either plan with a high deductible, you may have to pay more due to the need for more money up front before any coverage is able to begin.
FAQs
Which is better?
Plan F covers a little bit more than Plan G, but not by much. Its premiums and deductibles are higher than those of Part G. In the end, the best choice will depend on what you need and how much money you are able to spend. If you are thinking about either plan, you should talk to a Medicare agent to find out which one they feel is best for you.
Should I switch from Plan F to Plan G?
It can be a good idea to switch from Plan F to Plan G depending on your needs. If you switch to Plan G, which is usually less expensive than Plan F, you may save money on premiums. In the end, it depends on what you need and how much money you have. You can switch plans at any time, but if you don’t have “guaranteed issue rights,” the insurance company can use “medical underwriting” to figure out how much your premiums will be and may even refuse to cover you.
Why Is Plan F Discontinued?
Federal law says that Medicare Supplement plans can no longer pay for the Medicare Part B deductible. The goal of the change is to cut down on visits to the doctor that might not be necessary, which will save money on health care.
Working 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 be time consuming as you’ll have to call multiple insurance companies to get price quotes. However, 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. Or enter your zip code in the bar below to start looking for a Medicare Supplement Plan.
Part A (hospital insurance) and Part B (medical insurance) pay for a lot of your healthcare needs, but they are not able to cover everything. Before your insurance kicks in, you’ll have to pay a deductible. After that, you’ll have to pay other fees, like coinsurance, which is a percentage of certain costs. Also, Original Medicare doesn’t cover routine services like eye, dental, and hearing care, so you may be paying more out of pocket costs than you think. Some people buy Medicare Supplement Insurance or a Medicare Advantage plan (also called Part C) to help pay for these costs. The way each one works is a little bit different so you will need to compare them to help figure out which one might suit you best.
Medicare Supplement Insurance works with your Original Medicare plan. It helps pay for services that Part A and Part B don’t cover, like traveling outside the country and extra costs, such as when a doctor doesn’t accept Medicare. It can also help pay for your Part A deductible, which was $1,556 in 2022 and the 20% coinsurance you’ll have to pay for your Part B coverage. Keep in mind that Medicare Supplement Insurance isn’t a standalone plan, so you’ll need to sign up for Original Medicare first. Prescription drugs are another thing that Medicare Supplement doesn’t pay for, and you will need a third plan, Medicare Part D, for that.
Plans A, B, C, D, F, G, K, L, M, and N are the 10 different Medicare Supplement insurance plans that exist as of right now. Unfortunately, people who sign up for Medicare after January 1, 2020, will no longer be able to choose Plans C and F. Medicare Supplement plans cover 100% of your Part A coinsurance costs, which is the percentage you pay for services after you reach your deductible. Most plans also cover 100% of your Part B coinsurance and copayment costs.
If you choose Medicare Supplement, keep in mind that it will also cost you money every month. The amount depends on the plan, but each month it could be hundreds of dollars and some plans also have co-pays and deductibles.
How Much Does Medicare Supplement Cost?
How much you pay for your Medicare Supplement premium can depend on your plan, your age, and where you live. In general, the cost of your plan can go up the more coverage you choose. Some Medicare Supplement plans limit how much you have to pay out of your own pocket. For a clear idea of how much you’ll pay, check out our state-by-state Medicare Supplement Plan guides.
Medicare Supplement Eligibility
You’re eligible to buy a Medicare Supplement plan if you’re:
65 years old or older.
Have signed up for Parts A and B of Medicare.
Currently living in a state where the policy you want is offered.
In some states, even if you are younger than the age of 65, you can get Medicaid if you have a disability or end-stage renal disease (ESRD).
The Medicare Advantage (MA) plans are an alternative to Original Medicare. Private insurance companies are able to give them out. Under an MA plan, you’ll still get Parts A and B, but you may also get Part D and other benefits, like regular hearing, vision, and dental care, all in one policy. By law, Medicare Advantage plans cover the same kinds of care as Original Medicare. For example, hospital stays, doctor visits, and lab tests are all covered by Medicare Advantage plans. However, before the plan will pay for the costs, you may have to stay in the network or get a referral. You can choose any doctor who takes Original Medicare.
If you sign up for Medicare Advantage, your benefits will be handled by that private plan and Original Medicare will no longer cover you. You also won’t be able to sign up for a Medicare Supplement plan or a Part D plan that stands on its own. Many Medicare Advantage plans don’t charge a premium on top of what you already pay for Part B. You may still have a deductible, copays, and coinsurance, but most MA plans limit how much you have to pay out of pocket each year, this is known as the out-of-pocket maximum.
How Much Does Medicare Advantage Cost?
Premiums, deductibles, and other costs for Medicare Advantage can vary by plan and change every year. To stay in your plan, you must pay the Part B premium, which was $164.90 in 2023 and keep paying it. The out-of-pocket limit can also vary by plan, but once you reach it, the plan pays for all of your covered health services for the rest of the year.
Medicare Advantage Eligibility
To sign up for a Medicare Advantage Plan, you must:
Sign up for Parts A and B of Medicare.
Live in the area where the plan is available.
Be a U.S. citizen or are in the U.S. legally.
Comparing Medicare Supplement and Medicare Advantage
There are several ways in which Medicare Supplement and Medicare Advantage plans are different. A Medicare Advantage plan (Medicare Part C) is an all-in-one option with low monthly premiums. Medicare Supplement plans provide extra coverage on top of Original Medicare for little or no extra cost. Let’s take a look at all of the differences.
Coverage
Medicare Advantage includes Original Medicare Parts A and B, plus extra benefits like routine dental, vision, hearing, and fitness services. While Medicare Supplement Plans help fill in Original Medicare’s “gaps” by paying for out-of-pocket expenses that Parts A and B won’t cover.
Enrolling
There are specific enrollment periods throughout the year during which you are able to sign up for a Medicare Advantage plan or switch to a different one. After turning 65 and enrolling in Medicare Part B, you are eligible to apply for a Medicare Supplement policy at any point after that age.
Providers
You may be required to use hospitals and doctors that are part of the Medicare Advantage network if you have Medicare Advantage. You are free to visit any doctor in the country who participates in Medicare if you have Medicare Supplement Plans.
Referrals
Medicare Advantage plans are more likely to require referrals to see specialists, while Medicare Supplement Plans do not require referrals at all.
Costs
Medicare Advantage has lower premiums but includes copays. Medicare Supplement Plans have higher premiums, but little to no copays.
Prescription coverage
Medicare Advantage Plans may include a Part D prescription drug plan with your policy. With Medicare Supplement Plans you’ll have to enroll in Medicare Part D separately to get this coverage.
Underwriting
Medicare Advantage has no medical underwriting and includes coverage for any and all health conditions. Medicare Supplement plans also have no underwriting as long as you enroll during your IEP. If you don’t enroll during this time, there is a possibility you will face underwriting.
Switching From One to The Other
You can’t change from Medicare Supplement to Medicare Advantage whenever you want. You’ll have to wait until the Medicare Open Enrollment Period, which runs from October 15th to December 7th each year. Before you sign up for a Medicare Advantage plan, you should tell your Medicare Supplement insurance company that you are dropping it.
On the other hand, if you want to switch to Original Medicare and buy a Medicare Supplement policy, you should check with your Medicare Advantage Plan to see if you can drop out. If you can leave a Medicare Advantage plan and go back to Original Medicare, you can only do so during two enrollment times:
The Medicare Advantage Open Enrollment Period (MA OEP) between January 1st and March 31st.
The Annual Enrollment Period (AEP) between October 15th and December 7th.
You can usually sign up for a Medicare Supplement plan once you’re enrolled in Original Medicare. When you switch from Medicare Advantage to Original Medicare, you usually lose your right to “guaranteed issue” Medicare Supplement coverage. When you are 65 or older and signed up for Medicare Part B, you usually have guaranteed-issue rights for 6 months. If you don’t have guaranteed-issue rights, insurance companies may check your health status before they sell you a plan.
How To Choose
If you want to know what your costs will be, be able to choose any doctor, avoid referrals, and feel safe when traveling, then you will need a Medicare Supplement plan. If you are willing to trade a lower monthly premium and more benefits for copayments that can change, as well as strict doctor networks, and referrals, then Medicare Advantage may be a good choice for you. The best thing about working with agents is that no matter which option you choose, we’ll make sure it’s the best one for you.
Working With an EZ Agent
We don’t offer Medicare Advantage, but if you’re looking for a Medicare Supplement Plan, it’s important to compare the benefits and costs of each one. That means you’ll have to do an abundance of research, which can take a while since you’ll have to call a lot of insurance companies to get price quotes.
If you decide to 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.
Medicare Medical Savings Accounts (MSAs) are a special type of Medicare Advantage plan that combines a high-deductible health plan (HDHP) with a medical savings account. The HDHP portion is a type of health plan where you have to pay a large annual deductible before your coverage benefits kick in. Specifically, you are responsible for the full cost of any Medicare covered services until you meet your deductible. After you meet the deductible, your plan covers 100% of all covered services.
The savings account portion is a savings account set up by your insurance company. Medicare annually deposits a predetermined amount into the account. The amount varies depending on the plan you select but is always less than your HDHP’s annual deductible.
Just like other Medicare Advantage plans, MSAs are offered by private insurance companies that are approved by Medicare. These accounts are tax-free and allow for tax-free withdrawals for medical expenses. While similar, these plans differ from regular Medicare Advantage plans in several ways, which we will get into below.
How MSAs Work
You can immediately pay for medical services with your MSA. You are not required to wait until you meet your HDHP’s annual deductible to access it. In fact, money you use from the account on Medicare approved health services will actually help you meet that deductible. For instance, say you have an MSA plan with a $4,000 deductible and Medicare deposits $2,500 annually into your MSA. If you spend your $2,500 on Medicare-covered medical expenses, you’ll meet your deductible. Now suppose you spend the $2,500 in another way. Such as $1,500 on dental expenses and $1,000 on medical costs. Only the $1,000 will count towards your deductible. This means you now have to pay an additional $3,000 before your deductible is met.
However, there are some rules to the MSA account that you should keep in mind. For one you don’t deposit funds into this account, but you can withdraw them at any time. The account will accrue interest, and any money you don’t use will carry over into the next year. While funds you use for medical services are tax-free, any non-medical expenses could cost you. You may face a 50% tax penalty for non-qualifying medical expenses, and the money will be considered taxable income.
Qualifying Medical Expenses
While all qualifying medical expenses are exempt from federal income tax, not all of them count towards your deductible. Keep in mind that if you use your MSA for expenses that don’t count towards your deductible, you may have to pay more out-of-pocket before your HDHP provides coverage.
Qualifying medical expenses that count towards your deductible are generally inpatient and outpatient services that Medicare Parts A and B cover such as:
Hospital stays
Doctor visits
Durable medical equipment (DME)
Home health care
Skilled nursing care
Expenses that don’t count towards your deductible are:
Dental care
Vision care
Part D or other prescription drug coverage cost-sharing (premiums, deductibles, copayments, coinsurance)
To enroll in a medical savings account plan there are some eligibility requirements. First you have to enroll in Medicare Part A and Part B. This can be easy if you are receiving social security benefits because then you will automatically be enrolled in Parts A and B. Also, if you are eligible for Social Security or Railroad Retirement Board benefits (RRB) you don’t have to pay a premium for Medicare Part A. So basically, if you qualify for Medicare you can enroll in an medical savings account. You can enroll in an MSA plan unless:
You have health insurance that covers the Medicare MSA deductible. This includes benefits from an employer or union sponsored retirement plan.
If you get benefits TRICARE or the U.S Department of Veterans Affairs.
You’re a retired federal employee and participate in the Federal Employees Health Benefits Program (FEHBP).
You’re eligible for Medicaid.
You have End-Stage Renal Disease (ESRD), However you can still enroll in an MSA plan if you formally had a Medicare Advantage Plan and left Medicare and you haven’t joined another Medicare Advantage Plan yet.
You currently receive hospice care.
If you live outside of the U.S for more than 183 days a year in total, either consecutively or not.
Pros and Cons Of MSAs
Deciding whether or not to use an MSA is highly personal. You have to consider your current financial situation as well as any medical needs you need or anticipate needing in the future. Take a look below at the pros and cons list to help decide if this is the best plan for you.
Pros
If you are unable to afford the higher premiums of a traditional plan, the HGHP plans can prove to be a more cost-effective alternative. An MSA refuses total costs, creating a Medicare plan with several advantages, especially if you are in good health. You do not pay into this account so there are no additional enrollment fees. Additionally, funds roll over annually. So if you are in good health you have the opportunity to continue saving your MSA funds year after year. Thus creating a large healthcare fund for any emergencies. Finally, there is no tax penalty on funds you use for qualifying medical expenses. This allows you to spend the money on medical expenses without having to report it as income.
Cons
The most significant disadvantage of an medical savings account is the high deductible. If you don’t reach this deductible within the year you could be left with large medical bills that you have to pay out-of-pocket. Additionally, if you use the funds for non-medical expenses you face a severe tax penalty. Meaning you have limited financial flexibility in the event of a non-medical emergency.
Cost of MSAs
The premiums for these plans vary depending on your plan. Additionally you have to continue to pay your Medicare Part B premiums. Your out-of-pocket expenses will also vary based on your plan and how you use your MSA funds. Different plans have different deductibles, and Medicare deposits varying amounts of money into your account.
MSAs Vs. HSAs
In some respects, the concept of an MSA plan is similar to high-deductible health plans (HDHPs) and health savings accounts (HSAs). However HSA contributions come from your employer, you, or anyone else who wants to contribute to the account. Whereas MSA contributions come from your Medicare Advantage plan. The money comes from funds that Medicare allotts to you, meaning you cannot contribute to your own MSA.
You can then use the MSA funds to pay for medical expenses throughout the year. Your MSA withdrawals are tax-free as long as you use them for qualified medical expenses. You can also use the funds for non-medical expenses, such as groceries, rent or utility bills. However any non-medical withdrawals are considered taxable income and also have a 50% penalty.
Similar to HSAs, MSA funds that remain unused at the end of the year will roll over into the following year. If you maintain your plan then next year’s deposit will be added to the funds remaining from the previous year.
MSAs Vs. FSAs
An MSA is typically for Medicare recipients, while a flexible spending account (FSA) is typically for employees with optional coverage. Accounts for FSAs have a “use it or lose it” rule. Meaning the funds will not roll over. However, some plan administrators may provide brief grace periods at the end of a benefit year to give employees an extra chance to spend the funds. FSAs are not a great long-term savings option, even for those who can benefit from the tax savings they offer. Additionally, if you change employers, you will most likely lose your FSA. Unlike MSAs, FSAs typically do not allow you to use the funds for non-medical expenses.
When to Enroll
You can enroll in an MSA when you first become eligible for Medicare during your Initial Enrollment Period (IEP). This is the 7-month period that starts 3 months before you turn 65, including your birth month, and then comes to a close 3 months after you turn 65. If you are eligible for Medicare due to a disability, you can enroll 3 months before and after you’ve received at least 25 months of disability benefits. You can also enroll during the fall Open Enrollment Period, between October 15th and December 7th every year. If you enroll during this time, your coverage will start on January 1st.
Let EZ Help
If you’re interested in an MSA, EZ.Insure can help you compare options based on deductibles and benefits, such as vision and dental care. We will assign you with your own personal agent who can answer all of your questions and help you find the best plan while saving you money. Our help is totally free! To get your free instant quotes give one of our licensed agents a call at 877-670-3602 or simply enter your zipcode into the box below. Let us remove the hassle of shopping around and make it simple for you.
Medicare is an essential program for seniors over 65, however, many of its benefits are underutilized or misunderstood. Consider the annual “wellness” visit. During which a physician will assess your health risks, take your blood pressure and other routine measurements, test for cognitive impairment, and provide personalized health advice. It’s Free! Nonetheless, a surprising number of people do not take advantage of this benefit. This isn’t the only benefit that has gone under the radar. Many healthy seniors ignore a variety of free preventive services, ranging from bone density screening to cancer detection. Other benefits such as home health care, are also frequently unused due to their strict eligibility requirements. Below you’ll find all the ways to make sure you’re using all of your benefits and getting your money’s worth.
Choose The Right Doctor
It is important to choose a doctor who accepts Medicare assignments in order to save money. If a doctor accepts a Medicare assignment, they accept Medicare-approved amounts as full payment, and you cannot be charged more. Most physicians who treat Medicare patients will accept Medicare assignments. Providers who don’t participate fall into two categories:
Non participating providers – These providers can charge up to 15% more than the Medicare approved amount for covered services and leave you responsible for the additional costs
Opt-out providers – These providers can charge whatever they want which is outlined in a private contract with the patient.
To locate physicians in your area who accept assignment, visit Medicare.gov to find doctors and other health professionals section. The search tool displays which physicians accept Medicare payments.
If you have a Medicare Advantage plan, check your plan’s provider directory or website to ensure you’re choosing doctors in the network. Keeping in mind that doctors may be added or removed at any time. Generally, you will pay more to see non-network providers. Make sure that you research different doctors. Confirm that they accept Medicare and are willing to educate you on what is and is not covered so that you are not overcharged.
Understand Your Policy
Medicare provides coverage for skilled services such as nursing, speech therapy, and physical therapy, but there are eligibility requirements. To qualify for these services, you must be homebound. Meaning you are unable to leave your home without assistance or because of a medical condition. Many seniors mistakenly believe that they are covered for these services, only to receive a hefty bill in the end. Before assuming something is covered, carefully read your policy’s guidelines.
Look Into Medicare Advantage
Medicare Advantage plans are offered by private insurance companies and offer the convenience of having Part A, Part B, and Part D services all bundled into one plan. Whereas traditional Medicare has you sign up for each plan individually. Medicare advantage plans may also include coverage for routine dental, vision, and hearing exams. Which are not available under Original Medicare. However, the biggest benefit of Medicare Advantage is the annual out-of-pocket maximums for seniors excluding
prescription drug plans. Which as of 2023 is $8,300. With Original Medicare, there are no annual out-of-pocket maximums.
However, you should also be aware of the disadvantages of Medicare Advantage. Original Medicare is widely accepted by physicians and hospitals all over the country. Whereas a Medicare Advantage plan will have a smaller network of providers. So, it’s possible that your doctor isn’t in their network. Next, you may be required to get a referral before seeing a specialist. Which is not the case for Original Medicare enrollees. There are also certain covered services that Parts A and B that may have a high copayment under a Medicare Advantage plan. Meaning you would have higher out-of-pocket costs with Medicare Advantage than you would with Original Medicare.
If you have a chronic or serious health condition and will likely visit the doctor frequently, you may want to consider a Medicare Supplement Plan. Medicare covers the majority of eligible medical expenses for seniors, but you are still responsible for 20%-25% of the total cost of care. Medicare Supplement Plans were designed to help cover a substantial portion of the medical expenses that come from having Medicare Part A and B, that you would otherwise be responsible for.
As with Part D, private insurers offer Medicare Supplement Plans and with Part D, there are a variety of plans to choose from. So you should shop around carefully to find the plan that fits you best. While yes, Medicare Supplement Plans do have premiums and can increase your monthly expenses, the additional coverage could give you peace of mind and eliminate some of the uncertainty that comes with your out-of-pocket Medicare costs.
Save On Medications
Even if you have Medicare Part D prescription drug coverage, your out-of-pocket costs can be astronomical, in part because Part D does not have a limit for out-of-pocket expenses. After you reach the catastrophic coverage threshold of $7,400 (as of 2023), the majority of people will continue to have to pay 5% of the cost of covered drugs. In certain instances, you can reduce drug costs by forgoing your Part D plan and paying cash. Big-box stores such as Costco and Target offer a variety of generic prescriptions for much cheaper, whereas many Part D plans have a high standard copay to fill a prescription. The only problem with paying in cash and not using your coverage is that the expense won’t count towards your deductible.
If you stick with your Medicare Part D plan’s list of “preferred” pharmacies you will typically pay less for your prescriptions. Also most Part D plans separate their drug formularies (list of covered drugs) into 5 tiers: preferred generic, generic, preferred brands, non preferred, and specialty. With preferred generics being the lowest cost-sharing tier and the most affordable for enrollees. If you find a drug that is approved for your condition on a lower tier than the one you currently take, ask your doctor if you can switch to the more affordable one.
Review Your Quarterly Summary
Your quarterly Medicare summary displays services and supplies for which Medicare was billed. This summary will also indicate whether or not any claims have been denied; if so it is important to contact the provider of the denied claim. If you believe the claim is unjust, you can appeal the claim denial by following the instructions on the summary’s final page. When admitted to the hospital, for instance, you will receive a notice outlining your Medicare rights. You may request an appeal of the decision and a review of your case if you believe you were discharged prematurely.
Use Your Preventative Care
Many Medicare recipients don’t realize that there is a long list of services that they can get for free. Medicare provides numerous screenings and annual wellness visits at no cost to you. These free preventative measures are important for detecting serious illnesses early. The screenings may include depression, cardiovascular disease, and other conditions. There are free counseling sessions for tobacco and alcohol abuse, as well as free vaccinations for flu and pneumonia. Additionally, you are eligible for a free “welcome to Medicare” preventive visit within the first 12 months of receiving Medicare Part B. During this initial appointment, you can also receive free assistance planning for end-of-life care. And your physician can help you draft an advance directive that outlines all of your wishes.
Utilizing these freebies can aid doctors in detecting major health problems before they worsen, thereby preserving your health. You might also have access to free wellness benefits if you have a Medicare Advantage plan. Some Advantage plans, for instance, include SilverSneakers membership at no extra charge. This program provides a basic gym membership and access to senior-specific group exercise classes.
Plan Yearly Expenses With The Out-Of-Pocket Maximum In Mind
Individuals’ Medicare costs can vary widely based on their circumstances and the type of coverage they have. Original Medicare typically covers 80% of a beneficiary’s Part A and Part B expenses. Such as doctor visits, hospital stays, and lab work. Individuals are responsible for remaining 20% of out-of-pocket costs, with no annual cap. Medicare Advantage plans offer predictable copayments and an annual limit on out-of-pocket costs. Once you reach your plan’s out-of-pocket maximum, all Medicare-covered services for the remainder of the year are covered in full. This cap can provide peace of mind if you have a sudden illness or are preparing for a major medical procedure.
Shop Around Every Year
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), is relatively simple. There is no need to shop around for Parts A or B because they come in a universal package. Where you should shop around is your Medicare Part D plan and your Medicare Supplement Plans. Medicare contracts with private insurance companies that offer Part D and Medicare Supplement Plans to provide seniors with a variety of coverage options. Moreover, these coverage options and their costs can change from year to year. This means that the plan you have this year might not be the best for you next year. The worst thing you can do is automatically enroll in your previous year’s plan without comparing options. This could result in higher out-of-pocket costs and for Part D could mean less coverage for prescription medications.
Get Help From EZ
If you’re looking for a Medicare Supplement Plan or Medicare Advantage Plan, you must compare the costs and benefits of each. This requires extensive research. Which can be time-consuming, as you will need to contact multiple insurance companies to obtain rate quotes. However, if you work with one of EZ’s agents, you can compare prices in half the time. Working with a licensed agent provides you with access to a variety of carriers and plans.
In addition to providing price comparisons, your agent can explain the differences between each plan. And explain the differences between each plan. In addition, your agent can assist you in determining which plan will be the most cost-effective for you in the long run by comparing out-of-pocket costs and premium costs. Call us today at 877-670-3601 or enter your zip code in the bar below to begin comparing.
Medicare is the nation’s health insurance program for seniors 65 and older. It also provides coverage for younger people who meet specific eligibility criteria. Medicare Parts A, B, C, and D cover a large variety of your major medical expenses. It’s a great program but it can be difficult to read through all of the plans, options, and rules. This can make it difficult to choose the right plan on time. Below we’ve outlined some of the most common Medicare mistakes so you know what to avoid and not wind up with penalties, coverage delays or gaps.
Signing Up Late
Medicare has specific deadlines to enroll. Your Initial Enrollment Period (IEP) happens when you first become eligible for Medicare. It starts 3 months before your 65th birthday, including your birth month, and then ends 3 months after you turn 65. This gives you 7 months to enroll. If you’re receiving Social Security benefits then you will be automatically enrolled and you don’t have to do anything or worry about the deadlines, Social Security handles enrollment for you. However, if you are not automatically enrolled you have to apply yourself during your IEP. If you miss the IEP you do have another opportunity between January 1st and March 31st called the General Enrollment Period (GEP).
Missing these enrollment periods is one of the most common and costly mistakes people make. If you miss both enrollment periods you can face late enrollment penalties for Medicare Parts A, B, and D. It’s important to note that there is a way to avoid these penalties. If you qualify for a Special Enrollment Period (SEP) then you will be able to enroll in Medicare penalty free with all the same benefits as when others enroll during the IEP.
SEP Types
Qualifying life event – If you have a qualifying life event then you qualify for a 2-month SEP where you have 2 months to enroll in Medicare. The most common qualifying events are:
You moved out of your current plan’s service area
Your plan no longer serves the area you are in
If you decide to switch from Medicare Advantage to Original Medicare within 12 months of enrolling in the Medicare Advantage plan.
You move into or out of a facility such as a nursing home
If you’ve lost Medicaid eligibility
Working past 65 – If you decide to continue working past 65 and have creditable coverage through your or your spouse’s employer’s health plan then once you leave your job you will open an 8-month SEP. This SEP does have a stipulation, if you want Part D you have to enroll in it within the first 2 months of your 8 month SEP, otherwise you still face penalties. Your 8 months begin the day you no longer have credible health coverage.
Medicare Part A Penalty
Some people qualify for Part A premium-free. If you’ve worked and paid into Social Security and Medicare taxes for at least 40 calendar quarters, then you are eligible for Railroad Retirement benefits (RRB), or have a spouse that qualifies for premium-free Part A then you will get Part A for free. However, if you don’t and have to pay for Part A, then you can face a 10% increase on your premium for missing the IEP. This penalty stays with you for twice the number of years that you were eligible and didn’t sign up. For instance, if you were eligible for Part A for 3 years and did not enroll, you’ll have the penalty for 6 years.
Medicare Part B Penalty
If you miss your enrollment period and don’t qualify for an SEP, you will face a Part B penalty. This penalty is a 10% increase for every year you did not sign up. For example, say you waited 2 years to enroll. You’re looking at a 20% increase in your premium, 10% for each of the 2 years you delayed. The standard Part B premium for 2023 is $164.90, plus adding the 20% will bring your premium up to $197.88 which will be rounded up to the nearest $.10, making it $197.90 for part B. That’s $32.98 extra every month that you could have saved by enrolling on time. Now that might not seem like a lot, but if you look at it on a yearly basis that is $395.76 a year!
Medicare Part D Penalty
The amount of the penalty depends on the length of time that you did not have Part D or a creditable prescription drug plan. Medicare determines the penalty amount by multiplying 1% of the national base beneficiary premium ($32.74 in 2023) by the number of full months you went without drug coverage. The penalty amount is then rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium can vary from year to year, so your penalty will change with it.
For example, say you waited 14 months to enroll in Part D and didn’t have creditable drug coverage for any of that time. You’ll have to pay a 14% penalty. For 2023 that would be $4.58 rounded up is $4.60 extra on your premium.
Assuming Spouse Coverage
Assuming your spouse is covered by Medicare because you have it or vice versa is a big mistake. It could leave you or your spouse without insurance. Medicare doesn’t work the same as an employer group plan. Meaning it won’t cover your family, it only applies to the individual who enrolls. If you worked and paid your Medicare taxes for the last ten years then at most your spouse who is 65 will be eligible for premium-free Part A. If your spouse is under 65, they need to find their own coverage elsewhere, such as a plan from the Health Insurance Marketplace, their own group plan, or COBRA. Additionally, if your spouse is under 65 they still may be eligible under certain conditions. Medicare is available to anyone who receives Social Security Benefits for at least 24 months, has End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
Not Weighing Your Options
There are many options to choose from with Medicare. There’s Original Medicare, Medicare Advantage, and Medicare Supplement Plans. It’s important that you know the differences and their benefits. If you make the mistake of not weighing your options you can leave yourself with large gaps in your coverage or end up paying far more than you need. Below we’ve outlined these plans to give you a starting point.
Original Medicare
Original Medicare, also known as traditional Medicare, consists of only Parts A and B. Medicare Part A is hospital insurance, and it covers hospital inpatient care and skilled nursing facility care. Part A coverage typically includes the following:
Semi-private hospital rooms
Hospital meals
Inpatient lab tests and X-rays
Operating room and recovery room services
Drugs and medical equipment used while in the hospital or skilled nursing facility
ICU care
Skilled nursing services
Hospice care
Part B of Medicare covers your general medical expenses. Such as doctor’s visits, urgent care, and specialists. Typically Part B covers:
Doctor visits and services
Some preventative screenings and services
Ambulance services
Outpatient surgery services
Mental health care
Some durable medical equipment
Some medically necessary tests such as X-rays, MRIs, CT scans, and EKGs
Medicare Advantage
Medicare Advantage, commonly known as Part C, is a type of Medicare plan that is offered by private insurance companies. These companies have a contract with the Medicare program that ensures the plans they offer comply with Medicare’s regulations. Medicare pays a set amount to the insurers for each participant enrolled in the plan. Additionally, you will pay your medical bills directly to your insurance company while your insurance provider must follow Medicare’s regulations. They are allowed to set their own rules for out-of-pocket expenses as well as decide if you need a referral to see specialists.
Medicare Supplement Plans
Medicare Supplement Plans are plans that you can buy to supplement your Original Medicare. These plans fill in any gaps in coverage, ensuring you get the most coverage for all the medical needs you specifically have. You do have to pay a monthly premium for these plans, and you must enroll in both Part A and Part B to be eligible for a Medicare Supplement Plan. However you may end up paying less than you would overall with your Original Medicare because Medicare Supplement Plans all have benefits that cover a lot of the out-of-pocket costs for Part A and B. One of the biggest advantages with Medicare Supplement is the variety. There are 10 plans to choose from and all of them cover different benefits at different amounts. It’s important you look through these plans and compare to tailor your coverage specifically to what you need.
Working With EZ
In order to save as much as possible during your Medicare journey, it’s important to keep all of these mistakes in mind. You can rely on EZ if you have any questions or need help choosing your plans. Whether you’re looking for help enrolling, or just need some information. Give us a call today at 877-670-3608 to speak to your own Medicare Agent or you can get free instant quotes by entering your zip code in the box below.
Your Initial Enrollment Period (IEP) is an important time if you’re considering your Medicare options. It’s natural that everyone has their own opinions regarding Medicare and the best coverage. While advice from family and friends can be helpful, when it comes to Medicare, there are a lot of myths passed around. Maybe you’ve come across information on social media or in conversation and wondered “Is that really true?”. You deserve accurate information about your coverage options so we’ve compiled a list of 10 common myths that we’d like to debunk for you.
There’s a misconception that since Medicare is a government benefit, seniors don’t have to pay for it because it has already come out of their taxes. While that would be great, it’s unfortunately not entirely true. Medicare Part A, or hospital coverage, doesn’t have any premiums. That is as long as you have paid your Medicare taxes for at least 40 calendar quarters. Even so, you still have a deductible and copays. So that part of the myth is kind of true.
However, Part A is the only Medicare product with no premium. Part B, medical coverage, has a monthly premium of $164.90 as of 2023. It’s important to note that the premiums are adjusted annually, meaning some years they increase and some years they’ll decrease. These premiums might also be higher for enrollees with higher income. The good news is that if you’re on Social Security, your Part B premium can be paid directly from those benefits, so while you may not be paying directly out of pocket, you are still paying for it. Additionally, if you choose the Medicare Advantage route you may also have to pay a monthly premium.
2. Medicare covers all healthcare costs.
Medicare does cover a large portion of your healthcare but not everything. Between Part A and Part B most of your hospital and basic medical expenses are covered.
Even with the services it does cover you are still responsible for deductibles, coinsurance, and copays. As you can see there are still several services that you may need that aren’t covered. Such as hearing, vision, and dental care. There is also no prescription drug coverage in Original Medicare (Part A and B). Typically to get those things covered most people will enroll in Medicare Advantage, Medicare Part D (prescription drug coverage), or a Medicare Supplement Plan. Any of those options do provide coverage for the gaps in your Medicare coverage.
3. You are automatically enrolled in Medicare.
This is another myth that is only partially true. If you have been receiving Social Security benefits or Railroad Retirement Board Benefits (RRB) for at least 24 months after you turn 65, then you will automatically be enrolled in Medicare Part A and B. Be aware that even after automatic enrollment, you are responsible for enrolling yourself in either Medicare Advantage, Medicare Part D or any Medicare Supplement Plans.
Now, if you’re not receiving Social Security or RRB, then enrolling is entirely up to you. The best thing to do is to enroll during your IEP, which will begin 3 months before you turn 65 and will end 6 months after your 65th birthday.
4. I can enroll in Medicare at any time.
This is completely false and can be one of the most detrimental myths to believe. If you don’t enroll during your IEP, you can face enrollment restrictions as well as a penalty. You will then have to wait for the next eligible enrollment period, which is known as the General Enrollment Period (GEP). The GEP lasts from October 15th to December 7th every year. The penalty for waiting is a premium increase of 10% for twice as many years that you were eligible and did not enroll. To make that simpler, If you did not enroll in Part A for 2 years after your IEP then the penalty would apply to your premium for the next 4 years. For Part B, the increase only lasts for the amount of time you did not enroll, so it would only apply for those first 2 years.
Now having said that, another way that you can avoid these penalties, aside from applying on time, is if you qualify for a Special Enrollment Period (SEP). To trigger an SEP you would have had to still be working and have credible health coverage through your employer or through your spouse’s employer during your IEP. Once you leave your job or lose the group plan coverage, you then have 8 months to enroll without penalty. Another way you can get an SEP is if you are under 65 and eligible for Medicare due to illness or disability, but have health insurance through a caregiver or spouse’s employer-sponsored health insurance. However, this only applies if their company has at least 100 employees.
5. Medicare costs the same for everyone.
While Medicare offers the same benefits to everyone, the cost is not universal. How long you worked and paid Medicare taxes, as well as your gross income determine your premiums and deductibles. The more you make, the more you will end up paying just like with regular health insurance. Additionally enrolling in Medicare Advantage, or Part D, or any Medicare Supplement Plans will change how much you pay for Medicare. So it varies greatly from person to person depending on their specific circumstances.
6. I can only enroll if I’m healthy.
This is a huge myth, Original Medicare cannot deny your coverage due to illness or a pre-existing condition due to implementation of the Affordable Care Act. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet. Once you turn 65 or retire you are eligible for Medicare Parts A and B, period. Also,there are no penalties or premium increases for pre-existing conditions. If you have certain medical conditions like End-Stage Renal Disease (ESRD) or ALS, you are eligible for Medicare even if you aren’t 65 yet.
7. Medicare Advantage and Medicare Supplement Plans are the same thing.
This is not true at all. They are similar in that private companies offer them but they are entirely different. Medicare Advantage is an alternative to Original Medicare. It may include prescription drug coverage. Medicare Supplement Plans are additional coverage you can buy to fill in the gaps left by your Original Medicare. Additionally, you can buy one or the other but not both.
8. Medicare doesn’t have as many options.
You may believe that Medicare is a one-size-fits-all program because it’s a government program. However, this is another one of those pesky Medicare myths. Medicare typically provides significantly more health insurance options than your employer’s group coverage. Whereas you may have had only a few plan options to choose from when enrolling in employer coverage, Medicare provides you with dozens of options. Medicare allows you to tailor your coverage to your specific needs.
9. Medicare will notify me when it’s time to enroll.
Obviously you don’t want to be late enrolling in Medicare. Nobody wants to have a penalty added to their premium. Unfortunately, Medicare does not give you an enrollment reminder when it’s time for you to enroll. The good news is that if you have Social Security Benefits or RRB before you’re 65, you will automatically enroll in Medicare Parts A and B. On the other hand, if you don’t have those benefits you have to remember to enroll on your own. So, it’s important that you note the specific times when you can enroll.
10. I am on COBRA so I don’t need to sign up for Medicare Part B.
COBRA does not count as active employment. To delay Part B enrollment without incurring a penalty, you or your spouse must be actively employed and covered by a group health plan. Additionally, if you are already on COBRA and your Medicare begins, your COBRA status will change when you turn 65. Meaning your COBRA coverage will end. You won’t be eligible to delay Part B without incurring a penalty. You may even experience a delay in the start of your Part B coverage, which could result in a serious coverage gap.
EZ Can Help
Now that you have all the facts it’s time to enroll with the help of EZ. EZ is able to help you enroll in Medicare, purchase a Medicare Supplement Plan, or just help you weigh your options. Our insurance agents collaborate with some of the most reputable insurance providers in the country. They are able to provide you with a free analysis that compares all of the plans that are available in your region. We will discuss your medical and financial needs and then assist you in locating a plan that is tailored to meet those requirements. To start, enter your zip code into the box below. Or give one of our licensed agents a call at 877-670-3602 and we’ll get the ball rolling for you.
