If you have Medicare, you should be up-to-date of the prospective costs of a hospital stay so that you can plan accordingly. While Medicare Part A normally covers hospital stays, including your room, nursing services, meals, medications, and so on, it only does so for 90 days. So, what if you need to be in the hospital for a longer period of time? This is when lifetime reserve days come into play. Lifetime reserve days are the number of hospital days that an insurance policy will cover beyond the number of days given per benefit period. However, be careful, you only get 60 of these extra days.
How Lifetime Reserve Days Work
Lifetime reserve days are one of many Medicare rules. Your benefit period begins when you enter a medical facility, such as a hospital, and continues until you are discharged from the facility and go 60 days without reentering the hospital. If you have to stay longer than the days provided per benefit period, you can use your lifetime reserve days to do so. For example, assume you have a 100-day hospital stay. The first 60 days are totally covered by Medicare. Days 61 through 90 will have a copay, while the remaining days will be covered by 10 reserve days. However, you will also have to pay a coinsurance for these reserve days, which will be $816 a day in 2024.
That is just an example though you don’t have to use them in this way. In fact, you are free to use these reserve days as you see fit. There are no guidelines for dividing the days. You are not forced to use these days, and you can choose to pay for your additional hospital days out of pocket. When you get close to your 90-day threshold, the hospital will notify you so you can let them know if you want to use your reserve days and how many. You can also change your mind about using your reserve days after you leave the hospital. You have 90 days from the date of discharge to provide the hospital written notice. They will then just bill you for the outstanding sum, and your reserve days will be reinstated.
What Do The Lifetime Reserve Days Cover?
Medicare pays all covered costs, minus your daily coinsurance, for each lifetime reserve day used during a hospital stay. Some of the expenses covered by Part A if you are admitted for inpatient care at a hospital that accepts Medicare. Which includes semi-private rooms, meals, general nursing, and medications for inpatient therapy. If you require care that is not covered by Part A, such as a private room or a private-duty nurse, you have to cover the additional costs on your own.
Medicare Rules
To use a lifetime reserve day, you must first be eligible for Medicare Part A inpatient hospital care. Your hospital status (whether you are an “inpatient” or “outpatient”) influences how much you pay for hospital services (such as X-rays, medications, and lab testing). The choice to admit you to an inpatient hospital is a difficult medical decision based on your doctor’s recommendation and your need for medically necessary hospital treatment. When you are expected to need two or more “midnights”, meaning you stay past midnight, of medically necessary hospital care, an inpatient admission is generally eligible for payment under Medicare Part A (Hospital Insurance), but your doctor must order this admission and the hospital must formally admit you for you to become an inpatient. In order to use a Medicare lifetime reserve day, you must also use Medicare Part A hospital inpatient services for more than 90 days in a benefit period.
As far as cost goes, lifetime reserve days aren’t free. Original Medicare imposes varying co-pays based on the number of days you remain in the hospital, with lifetime reserve days beginning after day ninety. The first sixty days of a hospital stay are free of charge, days 61 to 90 have a daily co-pay of $408 (in 2024), and days over 90 have a $816 co-insurance per lifetime reserve day used.
Your Part A daily lifetime reserve day co-insurance might be covered by a Medicare Supplement insurance coverage. Part A inpatient hospital care co-insurance is covered in full by all Medicare Supplement Plans. If you get eligible Part A hospital inpatient care and need to take advantage of a lifetime reserve day, your Medicare Supplement coverage will cover the daily co-insurance. These plans will also cover up to an additional 365 days in the hospital. Although private insurance companies provide the coverage, the federal government requires that the policies be standardized. Which means no matter where you buy a policy from every plan of the same letter will have the same benefits.
Plans A, B, C, D, F, G, and N all cover 100% of your Medicare Part A hospital cost and coinsurance as well as 100% of your Part A deductible.
Plans K and M will cover 100% of Part A’s coinsurance and 50% of your part A deductible.
Finally Plan L will cover 100% of your Part A coinsurance and 75% of your Part A Deductible.
It’s important to note that Plan C and Plan F are no longer available to new Medicare enrollees. It is still available to those who were eligible for Medicare before January 2020.
Medicare Supplement Plan A only covers the minimal benefits that are needed of all Medicare Supplement Plans. That means this plan is a wonderful option for people looking for a low-cost plan that will still help lower Original Medicare expenses, such as the 20% Part B coinsurance, which can quickly pile up. Plan A further lowers out-of-pocket expenditures by having a yearly out-of-pocket maximum, which Original Medicare does not have. It also covers:
Plan B includes all of the essential benefits of Plan A, as well as some of the added benefits provided by other Medicare Supplement Plans. Although Plan B is not the most comprehensive Medicare Supplement Plan available, it is an excellent choice for those seeking additional coverage for out-of-pocket expenses. Plan B includes:
Anyone who was qualified for Original Medicare before January 1, 2020, is eligible to enroll in Plan C. If you were not Medicare-eligible at the time, you cannot enroll in Plan C. Medicare Supplement Plan C compensates for any Medicare-approved expenses not covered by Original Medicare. This covers, among other things, annual deductibles, copays, and coinsurance. It covers:
Plan F has long been the best-selling plan on the market. It covers all of your out-of-pocket payments, so if you have this plan, you’ll just have to pay the monthly Plan F premium. The only restriction is that, like Plan C, Plan F is not available to anyone who became Medicare eligible after 2020. If you were eligible for Medicare before 2020, you can purchase one of these plans; if you had purchased Plan F and are grandfathered in, you can keep it indefinitely. It includes:
Plan G is the most comprehensive Medicare Supplement Plan accessible to new Medicare beneficiaries. Since the ending of Plan F, this plan has gained in popularity and has become one of the most popular Medicare Supplement Plans available today, if not the most popular. Plan G bridges the gap between what Original Medicare covers and the charges that you have to pay in an extremely cost-effective manner. It includes:
Plan K is a fantastic solution for decreasing your cost-sharing requirements when combined with Original Medicare. This plan, like all Medicare Supplement Plans, seeks to pay some of the expenditures that Original Medicare does not cover, although to varying degrees. It includes:
Plan L, like Plan K, is a supplemental healthcare plan that includes cost-sharing benefits. In addition to the monthly premium for your policy, you will be responsible for deductibles, coinsurance, and copayments with Plan L. However, your plan will have a maximum out-of-pocket limit. It covers:
Plan M is an excellent option for consumers who want to keep their monthly costs low. Its coverage helps with many out-of-pocket expenditures that Original Medicare does not cover, such as copayments, coinsurance, international travel emergency care, and your first three pints of blood. It addresses:
Along with Original Medicare coverage, Plan N offers complete benefits. You will only be liable for your Medicare Part B deductible, minor copays at the doctor’s office, and excess charges if applicable in your situation if you choose this plan. Plan N includes:
Medicare Part A coinsurance and hospital cost
Medicare Part B coinsurance or copayment
First 3 pints of blood
Part A hospice care or coinsurance
Skilled nursing facility coinsurance
Medicare Part A deductible
80% of foreign travel emergency
Need Some Help?
Lifetime reserve days are an effective tool. If you plan ahead of time, you can reduce your out-of-pocket expenses and focus solely on getting better. However, if you believe you will want additional coverage for hospital stays, a Medicare Supplement Plan can help. After you’ve used all your lifetime reserve days, all Medicare Supplement Plans provide an additional 365 days of hospital care.
If you have any concerns or need assistance in locating a Medicare Supplement Plan, EZ.Insure can assist you. Our knowledgeable agents collaborate with the best companies in the country, making it simple for you to find what you require. Simply enter your zip code into the area below to receive your free, no-obligation quote. If you’d rather chat with an agent directly, call 877-670-3602.
Every year, from October 15 to December 7, the Medicare Annual Enrollment Period takes place. This is a good time to look over your present Medicare coverage. Does it cover the medicines you need? Are you able to pay for the plan? Are you able to see your favorite doctor through the plan? The Medicare AEP is not the same as the other times you can sign up for a Medicare plan. You can add, change, or get rid of Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans during the Medicare AEP. After that, you can also make the following changes:
There is a time every year when people who already have Medicare can switch from Original Medicare (Parts A and B) to Medicare Advantage (Part C). Or the other way around. However, if you want to change, you might have to do some other things too. Changes to and from different types of plans will require you to make different choices.
In this scenario, you are currently enrolled in Traditional Medicare and are considering switching to a Medicare Advantage plan. In addition to that, you can also have a separate Part D plan for your prescription medication. The majority of Medicare Advantage plans offer comprehensive coverage that encompasses all of your needs. They will pay for your Medicare Part A and Part B benefits. As well as your Medicare Part D prescription medicines and most other health services or items that are not covered by Original Medicare. A few of these additional things are dental, eye, and hearing care, in addition to memberships at fitness centers. To prevent you from spending an excessive amount each year, Medicare Advantage plans come with a cap on the amount of money you are responsible for paying out of pocket.
You have the ability to switch from Original Medicare to a Medicare Advantage plan if you do so during the Annual Enrollment Period. If you already have Medicare Part D coverage, but decide to enroll in a Medicare Advantage plan, you may find that you no longer require a separate Part D plan. If you decide to enroll in a Medicare Advantage plan instead of Original Medicare, the plan will coordinate the transfer of your benefits with Medicare. There is no requirement for you to initiate contact with Medicare on your own. Your new plan will begin covering you as of the first of the year.
Only Part A (covering for hospital stays) and Part B (coverage for medical services) are included in Traditional Medicare. It doesn’t cover prescription drugs, dental care, vision care, or fitness programs like some Medicare Advantage plans offer. Because there is no yearly out-of-pocket maximum with Original Medicare, there is also no built-in financial security for beneficiaries.
You will need to get additional coverage if you still intend to have these things. For instance, if you want coverage for prescription drugs. You will have to search for a stand-alone Part D plan and sign up for it. Previously, this was not the case. In the event that you determine you require additional coverage, you will be required to select a Medicare Supplement Plan and register for it directly with the issuer of that plan. In order to make the transition back to Original Medicare, you will need to contact either the provider of your Medicare Advantage plan or Medicare itself.
What If I Miss The AEP?
A number of different things might happen, and it all depends on the coverage that is being given right now. What transpires next will be determined by the type of coverage you currently have in place. The majority of people who are enrolled in Medicare have either Original Medicare with a Part D prescription medication coverage or Medicare Advantage together with a Medicare Supplement insurance policy.
Missing The AEP With a Medicare Advantage Plan
During the AEP, beneficiaries who are enrolled in Medicare Advantage plans have the opportunity to make modifications to their coverage. If you do not enroll in the new plan during the Annual Enrollment Period, your existing plan will be transferred to the new plan automatically. One possible exception to this rule is if your existing Medicare Advantage plan moves out of the area it serves or is terminated. In the event that this takes place, you will be eligible for a Special Enrollment Period. The SEP will extend for two months after the Part C program has concluded.
You have the ability to make modifications to the Medicare Advantage Open Enrollment Period if you are enrolled in a Medicare Advantage plan and you are currently enrolled in the plan. Every year, the MAOEP begins on the first of the year and continues until the end of March. You have the opportunity to make changes to your Medicare Advantage plan during this period of enrollment. If you do not enroll during the AEP or MAOEP, you will not be able to change your plan until you have a Special Enrollment Period that meets the requirements.
Imagine you are only eligible for Original Medicare, and you fail to enroll during the Annual Enrollment Period. If this is the case, the only way for you to add a Medicare Advantage plan or a Medicare Part D plan is if you have a Special Enrollment period during which you are eligible to do so.
Missing The AEP With a Part D Plan
If you miss the AEP, your existing plan will carry over into the following year. Just like it would with a Medicare Advantage plan, unless the program is discontinued. If you miss the enrollment period for a program and then decide you want to switch to a different one, you won’t be able to make the switch unless there is a special enrollment period. An SEP is triggered by particular occurrences in a person’s life as well as unusual conditions.
Options After Missing The AEP
Even if you miss the Annual Enrollment Period for Medicare, you still have choices available to you to obtain health insurance.
Special Enrollment Period
You may be able to make changes to your Medicare coverage outside of the Medicare Annual Enrollment Period if you meet the requirements to qualify for a Special Enrollment Period (SEP). There are numerous instances in which you may be eligible for a SEP. Some of these circumstances could result in you losing your health insurance coverage, either temporarily or permanently. The following are some instances of circumstances that may qualify you for a Special Enrollment Period, which allows you to join up for a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, or alter your current plan, without having to wait for regular enrollment periods.
You moved out of your plan’s service area.
You moved into, out of, or still live in a skilled nursing facility. Or another institution such as a long-term care hospital.
You left your employer-based or union-based health insurance.
You used to be eligible for Medicaid, but now you’re not.
You just got out of jail.
You’re moving back to the United States after living outside the country.
Your plan is losing or ending its contract with Medicare.
Keep in mind that these are only some examples. If you suffer significant changes to your plan, your coverage, or even your health, it may be worthwhile to check with Medicare to see if you may qualify for a Special Enrollment Period to change your coverage. This can be done if you contact Medicare after you have experienced any of the aforementioned changes. There is a possibility that various SEPs will have varying durations. Your specific circumstances will determine how much time you have to make the adjustment. But in most cases, you will have at least two months to do so.
COBRA Coverage
After certain qualifying events, such as the loss of a job or a reduction in the number of hours worked, individuals who are eligible are able to continue their employer-sponsored health insurance coverage for a limited amount of time through COBRA coverage, which is an abbreviation for the Consolidated Omnibus Budget Reconciliation Act. It can provide temporary coverage and assist you in bridging the gap until you find alternative options for health insurance.
If you are qualified, you have the opportunity to continue receiving health insurance coverage from your employer even after you have left your position there. This enables you to keep your present health benefits after becoming eligible for Medicare, which is a significant advantage. It is crucial to check with your employer to understand the precise rules and requirements for remaining on your company’s plan while still being eligible for Medicare. This information can be obtained by checking with your employer.
Wait For The Next AEP
In the event that you don’t qualify for any SEPs or any other special enrollment choices, you will have to wait until the subsequent open enrollment period in order to make any modifications to your Medicare coverage. Both the AEP and the IEP are considered to be the most important enrollment periods. You have the ability to make modifications to your current Medicare plan. Or enroll in a new plan for the following calendar year during these enrollment periods. It is essential to be aware of these enrollment times. And to make appropriate preparations in order to guarantee that you will have the necessary coverage.
Help From EZ
If you miss the Medicare Annual Enrollment Period, you can find yourself in a stressful situation. Agents located in your area are available through EZ.Insure to provide assistance and answer any questions you might have. Our sales representatives have received extensive training to assist you in selecting the solution that is most suited to meet your requirements. Estimates for Medicare Supplement Plans will be sent to you by our agent. Who will also assist you in signing up for coverage at no additional cost. These estimates will come from the leading insurance companies in your area. Simply enter your zip code in the box below to get free immediate quotes. If you would like to speak to a local licensed representative, you can call us at 877-670-3602.
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.
You can technically enroll in Medicare and Medicare products on your own. You can do all your own research on Medicare, Medicare Advantage, and Medicare Supplement Plans. Or you can look into all of the providers available. You can even search for quotes for these plans on your own. However, is this the best way to enroll in Medicare? We don’t think so. The issue with doing your own research is that you may not find all of the information you need. Due to years of experience, a Medicare Agent will have more information for you, including things not commonly found on the internet.
Contrary to popular belief, you don’t pay your Medicare agent. Since the insurance companies pay your agent for their services, you never pay them a dime. Your premium will also not increase just because you used an agent. So using an agent is free and absolutely no hidden fees. They are there to give you all the information you need and help you find the best options for you.
What Is A Medicare Agent
Before we dive into why you should use an agent, let’s look at what they actually do. A Medicare agent is a licensed expert who assists you in reviewing and evaluating Medicare plans and their benefits, as well as assisting you in selecting and enrolling in the best plan. There are two types of Medicare agents. The first is an independent agent. This type of agent works with numerous insurance providers and can enroll you in any of their plans. The second type is a captive agent. These agents work with one specific insurance company. EZ’s agents are independent so we can provide you with plans from all providers.
Benefits of Medicare Agent
We know it’s hard to trust that you’ll be in good hands. So, we’ve made a list of reasons a Medicare agent could be beneficial to you. Since EZ’s agents are independent we’ve based this list on the benefits of working with independent agents.
1. Expert Knowledge
Simply put, Medicare can be confusing. You can spend countless hours reading about Medicare and its products and you could get a fairly solid understanding of how it operates. However, our Medicare agents continuously educate themselves and are familiar with Medicare’s rules and regulations, which changes frequently. A simple mistake, such as missing your Initial Enrollment Period (IEP), could result in penalties or delays in coverage. Even selecting the wrong Medicare Supplement Plan can leave you with big gaps in your coverage. Meaning you’ve got unnecessary money coming out of your pocket for healthcare costs that you could have saved with the right plan. When it comes to Medicare, the devil is in the details. Our agents will ensure that you are educated and supported through your entire Medicare journey.
2. Help Choosing a Plan
Once you’re eligible for Medicare it’s not as simple as enrolling. You have some options to consider. For instance, you can choose to enroll in a Medicare Advantage plan instead of Original medicare. If you enroll in Medicare Advantage through a private insurer you’ll still have Medicare but your coverage comes directly from the Advantage plan rather than Original Medicare. Medicare Advantage can include additional coverages such as vision, hearing, dental and wellness programs. They also usually have prescription drug coverage under Medicare Part D.
On the other hand you can choose to stick with Original Medicare and then purchase a Medicare Supplement Plan and enroll in Part D on your own. Going this route also gives you these additional benefits but deciding which path to take depends on your specific needs. You need a thorough understanding of each path in order to choose the right one. There are so many factors to consider, like your budget, provider networks, and current prescriptions. Our licensed agents understand the pros and cons of both paths and as they get to know your circumstances, they can help you figure out which is the best one for you.
3. Help with underwriting
Underwriting is a process that private insurance companies use to figure out your health stats when you apply for health insurance, such as Medicare Advantage or Medicare Supplement. The process helps companies decide how much your premium will be. Our Medicare sales agents are very familiar with the underwriting application questions from various companies. Suppose you are interested in switching Medicare Supplement companies. We can match you with the company that is most likely to accept you –even if you have a medical condition that you think might make you ineligible. We’re here to find you coverage, no matter what.
4. Benefit clarity
When you’re searching for coverage or deciding what choice is best for you, you’ll mainly be looking at benefits. Our agents can help you read through all the legal jargon to find out what benefits are specifically being offered and if they’re beneficial to you.
5.Access to a variety of providers
Medicare agents work for you, not the insurance company. So we won’t just offer you plans from one source, we offer you dozens of options. We can research pricing for nearly every provider in the country for any given plan. For instance, Medicare Supplement Plans are standardized, meaning the plans all have the same benefits no matter where you live or who you buy them from. So, say you like Plan G, you can compare prices from all the available providers in your area. Why pay more than necessary for the same coverage? When you work with a Medicare agent you never will.
6. Continued service
Your relationship with your agent continues even after you enroll in Medicare. During the annual enrollment period, your agent can help you review your coverage. Then, they can help you decide if your current plan is still the best option or whether you need to make adjustments. They will then help you make those adjustments. They can also help you with any concerns or questions about your coverage no matter the time of year or how long you’ve had Medicare. Once you find an agent they are available to you the entire time you have Medicare.
7. Time saver
Working with a Medicare agent can save you a great deal of time. You won’t be stuck spending hours, days, or even months researching Medicare and looking for plans on your own. Agents can compare every plan for you quickly and efficiently. They can also answer any questions you have immediately and accurately rather than having to read through hundreds of internet searches hoping to find the answers you need and hoping the answers you find are accurate .
8. It’s free!
You don’t pay any fees to work with a Medicare agent. Using their services is completely free. You’re probably wondering, “So, how do they get paid?”. Their pay comes directly from the insurance companies. Most agents are paid commission. When they enroll you in a plan, the insurance company pays them for the first year of coverage as well as an initial sum for each year you are enrolled. Now, don’t worry, they aren’t incentivized to enroll you with a specific company. So you don’t have to worry that they’ll push you to enroll with a certain company to get more commission. They’re only motivation is getting you enrolled in the best coverage possible.
Choosing a Medicare Agent
After you provide us with some fundamental information through EZ, we will provide you with quotes and match you up with an insurance agent who is the most suitable for your circumstances. Who we match you up with depends on a variety of factors, including your location and the kind of coverage you’re looking for in a plan. We take measures to ensure that your agent is familiar with the area in which you live. This way, you won’t have to worry about being assigned an agent who lives in another part of the country and who isn’t as knowledgeable about the services provided in your area as a local agent would be.
Why Work With EZ
EZ is able to help you with enrolling in Medicare, buying a Medicare Supplement Plan, or even just answering any questions you might have. We can also help determine which options are best for you. Our insurance agents work closely with a number of the country’s most well-known and respected insurance companies. They are able to give you a free analysis and quotes that compare all of the plans offered in your area. First our agents will talk with you about your medical needs and your budget. Then we help in finding you a plan that we can help customize to fill those needs while staying well within your budget. We can actually save you hundreds of dollars a year. If you’re ready to start, simply enter your zip code into the bar below or give us a call at 877-670-3602 and we’ll get the process started right away.
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 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.
Missing The AEP With a Part D Plan
In the event that you don’t qualify for any SEPs or any other special enrollment choices, you will have to wait until the subsequent open enrollment period in order to make any modifications to your Medicare coverage. Both the AEP and the IEP are considered to be the most important enrollment periods. You have the ability to make modifications to your current Medicare plan. Or enroll in a new plan for the following calendar year during these enrollment periods. It is essential to be aware of these enrollment times. And to make appropriate preparations in order to guarantee that you will have the necessary coverage.
