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Medicare Coverage VS Medicare Supplement Coverage

Medicare is the federal health insurance program for people who are 65 or older. When you enroll in Medicare, it is important to understand how it works and whether or not you will need a Medicare Supplement plan to go with it. Once you pay your deductible, Medicare covers only 80% of your Part B expenses, leaving you to pay the rest. Medicare Supplement is an insurance plan that is sold by private companies. Medicare Supplement plans help pay for the 20% of the Medicare Part B costs which is left for you to pay.

Original Medicare, and Medicare Supplement plans cover different healthcare. It is important to go over each program, and what they offer in order to determine if a Medicare Supplement plan will benefit you.

How Medicare Works:

Every year, you must pay a set amount, a deductible, for your health care before Medicare pays its share. You can sign up for Part A and/or Part B insurance, but most people have both. You pay a monthly premium for Part B. Medicare only covers 80 percent of Part B services, leaving you with the other 20 percent to be paid out of pocket. Depending on your medical needs in a given year, that 20 percent gap can become a large financial burden.

For 2017, the Medicare Part A deductible is $1,316 a year, while Medicare Part B’s yearly deductible is $183. Once you have paid your deductible in health bills such as physician visits, outpatient hospital services, and covered medical equipment, then Medicare will pay cover the rest up to 80% for Part B, and 100% for Part A.

Medicare covers wellness visits every month. — *Medicare will cover annual wellness visits once a month.*

What Medicare covers

Medicare benefits are divided into two parts, Part A and Part B.

Medicare Part A (Hospital Insurance) — covers inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, and some home health care. (100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.)
Medicare Part B (Medical Insurance) — covers annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.)

What Medicare does not cover

Annual physical exams except other than one annual wellness visit
Health care you get while traveling outside of the United States (Very limited exceptions)
Hearing aids, and most hearing exams
Long-term nursing home care for more than 100 days
Acupuncture, naturopathy, etc.
Most eyeglasses
Most dental care

Prescription drugs are not covered under Parts A and B, but it will cover some drugs in certain cases like immunosuppressive drugs for transplant patients, and oral anti-cancer drugs. For prescription drug coverage, you should consider signing up for stand-alone Medicare Part D plan.

How Medicare Supplement Works:

There is a monthly premium for your Medicare supplement plan, and in return, the plan pays most of your expenses not covered by Medicare parts A & B. For example, if you have a $4,000 ambulance bill and have already met the yearly Medicare Part B deductible, Medicare Part B will pay 80% of the bill. This leaves you to pay the 20% that us left, $800, out of pocket. But if you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then it will pay the $800 remaining.

The Medicare Supplement Open Enrollment period is the six-month period that starts on first day of the month that you are 65 and enrolled in Medicare Part B. During the open enrollment period, you can enroll in any Medicare Supplement plan offered in your service area with guaranteed issue. This means that insurance companies are not allowed to deny you or charge you more due to pre-existing conditions. There are many different types of Medicare Supplement plans to choose from, and they vary in levels of coverage and cost.

What Medicare Supplement covers

Medicare Supplement covers nurse care and Part B excess charges. — *Medicare Supplement will cover nursing facility costs after you run out of Medicare-covered days.*

In general, all Medicare Supplement plans cover at least part of:

Medicare Part A and Part B deductibles
Skilled nursing facility costs after you run out of Medicare-covered days
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)

Some will cover:

Foreign travel emergency (up to plan limits)
Part B deductible

Two Medicare Supplement plans (Plan K and L) include an out-of-pocket limit. Once you have reached a certain amount spent on Medicare-covered services, the Medicare Supplement plan will cover 100% of the costs for the rest of the year.

What Medicare Supplement does not cover

Medicare Supplement policies generally do not cover:

Long-term care (care in a nursing home)
Routine vision or dental care
Hearing aids
Eyeglasses
Private-duty nursing.
Prescription drugs

Looking for more details or help?

You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 855-220-1144. There is no hassle and no obligation. We will help you answer any questions, go over all of your plan options, find the Medicare Supplement plan most suited for your needs and budget, and even help you sign up if you’re ready. No hassle necessary! We work on your time and do not hound you with calls like the other guys.

Is There A Difference Between Medicare & MedSup?

Medicare is the federal health insurance program for people who are 65 or older. When you enroll in Medicare, it is important to understand how it works and whether or not you will need a Medicare Supplement plan to go with it. Once you pay your deductible, Medicare covers only 80% of your Part B expenses, leaving you to pay the rest. Medicare Supplement is an insurance plan that is sold by private companies. Medicare Supplements plans help pay for the 20% of the Medicare Part B costs which is left for you to pay. Original Medicare, and Medicare Supplement plans cover different healthcare. It is important to go over each program, and what they offer in order to determine if a Medicare Supplement plan will benefit you.

How Medicare Works:

What Medicare covers

Medicare benefits are divided into two parts, Part A and Part B.

Medicare Part A (Hospital Insurance) — covers inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, and some home health care. (100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.)
Medicare Part B (Medical Insurance) — covers annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.)

What Medicare does not cover

Annual physical exams except other than one annual wellness visit
Health care you get while traveling outside of the United States (Very limited exceptions)
Hearing aids, and most hearing exams
Long-term nursing home care for more than 100 days
Acupuncture, naturopathy, etc.
Most eyeglasses
Most dental care

How Medicare Supplement Works:

What Medicare Supplement covers

In general, all Medicare Supplement plans cover at least part of:

Medicare Part A and Part B deductibles
Skilled nursing facility costs after you run out of Medicare-covered days
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)

Some will cover:

- Foreign travel emergency (up to plan limits)

Part B deductible

What Medicare Supplement does not cover

Medicare Supplement policies generally do not cover:

Long-term care (care in a nursing home)
Routine vision or dental care,
Hearing aids
Eyeglasses
Private-duty nursing.
Prescription drugs

Looking for more details or help?

There are roughly 10 different types of medicare supplement plans on the market, and they all vary in coverage and cost. Figuring out which plans are best for you can be hard, but we are here to help. If you would like to gather more information on Medicare and Medicare Supplement plans, one or our highly trained agents are ready to help. You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 855-220-1144. There is no hassle and no obligation. We will help you answer any questions, go over all of your plan options, find the Medicare Supplement plan most suited for your needs and budget, and even help you sign up if you’re ready. No hassle necessary! We work on your time and do not hound you with calls like the other guys.

Trump Takes Action on Lowering Medicare Drug Prices

Medicare drug prices continue to increase making it harder for seniors to afford, President Trump decided to take action. Trump proposed a plan to bring down the prices of Medicare drugs by giving back to customers and focusing on raising foreign drug prices.

The federal government is not allowed to negotiate Medicare drug prices, so Trump said his plan will work without needing Congress’ approval. Insurers get discounts for the expensive name brand drugs, which are negotiated by pharmacy managers. Trump wants these rebates and discount distributed to the customers, which would help lower the prices. President Trump’s plan is to give at least one-third of the rebates to beneficiaries.

Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, stated that the rebates are a “convoluted system,” because they allow manufacturers to raise list prices. This, in turn, increases the amount of money that insurers and pharmacy benefit managers collect in rebates, giving them no incentive to keep prices down.

“When prices go up, patient cost-sharing also goes up,” she said in a speech before the American Hospital Association earlier this week. “We’ve all noticed the increase in the amount we have to pay at the pharmacy counter. For seniors who are sometimes on fixed incomes, the pain is real. This is not acceptable.”

The Trump administration wants to raise the prices of foreign drugs in order to reduce the drug prices at home. The reasoning for this is because foreign places keep their prices low while Americans continue to pay highly for their drugs. The foreign countries benefit from America paying high prices for these drugs and essentially their development. “The United States both conducts and finances much of the biopharmaceutical innovation that the world depends on, allowing foreign governments to enjoy bargain prices for such innovations,” the council’s report said. “Simply put, other nations are free-riding, or taking unfair advantage of the United States’ progress in this area.”

The Food & Drug Administration is focusing on trying to introduce more generic drugs that are identical to name brand drugs. This way customers can opt to buy the generic brand and save some money. The agency is hoping that by producing more generic drugs will increase competition and eventually bring down the pricing of brand-name drugs.

Seniors have been struggling to obtain the medications they need due to how expensive they are. Some have to make drastic changes in order to get these medications because they can die without them. There are still talks amongst the Trump administration about reducing Medicare drug prices and they are hoping to make some positive changes in 2019.

U.S. Government Proposes 1.84% Increase in 2018 Payments to Medicare Insurers

The US government and the Centers for Medicare and Medicaid Services, CMS, have proposed an increase in Medicare Advantage payment rates. The increase will be an average of 1.84 percent. This increase is up from the 0.45% that plans got last year from the government. Health insurers will receive these payments to help benefit the seniors eligible for Medicare.
The CMS stated that the average Medicare Advantage payment rate will increase by 3.1% after factoring in how members’ diagnoses are coded by health plans. This makes the increase 2.95% from last year.

Medicare Advantage enrollment data by the CMS shows a growth in medicare advantage enrollees of 9%, nearly 20.9 million in 2018. The estimate is that more than one-third of all Medicare enrollees, or 34%, will enroll in a Medicare Advantage plan.

The percentage insurers receive affects how much they will charge for their premiums and benefits. This percentage also reflects how much these insurance companies will profit. The government pays this percentage to these insurers in order to cover their member’s healthcare costs. So if the insurance companies do not get much of the percentage, then the member’s will not receive as much towards their healthcare costs. This means that the healthcare member will be charged more by their insurer, and have to pay more out of pocket.

With such a large percentage payment proposal coming in 2019, insurers will be able to provide more to their members. Benefits will be extended to their customers to include things like wheelchair ramps and other assistive devices in order to help reduce the effects of major health conditions. These benefits are hoped to help the customers live a more comfortable life and prevent conditions from worsening.

The CMS conducts Risk Adjustment Factors on a regular basis in order to keep track of their enrolled beneficiaries and their needs. These risk factors take part in how they pay for plans based on the beneficiaires needs, so that they can make the exact payments for enrollees with differences in expected costs. The risk adjustment allows the CMS to use bids as a base payment to plans. According to the CMS, the payment increase is based on better use of encounter data, which is information about the care that a beneficiary got from a provider. With this data, they can determine risk scores for plans.

The risk scores for 2019 will be based 75% on fee-for-service data, and 25% based on encounter data. The scoring was based on 85% on fee-for-service data and 15% encounter data in 2018.

The CMS states the payment increase will promote stability and the resources needed to support beneficiaries. “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma.
Medicare Advantage has always competed with the traditional Medicare fee-for-service program. But due to the “baby boomer” generation, has increased enrollment in both Medicare and Medicare Advantage. In fact, Medicare Advantage enrollment is at an all-time high right now and continues to gain popularity with high satisfaction ratings.

If you would like to find out more about this increase and how it will impact you, EZ.Insure will be more than happy to help. One of our highly trained agents that specialize in your region will help you with all of your Medicare needs. You will be provided with your own personal advisor free of charge to guide you through the shopping process. To get started contact us by email at [email protected] or call 855-220-1144. You can also get an instant quote by entering your zip code in the bar above, it’s that easy.

Medicare Prices Steadily On The Rise

Details have emerged after a report was released on the investigation into Medicare drug prices. The report “Manufactured Crisis: How devastating drug price increases are harming America’s seniors,” and its findings were released by U.S. Sen. Claire McCaskill, Democrat-Missouri. This report talks about the hiked up drug prices for senior citizens and how it needs to be further investigated. Medications for seniors have gone up nearly 10 times more than the annual inflation rate.

The report stated that “Soaring pharmaceutical drug prices remain a critical concern for patients and policymakers alike. Over the last decade, these significant price increases have emerged as a dominant driver of U.S. health care costs — a trend experts anticipate will continue at a rapid pace.”

The cost of about 20 of the most prescribed drugs for Medicare have gone up significantly from 2012 to 2017 according to the report. The lowest increase being Zostavax going up 31%, to the largest increase being 477% for the drug Nitrostat. Twelve of the drugs investigated, increased over 50% during the five-year time span, while six of them increased over 100%. The rise has gone up so much that some Medicare enrollees are unable to pay for their meds.

Some Medicare Drug Prices Have More Than Doubled Each Year!

The Pharmaceutical Research and Manufacturers of America did not agree with the report and followed up with comments reported by CNN. “This is yet another misleading report that ignores the robust negotiation that occurs between Medicare Part D plans, middlemen, and biopharmaceutical companies,” Juliet Johnson, a spokeswoman for PhRMA, said in a written statement. “Negotiated rebates can reduce list prices by as much as 30 to 70 percent for medicines used to treat diabetes, high cholesterol, and chronic respiratory illnesses. Notably, half of the 20 brand medicines in this report are used to treat these chronic conditions.”

As stated, the medicines are used to treat chronic conditions, but the reality is that many seniors need these medications. A lot of Medicare enrollees have some sort of health issue, whether chronic or not that requires treatment and medication to stay healthy.

Juliet Johnson later stated “we agree more can be done to make Part D more affordable and predictable for seniors. One way to do that is to ensure seniors benefit from the significant negotiated savings when they pick up their medicine at the pharmacy.”

The prices of pharmaceutical drugs for seniors has been an ongoing issue, they are becoming more expensive every passing year. It can become too much for seniors to include in their budgets, which can be very harmful to their health. Medicare enrollees can purchase a Medicare Advantage plan or Medicare Part D plan to help pay for pharmaceutical drugs needed. But as drug prices continue to rise, the premium costs will go up as well to pay for the difference.

By law, Medicare is not allowed to negotiate drug prices, which is something Democrats have tried to change for a long time. Some sort of change or assurance must be given to seniors that these prices do not continue to climb and become unattainable. During Trump’s State of the Union address, President Trump states he will fight to make the drug prices go down. This will hopefully put a resolution of the soaring drug prices, and provide relief for seniors.

EZ.Insure will provide you with the best information on how to get the most out of your Medicare budget.. We provide you with your own personal advisor who is trained in your region to give you quotes and guidance on which plan will work best for you. To get a quote, email [email protected], enter your zip code in the bar above, or call 855-220-1144. It’s that simple and easy to start saving.

There Is NO Open Enrollment For Medicare Supplement Plans

Medicare Supplement Insurance Does Not Have a Deadline

Many senior citizens think that the Medicare Open Enrollment period is the only time they can purchase a Medicare Supplement plan. But, there is no deadline to purchase Medicare Supplemental Insurance. During the Medicare Open Enrollment Period, everyone is busy picking a plan that is best for them. Some retirees rush into a new plan without focusing on the coverage, and some may miss the period. Missing the period does not mean you miss the opportunity to change or purchase a plan. You can change or buy it year round.

In order to actually sign up for a Medicare Supplement Insurance Plan, you must be 65 and have Original Medicare. You are most eligible to be guaranteed issue rights when purchasing a plan six months from when you turn 65. Guaranteed issue is the protected right that an insurer cannot deny you or raise rates due to pre-existing conditions.

While there is no deadline to buy or change a Medicare Supplement Plan and anyone eligible is able to buy a plan any time of the year, it comes with a catch. Medicare Supplement Insurers do have the right to ask you questions regarding your health. They can then determine if they want to insure you, deny you, or raise your rates due to pre-existing conditions. This is possible because you will not have guaranteed issue rights.

Picking a Medicare Supplement Plan can be a long and tough process. There can be questions you have about the coverage, costs, and the different types of plans. EZ.Insure offers you a trained one on one agent to assist in figuring out the process, coverage, and sign you up. We compare all plans for you, and find the best prices. Enter your zip code in the bar above to receive quotes, or contact your own advisor by calling 855-220-1144, or e-mailing [email protected]. We promise to provide the best service with no obligations, it’s that easy!

Tag: medicare supplement