2019 Changes in Medicare

Medicare has under gone a number of changes since it originated in 1965.  With over 60 million participants Medicare continues to have the highest satisfaction rate of any form of health insurance available.  With every year that passes, Medicare and Medigap keeps getting better and 2019 is no different.  Some of the modification that Medicare is making only affect individuals enrolled in Medicare Advantage plans while other updates will affect all beneficiaries.

Donut Hole

One unappealing element of Medigap Plan D, prescription drug coverage is that once participants have reached a certain level of spending in a year they are required to pay more for the prescription medicine they need.  This creates what is known in Medicare lingo as a “donut hole”.  A second threshold is in place that once reached participants are then “rewarded” with lower cost prescription drugs.  This feature of Medigap Plan D was scheduled to be closed in 2020 however, Congress passed a bill that will close the donut hole for brand name prescriptions in 2019.  The gap for generics is still scheduled to close in 2020.

Therapy Cap

Congress has repealed the therapy cap limiting coverage to outpatient physical, speech, and occupational therapy services.  Original Medicare enrollees will not longer be required to pay the full cost of therapy services.

 Improved Information

The Medicare handbook is sent out to its enrollees every fall.  As if 2019 the handbook will be updated to include checklists and flowcharts to help participants make decisions on coverage decisions.  The Medicare Plan Finder will be included online and updated to make it simpler to use.  Enrollees will also have a chance to compare out-of-pocket costs and coverage options between Medicare and Medicare Advantage with updated online coverage tools.

Increased Telemedicine

All methods of technology are advancing, and Medicare is using this to their advantage with increased telehealth programs.  These programs allow patients to confer with doctors and nurses over the internet.  Telehealth services will be covered in 2019 for people with end-stage renal disease and stroke treatment.

Lifestyle Support

For enrollees in Medicare Advantage there will be the option to have meals delivered to their home, transportation to the and from the doctors, and the installation of safety devices like bathroom grabs bars and wheelchair ramps.  For home safety improvements and prepared meals to be covered a medical provider will need to recommend them.

In-Home Assistance

In 2019 Medicare Advantage plans will also have an option to pay for home health aides.  These aids assist in everyday activities such as dressing, eating, and personal hygiene.  This is part of a broader definition of traditional services required by Medicare.

Trial Period

Participants will now be able to try the Medicare Advantage plan for three months.  If they aren’t satisfied they can switch to Original Medicare Part A and Part B or another Medicare Advantage plan.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

Medicare prescription drug coverage: You may need a new plan

Do you have the right Medicare prescription drug coverage? The answer could help you save big money on your out-of-pocket health care costs during your retirement years.

“Retirees who regularly take prescription drugs can potentially save hundreds or even thousands of dollars with careful shopping for a Medicare Part D prescription drug policy,” said Diane Omdahl, president of 65 Incorporated, an independent firm that helps people make smart choices regarding their Medicare coverage.

If you’re new to Medicare, you may not even realize you need to buy a separate policy that covers prescription drugs. A possible exception: If you select a Medicare Advantage Plan that simplifies and combines Medicare’s various parts and also covers prescription drugs. Even then, not all Medicare Advantage Plans cover prescription drugs, and when they do, they often have different features regarding their coverage.

As a result, if you regularly take one or more prescription drugs for chronic conditions, it’s a very good use of your time to shop carefully for prescription drug coverage. You can make changes during Medicare’s upcoming open-enrollment period, which runs from Oct. 15 to Dec. 7, with the changes becoming effective at the beginning of 2019. Unlike Medicare supplement plans, you can change your Part D plan each year without needing to satisfy medical underwriting.

Omdahl said if one or more of these red flags apply to you, it might be time to shop for new drug coverage:

  • If you haven’t changed your Part D policy for several years
  • If you take brand-name prescription drugs or many drugs
  • If your doctor has prescribed different drugs for you during the year

Comparing prescription drug plans can be a daunting task. A key component of each plan is its drug “formulary,” a list that assigns drugs to various tiers. Each tier can have a different set of co-payments and co-insurance features. The lowest tiers typically cover the least expensive or generic drugs, whereas higher tiers will cover more expensive, brand-name drugs. You’ll typically pay less out of pocket for lower-tier drugs compared to those in higher tiers.

Each year, insurance companies can change a specific drug’s tier level or change the co-insurance and co-payment features that apply to each tier. In addition, some plans negotiate for lower prices with specific pharmacies, identifying them as a preferred drugstore that charge less if you use them. Many policies also provide price breaks for mail-order prescriptions.

Due to all these potential changes, anyone regularly taking one or more prescription drugs will want to determine how much you might pay for them under a new plan. Medicare’s Plan Finder is a free, online resource that can help you make this determination. Or you can hire an independent firm such as 65 Incorporated to help you select a plan.

If you’re already enrolled in a prescription drug plan, you should soon receive a disclosure from your drug company about changes for 2019. Be sure to read it carefully — don’t toss it with your junk mail!

If you became newly eligible for Medicare during 2018 and selected a Part D insurance policy for the first time, it’s effective only for 2018, and it might change for 2019. Again, read any paperwork you receive carefully to find out if your plan is changing.

Omdahl shares that all of her clients who’ve never previously changed their Part D plan ended up doing so as a result of an independent review — which had an average out-of-pocket savings of $973. This example applies to people who regularly take either expensive, brand-name drugs or many drugs. If you take only a few, low-cost generics, your potential savings by changing policies could be much less.

Smart choices regarding Medicare prescription drug coverage will help keep you healthy and could potentially save you a lot of money. Be sure not to neglect your homework: Shopping for coverage is part of your new “retirement job.”

Original Source: https://www.cbsnews.com/news/medicare-prescription-drug-coverage-open-enrollment-starts-oct-1-how-a-new-plan-can-save-money/

Original Date: Sept 26 2018

Written By: Steve Vernon

The Pros to Medicare Supplemental Insurance Plans

Protection from Astronomical Medical Bills

Health coverage through Medicare only covers 80% of the total costs which leaves you to cover, out of pocket 20%.  In order for Medicare Part B to begin paying it’s 80% you must reach the yearly deductible.  Depending on the Medicare Supplemental Insurance Plan you choose the extra 20% will be partially covered.

Coverage When Visiting Outside the United States

Some Medicare Supplement Plans offer coverage outside of the U.S. in case of an accident or unexpected illness.  If you find that you travel outside of the United State on a regular basis it is important to purchase a Medigap plan that covers your health care needs outside of the country.

During Open-Enrollment – Guaranteed Acceptance

If you apply for Medigap within your open enrollment period (six months after the 1st of the month in which you turn 65) coverage and rates are guaranteed.  This means that it doesn’t matter what illness you bring to the table, Medicare and Medicare Supplemental Plans are guaranteed to accept you for coverage.  This is just one of the reasons it is important to enroll during the open enrollment period.  After this time, insurance companies can deny you coverage or increase your rates, on top of a late enrollment penalty that you will be responsible for.

Renewable Policies

No matter what health problems arise, all standard Medigap plans are assured to be renewable to you.  This means that no matter what you are diagnosed with insurance companies cannot deny you plan coverage as long as you make the premium payments.  Your policy renews automatically each year.

Choice of Medicare Doctors

When you purchase Medicare Supplemental Insurance you will be covered when you visit doctors that participate with Medicare.  The only exception is Medicare SELECT.  This is a type of Medicare Supplemental Insurance that requires use of select medical providers and hospitals within the network.

Multiple Plans to Choose From

Medigap offers 10 different plans to choose from to help Medicare enrollees pay for expenses not covered by Original Medicare costs.  Medigap plans that offer the most coverage also have the highest monthly premiums whereas the opposite is true with lower premium Medigap policies.

Standard Policies

There are ten different Medigap policies.  The plans are standard throughout the U.S. and are regulated by the law.  Plan benefits are the same from state to state meaning that the Medigap Plan F coverage in Michigan is the same as Medigap Plan F coverage in Texas.  In Massachusetts, Minnesota, and Wisconsin standardized plans are a bit different.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.


Now’s the time to sign up for Medicare

People with Medicare, it’s time to mark your calendars! Open Enrollment Period runs from Oct. 15 to Dec. 7.

Open enrollment is but one of the terms you will encounter when trying to decipher the maze known as Medicare. Let’s not forget initial enrollment period; general enrollment period; original Medicare; Medicare Advantage; supplemental insurance; prescription drug coverage; and late enrollment penalties.

So, yes, if you think it’s a complicated issue, you’re right — and you’re not alone!

Even the experts agree that signing up can be a daunting experience.

“It is complicated and intimidating,” suggests Barry Klitsberg, president of Queens Interagency Council on Aging and a longtime employee of the U.S. Department of Health and Human Services. “People don’t know where to start.”

A good place might be to get an understanding of what Medicare is and what it provides.

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services. It provides healthcare insurance for Americans aged 65 and up who have worked and paid into the system through payroll tax and for certain younger people with disabilities.

Among the items Medicare does not cover are long-term (or custodial) care, most dental care, eye exams related to prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids and routine foot care. Still, Medicare has much to offer.

Depending on the situation, some people may get Medicare automatically and others need to apply. Individuals collecting Social Security or Railroad Retirement benefits before they turn 65 will be automatically enrolled into Medicare when they turn 65. Individuals who are eligible for Medicare but who are not yet collecting Social Security of Railroad Retirement benefits will have to actively enroll into Medicare by contacting the Social Security Administration.

It is important to note that, while Social Security works with the CMS by enrolling people in Medicare, they are not the same.

An individual is entitled to apply for Social Security benefits beginning at age 62. Eligibility for Medicare comes approximately three years later during the initial enrollment period, with eligibility beginning three months prior to one’s 65th birthday, extending through one’s birth month and continuing for the next three months, giving new enrollees a seven-month window.

There are two choices for how to obtain Medicare coverage, original Medicare and Medicare Advantage.

Original Medicare includes Part A (hospital insurance), which covers hospital inpatient care, skilled nursing facility care, home health and hospice care; and Part B (medical insurance), which covers doctors’ services, outpatient care, durable medical equipment (like wheelchairs) and preventive services (like screenings, shots and yearly wellness visits). To this you may add Part D  (prescription insurance) as well as supplemental insurance.

Medicare Advantage, also known as Part C, includes Part A, Part B and usually prescription drug coverage as well. Additional benefits may be included such as dental, eye care and hearing care.

According to the CMS, you usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain period of time. For Part B, most individuals pay a monthly premium; the amount can vary depending on income. The premium is generally deducted directly from a person’s Social Security.

The CMS indicates that if you have original Medicare, you may see any doctor who is enrolled in Medicare and accepting new patients. Referrals are not needed. You generally pay a portion of the cost for each covered service. You can join Part D and you may buy supplemental insurance to pay costs that original Medicare doesn’t cover.

If you don’t have prescription drug coverage, or the coverage you have isn’t at least as good as Medicare, you should consider enrolling in Part D. If you need prescription drug coverage, you have to sign up for it.

Medicare.gov, the official federal government website, indicates two ways to get prescription drug coverage: Medicare Part D or a Medicare Advantage Plan (see below) that offers drug coverage. Costs will vary, depending on the drugs you use, the plan you choose and other factors.

Note that there are different types of Part D plans, and each one may cover different prescriptions. Each drug plan has its own list of covered drugs (called a formulary). Many plans place drugs into different “tiers” on their formularies, with drugs in each tier having a different cost. It is important to find out which plans cover the drugs you need.

Something else to look out for is what is known as the coverage gap, or donut hole, a temporary limit on what a plan will cover. This gap begins after you have spent a certain amount for covered drugs. The amount may change each year.

Klitsberg indicated that the donut hole has been shrinking and, in 2019, the gap will be disappearing for brand-name drugs. He suggested that in 2020, it will do likewise for generic drugs.

According to the CMS, you have up to three months after your Medicare coverage starts to join a Part D plan. It warns that “if you don’t join a Medicare drug plan when you’re first eligible for Medicare, you may have to pay a monthly Part D late enrollment penalty if you join a plan later.” The penalty goes higher the longer you wait to enroll.

The CMS also warns that there are risks for not signing up for Part B: You may pay all of the costs for doctors’ services, outpatient care, medical supplies and preventive services; you will have to wait until the general enrollment period (Jan. 1 to March 31 each year) to sign up if you decide you want Part B later; and you may have to pay a late enrollment penalty for as long as you have Part B. The penalty amount increases the longer you go without Part B coverage.

Whether it’s best for you to sign up for Part B depends on your individual situation, such as your employment status, among other considerations.

Do you need a supplemental insurance (or Medigap) policy? Original Medicare pays for much, but not all, of the cost for healthcare services and supplies. Some people opt for additional coverage from a private company to fill in the gaps in Parts A and B. You need both Part A and Part B to buy a Medigap policy, which can cover costs like coinsurance, copayments and deductibles. According to Elder Law Review, a publication of Ronald Fatoullah & Associates, “Under Original Medicare, there is no limit on how much you pay out of pocket per year unless you have supplemental insurance.”

Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare. You must have both Medicare Part A and Part B to join. The CMS suggests that “it may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower or included.”

Signing up for Part C places an individual in a health maintenance organization. Members must generally get a referral from their primary care physician in order to see a specialist or other doctors. You may pay lower costs for covered services as long as you see doctors or go to hospitals that belong to the plan’s network.

You can join a Medicare Advantage plan when you first become eligible for Medicare (the seven-month window). These plans include Part A, Part B and usually Part D coverage. Some offer extra benefits like vision, hearing or dental.

You usually have to pay a monthly premium, in addition to your Part B premium, and a copayment or coinsurance amount for covered services.

Premium deductibles and copayments can vary significantly from plan to plan, so it is important to compare costs and coverage each year.

Medicare Advantage insurers negotiate with healthcare providers to find the lowest cost providers each year. In recent years, these provider networks have become smaller, with fewer specialists, according to reports. In addition, providers can join or leave a network at any time.

The right coverage can make all the difference. It is important, therefore, to be aware of any changes in coverage.

“In October, you should start comparing your current coverage with other options to see if you can save some money and to ascertain whether your provider(s) are still covered under your plan’s network,” Fatoullah’s publication advises. You can change your health or prescription drug coverage between Oct. 15 and Dec. 7 each year, the open enrollment period, or annual election period or annual coordinated enrollment period.

Klitsberg suggests it is vital for anyone enrolled in a Medicare plan to “read your mail.” Every year, you will be receiving information on any changes in costs and coverage. And, he points out, during the open enrollment period “you have a lot of choices.”

There is a lot to consider when choosing Medicare coverage. For further information, visit Medicare.gov, where the government’s official guide to the program, “Medicare & You,” runs more than 100 pages, or call 311 and ask for “HIICAP,” the Health Insurance Information Counseling and Assistance Program.

Original Source: http://www.qchron.com/editions/central/now-s-the-time-to-sign-up-for-medicare/article_c07d3876-c680-11e8-83e2-9b686d3de1d0.html

Original Date: Oct 42018

Written By: Mark Lord Chronicle Contributor

Medicare vs Medicaid

Both Medicare and Medicaid are both health care programs sponsored by the government, many people mistake the two for being the same.  This is of course, not the case.  Medicare is a federal health care plan that is available to enrollees over 65 years of age.  Medicaid is a jointly funded health care program that is funded at both the state and federal level and is intended to supplement a need for coverage in lower-income families and individuals.

Medicare/Medigap Supplemental Insurance  

As stated earlier, Medicare is a program that supplies health insurance to individuals who have attained 65 years of age.  Qualification for Medicare comes when a participant or their spouse has worked at least ten years and paid Medicare taxes.

Medicare covers the basic health care needs of enrollees.  Medicare breaks down into multiple parts: Original Medicare (Part A and Part B), Medicare Advantages, Medicare Supplemental Insurance Plans, and Medicare Part D, prescription drug coverage.  Medicare Part A and Part B cover most health insurance needs.  Voids and gaps in coverage are filled with the purchase of additional coverage in the form of Medigap Plans A – Z.

It is important to note that Medicare/Medigap do not cover vision, dental, or hearing.  Coverage for the services will need to be purchased separately from any Medicare or Medigap policies.


Medicaid aids low-income families and individuals with health care assistance.  Coverage is funded through both the state and federal government and is available to people of all ages.  The requirements that are needed to qualify for Medicare vary greatly depending on where you live.  Medicaid is eligible for Medicaid if they meet certain requirements such as passing a necessity test, an asset test, and an income test.

Medicaid offers additional coverage that Medicare does not such as dental coverage, vision, and hearing care.  Medicaid also covers prescription drugs without having to add additional coverage.  To check availability in your state, check out the Medicaid website.

Differences Between the Two

The biggest difference between Medicaid and Medicare don’t stop at funding.   Coverage between the two vary a great deal as you can see from above. Medicare doesn’t offer coverage for dental, vision, or hearing. Medicare doesn’t have financial limits on who qualifies and who doesn’t.  It is possible to have dual-eligibility.  This means that a participant is over 65 and has met the financial or medical eligibility requirements associated with enrollment in Medicaid.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

Senior Living: Two ways to get your Medicare

Senior Living: Two ways to get your Medicare

Contributing writer

At a family reunion, my Aunt Abby and Uncle Glen got into a squabble over the best way to get their Medicare benefits.

Uncle Glen is an Original Medicare man, and has been for a decade or so. Aunt Abby prefers Medicare Advantage, which is similar to a health plan she had before enrolling in Medicare.

Greg Dill

When they turned to me, asking me to referee and declare which form of Medicare is better, I gave them a big smile and answered, “Well, it depends.”

Original Medicare and Medicare Advantage have different benefits and costs that you should consider based on your personal needs. Medicare open enrollment season runs from Oct. 15 to Dec. 7, and it’s a good idea to know how the two types of Medicare work before you select one.

With Original Medicare, you can choose any doctor, hospital, or other healthcare provider you want, as long as they accept Medicare. When you receive medical services or goods, Medicare pays the provider directly. About 70 percent of all people with Medicare have Original Medicare.

The other way to get your benefits is Medicare Advantage, which is a form of managed care, like an HMO or PPO. Medicare Advantage is provided by private insurance companies approved by Medicare. If you’re in Medicare Advantage, you generally must go to doctors and other providers in the company’s network.

If you go outside the network, you may have to pay more.

On the other hand, Medicare Advantage plans may offer some services – such as dental, hearing, vision, and prescription drug coverage – that Original Medicare doesn’t.

Most people with Original Medicare pay a monthly premium. If you’re in Medicare Advantage, you may have to pay an additional monthly premium to the private insurer that covers you.

With Original Medicare, you or your supplemental insurance must pay deductibles, co-pays, and coinsurance.

To cover these “gaps” in Medicare, some people buy supplemental insurance called Medigap. If you have a Medigap policy, Medicare pays its share of the covered costs, and then your Medigap policy pays its share.

Original Medicare does not cover prescription drugs. If you want drug coverage, you can buy a separate Medicare Part D plan. Such plans are sold through private companies approved by Medicare. You have to pay an additional monthly premium for Part D.

Medicare Advantage companies must cover all of the services that Original Medicare covers. (However, Original Medicare covers hospice care, some new Medicare benefits, and some costs for clinical research studies, even if you’re in a Medicare Advantage plan.) In all types of Medicare Advantage plans, you’re always covered for emergency and urgent care.

You can join a Medicare Advantage plan even if you have a pre‑existing condition – except for end-stage renal disease. People with ESRD usually are covered through Original Medicare.

Keep in mind that Medicare Advantage plans can charge different out-of-pocket amounts and have different rules for how you get service.

For example, you may need a referral to see a specialist. And you may need to stay in the plan’s provider network, unless you’re willing to pay more to go outside the network.

You should always check with the plan before you get a service to find out whether it’s covered and what your costs may be. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

How can you decide whether Original Medicare or Medicare Advantage is better for you?

There’s a good comparison of Original Medicare and Medicare Advantage in the “Medicare & You” handbook. “Medicare & You” is mailed to all Medicare beneficiaries every fall. You can also find it online, at www.medicare.gov.

Original Source: https://www.presstelegram.com/2018/09/26/senior-living-two-ways-to-get-your-medicare/

Original Date: 9/26/2018

Written By: Greg Dill

Medicare Supplemental Insurance Plans: Read This Before Enrolling in Medicare Coverage

What is Medicare Supplemental Insurance, Medigap?

Once you have enrolled in both parts of Original Medicare, Part A and B, you will be eligible to purchase insurance that supplements your health insurance coverage that fills insurance gaps left by Part A and Part B.  The supplemental insurance plans are known as Medigap or Medicare Supplemental Insurance.

Why do you need Medicare Supplemental Insurance Plans?

There are a couple of reasons you may need to purchase Medigap including filling in the gaps left from what Medicare Part A and Part B don’t cover and for assistance with costs that are not covered by Medicare.

How does Medicare Supplemental Insurance Plans work?

There are ten different supplemental plans that are regulated by Medicare and our federal government.  Medigap plans are labeled Plan A through Plan N alphabetically.  Only certain plans are available depending on where you live in the United States.  The plans are all standardized and offer the same benefits no matter where they are purchased, meaning Plan A in Michigan offers the same coverage as Plan A in Texas.  There are changes however in the premiums paid and the insurance companies that are permitted to sell them.

Things you should know about Medicare Supplemental Insurance:

Qualify:  If you are over 65 years of age, are enrolled in Medicare Part A and Part B, are 6 months from the first day of the month you apply for Medigap your acceptance in Medigap is guaranteed.  If you enroll in Medigap during this period, open enrollment, of time then there is no need to have a medical examination to obtain coverage.

Coverage: Original Medicare Part A, Part B, and Medigap coverage applies to only one person.  Your spouse will need to have their own policy, separate from yours.

Purchase: Medigap participants may purchase plans from any private insurance company that is licensed in your state.

Payment: The monthly premium that you pay for Medigap is paid directly to the private insurance company.  The payment is in addition to any premium that you are required to pay for Medicare part B.  The payment for Medicare part B is paid directly to Medicare.

Not Covered: There are certain things that Medigap doesn’t cover such as: long-term care, vision, dental care, hearing aids, eyeglasses, or private-duty nursing.

Return Policy: You have the right to cancel your Medigap insurance policy without penalty within 30 days of purchase.

Renewable Plans:  Medigap insurance policies are guaranteed even if you have health problems during the period in which you were covered.  This means insurance companies are not able to terminate your Medigap policy as long as you continue to make the monthly payment for the premium.

Preventative Maintenance:  Medicare pays for the entire proposed medical service if it is deemed it will help avoid future health issues.  If the doctor you are seeing accepts the amount that Medicare approves for the service, you will not have to pay a penny for the preventive services.

Prescription Drug Coverage:  Up until 2006 many Medigap plans covered prescriptions however, as of January 1, 2006 Medigap plans are no longer allowed to offer prescription drug coverage.  If you want prescription drug coverage you will need to purchase Medigap Part D, which offers this coverage at an additional premium.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.

Medicare supplement plans are changing: What you need to know

CHICAGO (Reuters) – If you are buying a Medicare supplemental policy in the United States, make sure you choose your insurance carefully over the next few months.

At the end of 2019, the doors will close on Plan F, which is considered the Cadillac plan of supplemental insurance policies known as Medigap. Designed for people who do not like healthcare cost surprises, it is the most popular of supplemental plans used to pay for services that Medicare does not cover.

But unless prices increase significantly, the existing Plan G may be a better deal.

The government is cutting off access to Plan F for new Medicare enrollees to control costs. Eight other supplements (here) will remain open.

Insurance experts expect Plan G to become the new draw for people wanting the most coverage without surprises.

Although Plan F is the most expensive option, retirees pay top dollar because they can go to any doctor or hospital that accepts Medicare patients. There is no surprise bill afterward – no deductible, co-payments or coinsurance.

Participants already in Plan F when the doors close at the end of next year will be able to stick with the plan (here). But if you turn 65 any time after the beginning of 2020, you will not be able to buy Plan F.

In addition, if you are in Medicare now and buy a Medicare Advantage plan or another Medigap insurance plan, switching after Jan. 1, 2020 could be difficult. Most states allow insurance companies to screen for conditions ranging from diabetes to heart attacks and cancer. On that basis, you could be turned away from Plan F or face high premiums.

Plan G is currently identical to Plan F except for the $183 deductible participants must pay at the beginning of the year.

Rates differ by state and insurance company, but the national average for Plan F premiums is $185.96 a month, compared with $155.70 for Plan G, said Kris Schneider, vice president of consumer and carrier engagement for AON Retiree Health Solutions.

“Buying G is a no -brainer,” said Jeff Goldman, an insurance agent at G.M. Goldman & Associates in Skokie, Illinois. “You save about $350 a year on premiums, so it makes no sense to buy F to cover the $183 deductible.”

Experts are not sure what will happen to costs once insurance companies see the effects of the 2020 changes. Some expect Plan G rates to jump because under Medicare rules, the plan must accept new enrollees regardless of health conditions.

Others estimate Plan F premiums to soar because new healthy 65-year-olds will no longer come into the plan, resulting in an older, sicker pool of people to cover.

“I see no way around Plan F rates continually increasing, perhaps exponentially after 2026,” said Adam Wasmund, chief marketing officer of Jack Schoeder & Associates, which advises health insurance brokers.

There will be more clarity as state regulators approve rates and insurance companies examine the claims of participants in both Plan F and Plan G. But Wasmund is concerned that the federal government could raise Plan G deductibles in an attempt to curb more Medicare usage in the future.

“Could the deductible be $200, $1,000 or $2,000?” said Wasmund. “Who’s to say what the government will do?”

(The opinions expressed here are those of the author, a columnist for Reuters.)

Original Source: https://www.reuters.com/article/us-column-marksjarvis-medigap/medicare-supplement-plans-are-changing-what-you-need-to-know-idUSKCN1LZ18F

Original Date: Sept 19 2018

Written By: Gail MarksJarvis

What You Need To Know Before Starting Medicare: The Basics


Starting Medicare can be an intimidating process. There are a lot of options, confusing terminology, and people everywhere trying to sell you something different.

Every year, the Center for Medicare & Medicaid Services (CMS) publishes a new Medicare & You handbook. This handbook thoroughly explains the parts of Medicare, what is covered and how it works. You’ll also come across another book dedicated solely to Medicare Supplement plans: Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

As the owner of an agency that helps seniors get insurance coverage, I know that these documents’ combined page count of over 200 pages can make this information very daunting. Those who attempt to start reading usually find themselves exhausted and confused. As your research continues, mail will start pouring in with brochures, flyers, postcards, booklets and pamphlets all related to Medicare options. The question is, “Where do I start?” The answer is the basics.

Original Medicare

Original Medicare consists of Part A (hospital coverage) and Part B (outpatient coverage). Original Medicare can be used at any doctor or hospital in the United States that accepts Medicare. To see if a specific doctor takes Medicare, you can use the Physician Compare tool.

Original Medicare is then often paired with a stand-alone prescription drug plan (Part D). Original Medicare generally only covers about 80% of outpatient services and has a separate deductible for inpatient care. There is no limit to the 20% coinsurance you are required to pay.

Because of these expenses, experience has shown me that most people who want Original Medicare also enroll in a Medicare Supplement (Medigap) plan to limit their exposure to out-of-pocket expenses.

Medicare Supplement

Medicare Supplement plans, also called “Medigap” plans, are also labeled with letters, like Plan F, Plan G and so on. You cannot have one of these plans without Original Medicare. Medigap Plans supplement the Medicare claims payment to fill in the gap for you. The Supplement is accepted anywhere that accepts Original Medicare and, similarly, allows participants freedom to travel across the country without worrying about whether a provider is in network. They provide coverage for the out-of-pocket expenses left by Original Medicare. When first enrolling in Medicare, there are no health qualifications, and you get to purchase any Medicare Supplement plan available. If you are outside of your initial election period, you may have to qualify with good health in order to get or change Medicare Supplement plans.

In my experience, Medigap plans are generally a good option for Medicare beneficiaries who want to keep Original Medicare but are concerned with the potential out-of-pocket costs they could be responsible for. Health and your individual desire to avoid networks play a large role in whether or not a Medicare Supplement is a good choice for you. Some beneficiaries choose to enroll in and pay for a Medicare Supplement policy even if they are in good health because they know they may not qualify for one in the future.

Medicare Advantage

Medicare Advantage Plans take you from the freedom of any Medicare provider into a network where, depending on the type of plan, you may only be able to obtain services from a privately contracted network of providers. You will still have to pay any premiums for Part A and B to be eligible. When shopping for these plans, it is important to know whether your doctor will be in-network. You will typically have to select a participating primary care doctor and have all referrals coordinated through him or her. Your specialists, too, must be part of the plan’s network.

Medicare Advantage plans tend to have lower premiums than Medicare Supplement plans or none at all. They are pay-as-you-go plans in which the maximum out-of-pocket cost per calendar year is as high as $6,700. While most Medicare Advantage plans, in my experience, do include built-in drug coverage, the drug component is not necessarily tailored to your specific list of medications. Seniors must be very careful to fully investigate how their medications will be treated.

Advantage plans can often have more out-of-pocket costs than Original Medicare with a Medicare Supplement. Typically, each doctor visit, test and hospital admission has a co-payment at the time of service. Medicare Advantage is also a calendar-year contract, so you can change from one Medicare Advantage plan to another without any health underwriting — but only during the Medicare Annual Election Period each year.

I believe that Medicare Advantage could be a good fit for beneficiaries who rarely travel, want low monthly costs and don’t mind paying more out of pocket at the time of service. Those who have health issues and want to choose their doctors and specialists may want to consider options other than Medicare Advantage.

Part D

Unlike Medicare Advantage plans with built-in drug benefits, stand-alone Part D coverage can be tailored to your specific situation. You can choose a unique plan based on your current medications and preferred pharmacy. This plan, like the others, can only be changed once per year during the Annual Election Period. Typically, you cannot have a Medicare Advantage plan and a separate Part D drug plan.

Regardless of whether you decide to pay a little more and have the freedom and flexibility of a Medicare Supplement or you decide to forgo the premiums and abide by the network and managed-care restrictions of a Medicare Advantage plan, I always recommend choosing a plan that limits the out-of-pocket expenses of Original Medicare. With Original Medicare alone, you are subject to unlimited coinsurance. But, of course, having some coverage is better than no coverage at all.

Everyone wants to know, “Which plan is best for me?” Some enrollees opt to speak to a representative who can show them all the options, look into their preferences and local market, and offer advice; either way, the answer to that question always depends on your current situation, your medications, where you live and your health, so evaluate how these factors fit into the plans available in your area.

Original Source: https://www.forbes.com/sites/forbesfinancecouncil/2018/09/13/what-you-need-to-know-before-starting-medicare-the-basics/#3e983db9552d

Original Date: Sept 13 2018

Original Author:

Avoiding the Medicare Late Enrollment Penalty

Three months before you turn 65 you should receive a packet of information that tells you exactly what you need to do during Medicare open enrollment to insure coverage.  Open enrollment only lasts for three months before the month you are set to turn 65 and for three months after.  If you choose to enroll in Medicare outside this period, you will be subject to a late enrollment penalty.

Late Enrollment Penalty

There are four different parts of Medicare which each have their own penalty for late enrollment.  These four parts are: Medicare Part A, Medicare Part B, Medicare Advantage, and Medicare Plan D.  There are penalties for each separate part of Medicare if you choose to enroll late.

Medicare Part A

Most likely you will automatically qualify for Medicare Part A when you turn 65.  If you do automatically qualify, often there is not premium.   Automatic coverage occurs for recipients who have, or who have a spouse who has, worked at least forty quarters in the United States.  This equates to ten years of employment in the U.S.

If you have not met this qualification, then when eligible you will be required to pay for premium for Medicare Part A.  If you choose not to at the time, waiting until a later date, your premium will increase monthly by 10%.  The increased premium will need to be paid for double the number of years you could have had Medicare Part A but did not choose to sign up.

Medicare Part B

Medicare Part B is like Medicare Part A in that your enrollment in benefits are automatic.  Like Medicare Part A, if you are not enrolled automatically you will need to enroll in Medicare Part B when you become eligible.  If you choose not to enroll in Part B when you are first eligible you will be charged a late enrollment penalty for the entirety of your coverage. The penalty has the potential to increase by 10% for every year you did not sign up but were eligible to do so.

Medicare Plan D

Medicare Plan D, also known as prescription drug coverage, is one plan that you will not automatically be enrolled in.  It is encouraged that you enroll in prescription drug coverage with in the enrollment period.  If you do not and you are not enrolled in any other prescription coverage the penalty you pay multiplies 1% of the “national base beneficiary premium” times the number of months that you have not had prescription drug coverage.   The premium is rounded to the nearest ten cents.


If you qualify for a Special Enrollment Period, you may avoid the late penalty for Medicare Part A and B.  This special enrollment period occurs when seniors are still working at 65 and delay enrolling in coverage.  The same is true as well if you are covered under your spouse’s medical insurance.

The experts at eMedicare Supplemental Insurance, powered by Omega, have all the answers you are looking for when it comes to your Medicare Supplemental Insurance needs.  More information can be found at http://emedicare-supplemental-insurance.com/.