Medicare Supplement Insurance is Standardized by the U.S. Government
Even though the U.S. Government standardized Medicare Supplement insurance (Medigap) Plans back in the mid 1960’s, the Medicare Supplement quotes you receive now can vary significantly and working with an agent has absolutely no bearing on the price. In other words, the price you get by going direct with a company or with an appointed agent are identical.
For example; you can get the exact same Medigap Insurance Plan that your friend has, but you could end up paying a different premium. Often times I receive calls from customers and they express that their friend has this Medigap plan for such and such a price. I then proceed to ask them the following: where does your friend live, how old are they, do they smoke and which Medigap plan do they have? Insurance companies set their own Medicare Supplement rates based on your age, where you live, gender and the Medigap Plan type you select.
If you live in California, you will get a different rate than if you live in Florida. The rates also vary based on which county you live in. For example, UnitedHealthCare Plan F in 2018 costs $277.30 in Palm Beach and Broward County yet only $195.22 in Martin and St. Lucie County. If you go with Medigap Plan F; the one that offers the most comprehensive coverage, expect to pay more. However, if you just need a simpler form of coverage such as Medigap Plan A, you’ll pay a lower premium.
Medicare Supplement Insurance Plans Require You Have Medicare Parts A and B
To enroll in a Medigap Insurance plan, you must have Medicare Parts A and B. There are 10 Medicare Supplement Insurance Plans or Medigap Plans to choose from, although they’re not all available in every state. Coverage is identical from one company to the next. Rates, on the other hand, can vary quite a bit.
When choosing a Medicare Supplemental Insurance Plan you should take three main factors into consideration:
- Your Current Health
- Your Financial Situation
- Your Family Health History
Paying for insurance is similar to gambling. The less you pay, the more risk exposure you have. It’s difficult to project a few years into the future let alone a few days. You never know what tomorrow will bring. Hopefully, you never have to use insurance at all. Medicare Supplement Insurance is considered a guaranteed issue insurance plan for six months when you join Medicare Part B. In other words, it’s guaranteed and without any medical underwriting for up to 6 months after the month you turn 65.
Ending Employer Sponsored Insurance Coverage or Dropping a Medicare Advantage Plan are Additional Reasons or Triggers for Guaranteed Issue Medicare Supplemental Plan Coverage.
If you are not in an open enrollment period or guaranteed issue period, you must qualify by answering some health related questions. Also keep in mind that Medigap plans are prices based on age bands. So, if you wait until you’re 66 or older, you’ll be in a higher age band and will pay a higher premium than a 65 year old. That monthly premium is then locked in for the rest of your life. Premiums can go up, but when they do, it’s across all age bands in a particular county or state.
When discussing Medicare and Medigap plans there is often a discrepancy when referring to Medicare Part A or B and Medigap Plan A, B, C, etc. So, please pay close attention when I refer to Part A, Part B verses Plan A, Plan B, Plan F, etc.
Medicare Supplement Plan F is the only Medigap plan without any holes or gaps in coverage. When admitted to a hospital, Medicare Part A – Hospital Services pays all but the Part A deductible of $1,316 (2018). The Medigap Plan F pays this $1,316 Part A deductible. This amount can and often does increase slightly from year to year.
Medicare Part A – Hospital Services also covers 100% of the initial 20 days at a skilled nursing facility. This is also referred to as a skilled rehab facility. From the 21st thru the 100th day at a skilled inpatient rehabilitation facility, Medicare Part A will continue to pay all approved amounts except for $164.50 per day (2018). Fortunately, the Medigap Plan F pays this $164.50. If there is any needed long term care above and beyond the 100 days, you would have to pay all costs yourself or have a long term insurance policy pay for it. At this point, having a long term care insurance policy would be very helpful since it would aid in defraying these costs as well as the costs associated with non-skilled care, if needed. This additional coverage for non-skilled custodial care is costly and you would have to apply and get approved to have such an insurance policy in place in order to pay for such services. Of course, it would be next to impossible to get a long term insurance plan after an incident such as a broken hip or stroke. At that point, you would be un-insurable for long term care insurance.
Medicare Part B – Medical Services pays 80% for all doctor costs, skilled home health services, out-patient physical therapy, occupational therapy and speech therapy. It also pays 80% for all other out-patient testing and treatment including out-patient surgery. Medigap plan F pays the other 20% for all of these services.
Since providers can opt not to accept Medicare on assignment, they can then charge an additional 15% to you, the patient. This is referred to as the excess charge and Medigap Plan F pays this excess charge for you. The only other Medigap plan that covers this excess charge is Medigap Plan G.
Florida Medigap Plan G
Medigap Plan G is identical to Medigap Plan F except for one gap in coverage. Medigap Plan G does not cover the one-time annual Part B deductible, which was $183 in 2017 and 2018. So, when comparing apples to apples, you can compare Medigap Plan F and Medigap Plan G but remember to factor in the annual out-patient deductible of $183.
Florida Medigap Plan A
Medigap Plan A has the most gaps in coverage. The only gap that it does cover is the 20% for all doctor bills and all out-patient bills.
Florida Medigap Plan B
Medigap Plan B is the same as Medigap Plan A except it does cover the Hospital Medicare Part A deductible of $1,316.
Florida Medigap Plan C
Medigap Plan C is identical to Medigap Plan F but it does not cover the Medicare Part B excess fees, when and if that should occur.
Florida Medigap Plan K
Medigap Plan K only pays 10%, rather than the usual 20% of all doctor bills and out-patient services. It also only pays ½ of the hospital deductible of $1,316. It does not cover the Medicare Part B deductible of $183, does not cover Medicare Part B excess and does not cover any foreign travel. The max-out-of-pocket for Medigap Plan K is $5,120, after which, the plan then pays all gaps fully.
Florida Medigap Plan L
Medigap Plan L is identical to Medigap Plan K except it pays 15% of all doctor bills and out-patient services and only pays ¾ of the hospital deductible of $1,216.
Florida Medigap Plan M
Medigap Plan M only pays 50% of the Medicare Part A Hospital deductible and does not cover the Medicare Part B outpatient deductible or excess charges.
Florida Medigap Plan N
Medigap Plan N also does not cover the Medicare Part B outpatient deductible or excess charges. It also asks that you pay a $20 co-payment for any office visit and a $50 co-payment for any emergency room visit.
Florida Medicare Supplemental High Deductible Plan F
The Medicare Supplemental High Deductible Plan F is a great value for a Medigap plan. There are significant savings on a monthly basis with a monthly premium just a fraction of the price of the Full Medigap Plan F. In 2018, the monthly premium for a female in Palm Beach County is $56 per month. The catch is the $2,240 yearly deductible that must be paid before the benefits will begin to pay. In other words, you would have to pay all gaps in coverage up to the max-out-of-pocket of $2,240. At that point, the Medicare Supplement company will pay 100% of all gaps in coverage for the remainder of the year. On January 1st of each year, that $2,240 deductible resets.
If a doctor or other health care provider chooses not to accept the Medicare approved amount that the government has implemented or simply does not want to accept Medicare on assignment, a limiting charge at 15% above the Medicare approved amount is the most that the provider can balance bill the patient. This 15% above the Medicare approved amount is referred to as the Medicare excess charge. Remember that Only Medigap Plan F and Medigap Plan G cover this excess charge.
In Summary, the language of Medicare and Medicare Supplemental coverage can be confusing at first. After a few reviews and after sitting down with an experienced independent Medicare Supplement agent, it will start making more and more sense. After you begin using your Medicare and Medicare Supplement benefits, you will be amazed at how easy and efficient this Government plan actually is.
For more information on how Florida Medicare Supplement Insurance can help with your health insurance needs call Neil Primack (561) 935-3907 or email him at: email@example.com.