Medicare Supplement Plans
If you are considering whether to sign up for Medicare Plans A & B, you may notice that both plans have annual coverage limits. If you find yourself hospitalized for more than 60 days, or if you have an extended stay at a nursing facility or mental health facility, you may find yourself paying a daily deductible, or stuck with other exorbitant costs. To prepare for such circumstances, you should consider a Medicare supplement plan. These plans are called Medicare Supplemental plans, because they close the gap between your medical expenses and the coverage limits of your A & B plans.
Medicare Supplemental Explained
Medicare Supplemental policies are offered by private insurance companies. Any doctor that accepts Medicare must also accept your Medicare Supplemental plan, no matter which company supports that policy. In other words, you can travel anywhere in the country and still be covered, as long as you use Medicare doctors.
These companies will raise their rates occasionally, like all companies. But they don’t do this based on pre-existing conditions. Regulated by Medicare, they are required to pay out a certain amount of every dollar of premium for claims. As such, they utilize a formula that accounts for the total premium coming in, and the total claim expense going out. Accordingly, they adjust their premiums to stay compliant with Medicare rules.
One of the best features of these plans is that you cannot be turned down if you sign up during the initial 7-month enrollment period. This period begins three months prior to the month in which you turn 65, and continues for three months after that month. Once you are enrolled, no company can cancel your plan. It automatically renews every month, as long as you make your payments.
However, if your company drops you for missing a payment, or if you switch to a different plan, or if you sign up after the initial enrollment window, then you may have to go through the underwriting process to get approved for a new plan. This means that your current health will be taken into account, including pre-existing conditions. The best way to avoid this process is to sign up for a Medicare Supplemental plan during the initial enrollment period along with your original Medicare plan. To be ready, you need to do your homework and know which Medicare Supplemental plan serves your needs best. A good insurance broker like CAP Insurance Services will save you a lot of time and money when making this decision.
Medicare Supplemental Plan Types
Medicare allows several different supplement plans for seniors. Although there are several insurance carriers that provide these plans, the plans are standardized. This means that any two companies that offer the same plan must offer the exact same coverage, though they may charge different premiums. For example, if two different companies offer Medicare Supplemental Plan N, they can charge different premiums for it, but they must cover the exact same services, and pay out the exact same amounts for them.
With identical coverage, you may reason that it is best to choose the company with the lowest premium payment. Generally, this is true. But other factors such as customer service may also play a role in your decision. Relying on a solid broker like CAP Insurance Services can help a lot in choosing the best company for your Medicare Supplemental Plan, and save you some headache down the road.
The Centers for Medicare and Medicaid Services (CMS) constantly monitor Medicare Supplement Plans and current economic situations while understanding the needs of senior citizens. In 2010, they passed the Medicare Modernization Act, which eliminated four Medicare Supplement Plans: Plans E, H, I, and J. Here are brief descriptions of the Medicare Supplemental Plans currently offered by private companies:
Medicare Supplemental Plan F is a comprehensive gap insurance plan that covers everything that Medicare A & B do not. It will pay for all of your deductibles, copays, and coinsurance. If you have an extended hospital stay, it will cover you. No matter what you are seen for, with your provider or a hospital, will not receive a bill. Of course, the premiums for this plan are the highest of all the Medicare Supplemental Plans.
Plan G is exactly like Plan F, except that it will not cover the deductible for Plan B. Because the deductible for Plan B is not very high, the premiums for Plan G are not that much less than Plan F.
Plan N is exactly like Plan G, except that Plan N also gives your doctor the option of charging you a copay between $0 and $20. Your doctor has complete discretion about whether to charge you this copay, and how much of the $20 he or she wants to charge. In addition, if you visit the ER, you will have a $50 copay, but only if you are not admitted.
Another factor in choosing Plan N pertains to Medicare Assignment. Some doctors accept Medicare patients but refuse to accept Medicare assignment. In other words, they may choose to charge the patient more than the amount approved by Medicare.
These excess charges are covered by Plan F and Plan G, but not plan N. Under Plan N, if your doctor charges you more than the assigned rate for your service, they have the right to charge you up to 15% of the assigned amount. For example, if your doctor charges you $250 for a service that Medicare only allows them to bill you $100 for, Medicare will cover $100 of the bill, and the doctor can charge you $15 (i.e. 15% of the billable amount, $100). To avoid this situation, check with your provider to make sure that they accept Medicare patients and Medicare assignment.
Plan M is exactly like Plan N, in that it will not cover your Plan B deductible and excess charges. However, it will not charge you copays for provider and ER visits. Also, it only covers half of the deductible for Plan A.
Plans C and D
Plans C and D are exactly like plan F, except that they will not cover provider excess charges in cases where your provider refuses to accept Medicare assignment. (See an explanation of Medicare assignment in Plan N, above.) Also, as with Medicare Supplement G, Supplement D will not cover your Plan B deductible.
Plans A and B
Supplement B, like Medicare Supplemental plan D, will not cover your Plan B deductible or excess charges. But it also will not offer you a foreign travel benefit, nor will it cover your coinsurance for any skilled nursing facility. Supplement A is like supplement B, except that A will also not cover your part A deductible.
Plans L and K
Plans L and K are similar to Plan M, except there are a few services, including hospice and nursing care, that they will pay portions of, whereas Plan M will cover them completely. Of these partially-covered services, Plan L pays 50%, while Plan K pays 75%. In addition, Plan K offers the foreign travel benefit, while Plan L does not.
Choose CAP Insurance Services for Medicare Supplements
If this list of Medicare supplements seems overwhelming, don’t worry. Each of these plans has a variety of pros and cons, depending the situation in which you might find yourself in need of using them. The important thing is: By choosing the right Medicare supplement, you acquire additional coverage that will put your mind at ease. When you face a difficult medical challenge, the last thing you want to think about is money.
Call on CAP Insurance Services to help you navigate through the selection of your Medicare Supplement. It takes keen insight to understand how these plans will help you going forward. Keen insight is what we offer. Come to us, and make the best choice.