Medigap: Providing Financial Security and Peace of Mind for Medicare Beneficiaries

Nearly 10 million Medicare beneficiaries currently rely on Medigap coverage to help cover significant out-of-pocket costs that are not covered by Medicare, such as deductibles, coinsurance, and co-payments. Medigap coverage allows seniors and Medicare beneficiaries with disabilities to budget for medical costs and avoid the confusion and difficulty of handling complex medical bills.

Medigap provides policyholders with financial security and peace of mind about their health care coverage.

An AHIP Study found that the vast majority of Medigap policyholders are satisfied with their coverage.

According to the survey:

Nine out of ten Medigap policyholders are satisfied with their coverage.

Overall satisfaction with Medigap coverage is comparable to levels in 2009 (77 percent) and 2005 (80 percent). found in 2009 (88 percent) and 2005 (90 percent).

The vast majority of enrollees (79 percent) say their Medigap policy provides an excellent or good value for the money, consistent with similar findings.

More than nine out of ten (91 percent) would recommend Medigap coverage to a friend or relative when they turn 65 and enroll in Medicare. This is higher than scores reported in either 2009 (87 percent) or 2005 (84 percent).

Medigap is particularly important to vulnerable populations.

An AHIP Study found that Medigap continues to be a vital source of coverage for low-income and rural beneficiaries:

Thirty-two (32) percent of Medigap policyholders resided in rural areas in 2010; by comparison, 23 percent of all Medicare beneficiaries resided in rural areas.

More than half of all Medigap policyholders (51 percent) and nearly two-thirds (60 percent) of rural Medigap policyholders had incomes below $30,000.

Overall, 45 percent of Medigap policyholders had incomes ranging from $10,001 to $30,000 in 2010. This income bracket accounted for the highest proportion of Medigap purchasers. In rural areas, 53 percent of Medigap policyholders had incomes in the $10,001 to $30,000 range.

Medicare and Mental Health

There seems to be a new attitude about mental health – an awareness that it’s not too different from physical health. Across our society, there’s more acknowledgement that mental illness does not necessarily make someone unproductive or push them out of the main stream. That’s a good thing. Unfortunately, there is more mental illness than ever – not a good thing.

Millions of People Are Dealing with Mental Illness

The large number of people who are working on mental health issues is the first surprise. Houston Rockets rookie Royce White is a case in point. He can’t fly with the team, so he takes the bus. His sports profile is drawing attention to the other 6.8 million of us who live with generalized anxiety, although not all have to face fear of flying as he does.

Mental Illness Has Contributed to Our Culture and History

That’s the second surprise. The Atlantic has featured some of our most influential historical people who were probably making history in spite of (or perhaps due to) forms of mental illness. As you can imagine, depression and panic attacks have plagued some leaders in our worst times.

For example, Abraham Lincoln reportedly suffered with severe depression. It also notes problems that Beethoven and Isaac Newton dealt with as they made lasting imprints on human civilization.

You Can’t Catch Mental Illness from Someone Else

While this may not surprise you, it does seem that people treat others who have mental illness as if they are contagious. As absurd as that sounds, people still hesitate to get treatment that could improve their life because they fear the stigma, if not discrimination, society once imposed. That’s a shame because most mental illness is treatable and Medicare has mental health benefits.

Medicare Covers Mental Health Care

Medicare has benefits for both inpatient and outpatient mental health care to diagnose and treat mental illness. You’ll have to meet the Part B deductible for both types of care. For doctor appointments to diagnose a problem, you also have 20-percent co-insurance and Medicare will pay 80 percent of the approved amount.

For outpatient treatment, you once had to pay 40 percent of the approved amount, but that’s been decreasing. It will be down to 20 percent in 2014.

High Deductible Plan F Medicare Supplement Insurance Rates

High deductible Plan F Medicare supplement insurance is a good choice for those who desire lower monthly premiums. Insurance companies are not required to offer HD Plan F, so consumers won’t have quite as many choices when it comes to providers.

Conversely, traditional supplemental Plan F is offered by all providers and can be a better choice for those who do not wish to meet a deductible each year. Monthly premiums will be higher for these traditional plans.

How Does High Deductible Plan F Work?

The plan itself is fairly straightforward and works like all other Medicare supplemental insurance coverages. The only difference is there is a one-time deductible that must be met each year before the Medigap insurance company will begin paying benefits.

In 2014, the amount that must be met for high deductible Plan F is $2,140. In 2013, the amount is $2,110. In 2012 it was $2,070 per year and in 2010 & 2011 it was $2,000. As you can see, the deductible can increase year over year, but it is determined by the Centers for Medicare and Medicaid Services – not the insurance companies. So, it is the same nationwide for any plan that offers a High Deductible F option.

While it is very unlikely that the deductible would increase to $5,000 for example, it is possible that the amount could increase by a few hundred dollars over the next few years. Currently, there are no other Medigap policy offering a high deductible option other than Plan F.

What Are The Disadvantages Of a High Deductible Plan F?

One disadvantage will be if the insured decided later on that he or she did not want a high deductible Plan F supplement. Often when the insured does not like less comprehensive coverage, it is because they are paying more out of pocket than they had originally anticipated.

Someone who was once in good health, but later finds that the $2,000 + deductible must be met each year as his or her health has changed might not like the coverage any longer. The issue then would be that it can be difficult to change plans if the insured is in poor health. Medicare beneficiaries cannot change coverage without undergoing medical underwriting with most providers in most states.

Thus, if the high deductible Plan F is chosen, it may be hard to switch to something more comprehensive later on. Contrary to popular belief, there is not an open enrollment period each year when Medicare supplement owners can switch to any new plan they want.

United American is one of the few Insurance Carriers offering the High Deductible F option. AM Best Rating of United American

Typical Medigap Quote for a 65 year old male in Palm Beach County

Medicare Annual Election Periods And Underwriting

The time period from October to December each year (collectively known as the Annual Election Period or (AEP) is for changing Part D plans and/or Medicare Advantage coverage, but it does not allow the insured to choose any new supplement without undergoing medical underwriting.

The insured cannot increase his or her coverage during their yearly anniversary without undergoing medical underwriting. That is to say that, the insured cannot switch from a high deductible to traditional Plan F (or most other plans for that matter) without first answering several health questions.

Who Might Purchase A High Deductible F Medigap Plan?

Typically those who purchase a High Deductible Plan F fit into a couple of categories. Generally speaking, they are in good health, have enough savings to cover the deductible year over year, and do not like the hassle associated with network driven coverage, like Medicare Advantage Plans.

The primary advantage to the high deductible Plan F is lower monthly premiums. Many consumers do not worry about potentially paying a $2,000 + deductible each year as they are often times leaving group health insurance plans with similar or higher deductibles.

Additionally, Medicare supplements do not have network restrictions like most other types of health insurance or Medicare Advantage plans. The insured is free to choose any doctor or hospital accepting Medicare and does not need to worry about higher costs associated with referrals to an out-of-network physician or facility.

Seniors who travel often or who have a residence in more than one state will likely choose a traditional Medigap plan like High Deductible F knowing that they can receive routine care both in and out of their primary resident state.

Request Medigap Quotes (Medicare Supplemental Insurance quotes) and Information or call Neil Primack at: (561) 935-3907.

Medicare Insurance…Which One is Right for You?

Trying to find the right Medicare insurance product can be a difficult task. It can be plain confusing. You want to make the right decision, but you don’t want to pay more than is necessary. In this current economy you have to save money wherever possible, and one of those places is insurance. You may have a memory of your parents talking about their Medicare supplement insurance. You probably have a few friends that are on Medicare now and have talked about what insurance plan they chose. Now it’s your turn to go through the process and it’s a decision you don’t want to guess on. Education is the best way to approach the buying process when in the market for Medicare supplement insurance. It can be a confusing subject, but with just a little research and time, you can educate yourself on the basics of Medicare and the insurance products related to Medicare. Once you learn the fundamentals, you can make a decision on your insurance, and feel great about getting the best product for the best price. Let’s start with the different “parts” to Medicare. There are four “parts” to Medicare: Part A, Part B, Part C, and Part D. You have probably heard of all those except for Part C. Let’s define those “parts” of Medicare right now so you can quickly understand what they do.

Medicare Supplement Insurance

The most common type of Medicare insurance is the Medicare Supplement. A Medicare supplement helps to pay the gaps in Medicare Parts A and B. The Plan F Medicare supplement (the most popular) pays all the gaps in Medicare, while other plans pay some of the gaps. The network for Medicare supplements is the Medicare network. Regardless of the insurance company you choose, they all utilize the Medicare network. Doctors and facilities that accept Medicare, HAVE to accept your Medicare supplement.

The billing process for Medicare supplements are also standardized. Medicare supplements utilize the “medicare crossover” billing system. The crossover system allows billing departments to review payment for claims without having to manually bill the insurance companies. All Medicare supplements are standardized in benefits as well. This makes the buying/shopping process much easier.

For example, you may see quotes like this: AARP Plan F $254 per month, Mutual of Omaha Plan F is $275 per month, Gerber Life Plan F is $249 per month. The prices vary, but the benefits are identical between companies.

Medicare Part A

This part of Medicare covers hospitalization. You become eligible for Medicare Part A on your 65th birth month. You cannot defer Part A even if you are working. As long as you or your spouse worked at least 10 years in the United States, you are eligible for Part A. There is no premium for Part A.

Medicare Part B

This part of Medicare covers physician/outpatient charges. Basically Part B covers any charge that is not considered hospitalization. In 2013 and 2014 the premium for Part B is $104.90 per month. If you are drawing your social security check now, this amount will be deducted from your check. If you are not drawing social security yet, this amount will be billed to your quarterly. You become eligible for Part B on your 65th birth month, but can defer Part B if you are working and have creditable coverage, and can later enroll in Part B when you have retired (you will not pay any penalty as long as your prior coverage was “creditable”).

Medicare Part C

This part of Medicare was put into law in 2005 and is the privatization of Medicare. Part C, referred to as Medicare Advantage, is a private Medicare type plan. When you select a Medicare Advantage plan, you are no longer covered by Medicare’s Part A and Part B, but by an insurance company solely. Medicare Advantage plans can have drug coverage rolled into the plan. These plans are not a Medicare supplement, but are a stand-alone plan. If you are interested in a Medicare Advantage plan, do your due diligence and make sure you have checked to see if your doctors will accept the plan you are considering. Also realize that providers can drop out of an Advantage plan at any time, but always with an effective date on the first of the month.

Medicare Part D

This part of Medicare refers to the drug coverage side of Medicare. When looking for a Medicare prescription drug plan, you should visit www.medicare.gov and utilize their prescription drug calculator. This tool is quite accurate and will help you find the drug plan that best suits you and the medications you take.

Hopefully this brief but informative article has helped you understand the basics of Medicare and Medicare insurance. If you have any questions or would like information/quotes regarding the Medicare insurance available in your area, give us a call at: (561) 935-3907.

Guaranteed Issue Medicare Periods

During guaranteed-issue periods, companies must offer you one of the private Medigap Insurance policies at the best price (street price) for your age, without a waiting period, health screening or underwriting.

You can usually apply for a guaranteed-issued Medigap policy in Florida as early as 60 – 90 days before your current benefits end to avoid a gap in coverage. In most cases, you must also apply for one of these plans no later than 63 days after your coverage ends as a result of one of the events described below. When you submit your application, you are typically required to provide evidence of the date your coverage ends or ended.

You have the right to purchase certain Medigap plans following the 7 events listed below, which apply to Medicare beneficiaries of all ages. For most of the events, you are only guaranteed the right to buy plans A, B, C, F (including F with a high deductible), K, L, M or N.

1. Termination of Employer-Sponsored Retiree Plan

You have the right to purchase certain Florida Medigap Insurance plans when your employer-sponsored retiree plan (including Cobra coverage) that is supplementing Medicare involuntarily terminates. This means that the employer sponsored plan ended due to no fault of your own. This federal right does not apply if the terminating health plan provided primary benefits or if you stopped paying your premium for the retiree plan or COBRA coverage.

2. Reduction of Employer-Sponsored Retiree Benefits or Loss of Eligibility

You have the right to purchase certain Medigap plans if your employer-sponsored retiree plan stops providing supplemental benefits to Medicare, but continues to provide other benefits. You are also eligible for guaranteed issue Medicare Supplement Insurance due to divorce or death of a spouse or family member, or your retiree plan stops paying the Medicare Part B 20% coinsurance for services.

3. Increased Premium, Increased Cost-Sharing, Reduction of Benefits or Termination of Provider in Your Medicare Advantage Plan

You have the right to buy a Medigap plan but only from the same Medicare Advantage (MA) organization in which you are enrolled, if it sells one, or from the parent company or network that contracts with the MA plan. If the MA plan you belong to doesn’t sell a Medigap policy, you still have the right to buy a Medigap from any other company IF your Medicare Advantage plan increased your premium or co-payments by 15% or more, reduced your benefits, or terminated its relationship with your medical provider who was treating you.

You have 63 days to purchase one of the guaranteed issue Medigap policies from the time you are notified of any reduced benefits, increased premium or cost-sharing, or that your plan is no longer contracting with one of your medical providers. Yet you can only use this right during certain periods when you’re allowed to dis-enroll from your Medicare Advantage plan.

Please check www.medicare.gov for additional information regarding these special exemptions.

Since Medicare Advantage plans may not reduce their benefits or increase premiums or cost-sharing during the plan year, you will only be notified of any reduction in benefits or increase in premiums or cost-sharing for the new plan year during the Annual Election Period (AEP) which allows you to dis-enroll from your Medicare Advantage plan. The AEP is October 15 – December 7 each year. If you dis-enroll during this period, the effective date of your dis-enrollment will be January 1 of the following year. A Medicare Advantage plan may, however, discontinue its contract with a provider anytime during the year. This means, even though you may have a guaranteed issue right to buy a Medigap when a provider no longer has a contract with your Medicare Advantage plan, you may not have a corresponding right to dis-enroll from that Medicare Advantage plan.

4. Moving Out of Medicare Advantage (MA) Plan or PACE Organization Service Area

You have the right to purchase certain Medigap plans if you move out of the area of your Medicare Advantage (MA) plan or Program for All-Inclusive Care for the Elderly (PACE) organization. You have the right to buy a Medigap policy even when Medicare Advantage plans and PACE organizations are available in your new area.

5. Medicare Plan Fraud, Loss of Contract, Misrepresentation or Failure to Meet Contractual Obligations

You have the right to purchase certain Medigap plans if your Medicare Advantage (MA) plan, Medicare Select Plan, PACE provider or any other health plan under contract with Medicare:

  • Commits Fraud
  • Ends or Loses its Contract with Medicare
  • Misrepresents the Plan you Bought
  • Has Failed to Meet its Contractual Obligations to Medicare Beneficiaries, as Determined by the Federal Government

6. Medicare Trial Period #1

You have the right to purchase certain Medigap plans during Medicare Trial Period #1: You joined a Medicare Advantage (MA) plan or Program for All-Inclusive Care for the Elderly (PACE) organization when you first became eligible for Medicare at age 65, and you want to switch to a Medigap policy during your first 12 months in the MA plan or PACE organization.

Note: If you were previously in an MA plan or PACE organization, you are not eligible for this guaranteed-issue right.

7. Medicare Trial Period #2

You have the right to purchase certain Medigap plans during Medicare Trial Period #2: You switch from a Medigap policy to an MA plan, PACE organization, Medicare SELECT plan, or any other health care organization contracting with Medicare, for the first time since becoming eligible for Medicare, and you dis-enroll from that plan within the first 12 months. You have the option to return to your previous Medigap policy if it is still available. If it is not available, you can choose plans A, B, C, F, K, L, M or N from any other Florida Medicare Supplement Insurance company.

If you were previously in an Medicare Advantage plan, PACE organization, Medicare SELECT plan or any other health care organization contracting with Medicare, you are not eligible for this guaranteed-issue right.

Florida Health Insurance Broker offers Medicare Supplement Insurance plans in South Florida including: Tequesta, Stuart, Hobe Sound, Jupiter, Palm Beach Gardens, North Palm Beach, West Palm Beach, Delray Beach, Wellington, Lake Worth, Boynton Beach, Boca Raton, Royal Palm Beach, Deerfield Beach, Ft Lauderdale and other communities in Martin, Palm Beach and Broward Counties.

Medigap High-deductible Plan F Versus A Medicare Advantage Plan

When you qualify for Medicare, the big dilemma is trying to understand your options. While you’ll have a choice of Medigap Plans, and most beneficiaries have a choice of Medicare Advantage Plans, you might say the two options are “worlds apart.”

Medigap Plans work with Medicare Part A and Part B to fill in coverage gaps. There are 10 different types of Medigap Plans that are standardized. A popular one is Medigap Plan F, and it comes in two varieties in many states. There’s a standard Plan F with comprehensive benefits, and a high-deductible version. That means you’ll have to pay for a certain amount of non-preventive health care every year before the plan pays for other services. In 2013, the deductible was $2,110. Recommended preventive health care services are now covered by Medicare, so a Medigap Plan will help with other types of health care.

Medicare Advantage Plans don’t work with Medicare like Medigap Plans. Advantage Plans are actually a way of getting Medicare benefits through a plan offered by private health insurance companies. Highly-rated Advantage Plans are federally subsidized and offer lower premiums.

So, can you compare Medigap Plan F to a Medicare Advantage Plan?

Advantage Plans do not have standardized benefits and Medigap Plans do. You could buy a Medigap Plan F, for instance, from any insurance company, and it would have identical benefits. Advantage Plans set independent rules and regulations, so you’ll need to read each plan separately.

Medicare Advantage Plans offer the same coverage as original Medicare, but you cannot combine an Advantage Plan with a Medigap Plan. So, you can’t use a Medigap Plan to fill coverage gaps. Medicare Advantage Plans often provide more benefits than original Medicare, but you’ll have to read the individual policy for specifics.

To see which plan will provide the health care you need, compare both Medigap and Medicare Advantage Plans. You can read more about both options here on our site. Not all plans are available in every state, though. You can request an instant quote to see which Medigap Plans are available in your area. You can also call us and we’ll assign a personal adviser for a free consultation, or you can sign up for our free Medicare Plan teleseminar to get the basic explanations and then you can call in to ask questions.

The Downsides of Medicare Advantage Plans

Before deciding to purchase a Medicare Advantage plan, it’s important to know the downsides:

Anyone who applies for a Medicare Advantage plan must voluntarily give up Medicare Part A and Medicare Part B Insurance Coverage.

Giving up Medicare Part A and Medicare Part B is necessary, because it allows the person to sign up with the insurance company that is selling the Medicare Advantage plan. This is a potentially dangerous sacrifice, considering the insurance company is not obligated to renew their contract with Medicare each year. If the insurance company did drop out of their Medicare Advantage contract, you would be dis-enrolled from that Medicare Advantage Plan.

Most Medicare Advantage plans do not allow members the right to choose their own doctor.

This means healthcare services will only be covered if they are performed by a doctor that is approved by the Medicare Advantage insurance company. There are no exceptions for those who want to see a doctor that came highly recommended or seeing a doctor who specializes in certain health problems. Basically, you would be leaving your well-being in the hands of those who decide which doctors are approved and which are not.

Medicare Advantage is a Medicare replacement, not a Medicare Supplement.

Medicare Supplement Insurance is Used to Supplement Medicare Insurance Plans.

Medicare Advantage, on the other hand, does not supplement existing Medicare. Instead, it replaces Medicare insurance altogether. It’s also important to note that Medicare Advantage plans contain gaps, so members are still responsible for paying deductibles and co-pays. The only way these gaps can be avoided is by staying on Medicare Part A and Medicare Part B and purchasing traditional Medicare Supplement Insurance.

America’s Top Experts Agree that Medicare and Medicare Supplement Insurance is preferable to Medicare Advantage Plans because you have:

  • The Freedom to Choose Any Doctor or Hospital
  • No Deductibles
  • No Co-Payments
  • No Referrals Necessary
  • No Claims Forms
  • One Comfortable Monthly Premium
  • 100% Coverage with No Remaining Bills to Pay (If you purchase Plan F).

Are Chiropractic Services Covered under Medicare?

Medicare Part B pays for a chiropractor’s manual manipulation of the spine to correct a subluxation. Additionally, manual devices (for example: those that are hand-held with the device being controlled by hand) may be used by chiropractors in performing manipulation of the spine. However, no additional payment is allowed for the use of the device.

Medicare does not cover the following services performed by a chiropractor:

  • Initial Pphysical Examinations
  • Evaluation Services
  • X-Rays
  • Acupuncture
  • Physical Therapy
  • Vitamin, Mineral and/or Food Supplements, or Other Supplies
  • Orthopedic Devices

Chiropractic treatment is covered by Medicare if: You have a health problem in the form of a neuro-musculoskeletal condition that needs treatment (such as pain, inflammation, swelling, leg and foot numbness, etc.) You have a subluxation of the spine and manual manipulation has been recommended for improvement of your condition.

What You Will Need To Pay?

You will have to pay the Part B deductible, and then 20% of the Medicare-approved amount. Many traditional medicare supplemental insurance plans will pay both the deductible and the co-insurance of 20 percent.

Medicare reimbursement will be limited to one visit per day, unless there is a medical need for more than one treatment each day. The hands-on nature of chiropractic treatment requires patients to visit the chiropractor a number of times, often 3-4 times per week. A chiropractor may provide acute, chronic, and/or preventive care thus making a certain number of visits sometimes necessary.

Each visit must be medically necessary and enhance your condition. Once further improvement cannot reasonably be expected from continuous ongoing care, the treatment is considered supportive/preventive, and Medicare will stop paying for treatment.

Do your homework before choosing a provider of chiropractic services. Ask the provider:

  • If They Are a Participating Provider for Medicare
  • If They Accept Assignment of Benefits from Medicare
  • To Write Down What They Will Charge and How Much of it You Will Have to Pay

If the chiropractor does not accept assignment: You may have to pay more than the Medicare-approved amount, usually 15% more. You may have to pay the entire cost of your services at the time they are performed. You may have to bill Medicare yourself and wait several weeks before you will be reimbursed.

If the chiropractor does not participate in Medicare, Medicare will not pay the claim. You must have paid your annual deductible for services and supplies before Medicare will begin to pay its share unless you have the right kind of medicare supplement plan. You may pay little or nothing if you are covered by a Medigap/Medicare Supplemental Insurance plan.

Medicare Advantage plans often do not cover chiropractic or may require a co-pay. Also, many chiropractors do not participate in medicare advantage plans. Call the plan or the agent who signed you up and ask about your share of cost.

For More Detailed Information on Medicare Supplement Insurance, Please Visit: Florida Medicare Supplement Insurance

Neil Primack – Your South Florida Medicare Supplement, Advantage Plan & Medigap Plan Expert!