Questions & Answers.

Medicare can be confusing with all it’s different parts and plans to consider. That’s why we’ve put together this resources section. Here we provide you with frequently asked questions (FAQs), guides & plan comparisons, and our blog to help you become an educated Medicare consumer. If you have any questions about the information provided in any of our resource sections, please don’t hesitate to contact us.

Original Medicare FAQs

Medicare is a federal health insurance program for individuals 65 or older and certain younger individuals with disabilities, and people with End-Stage Renal disease (ESRD).

Medicare typically covers only 80% of approved cost after deductibles have been satisfied by the Medicare beneficiary. So, in most cases, individuals will enroll additional coverage to help offset the cost left behind.

In most cases you will be enrolled automatically for Medicare Part A and Part B. For those folks enrolled automatically, you will typically receive your Medicare (Red, White and Blue card) in the mail 3 months prior to your benefits starting. However, for people that have opted to delay their Social Security benefits and/or are still working full time, there is a likely chance you will NOT be enrolled to Medicare automatically and will need to follow appropriate steps to either delay Medicare benefits or enroll yourself.

You can contact the Social Security office to complete an application for enrollment. If you were not enrolled in Medicare automatically and not given a Special Enrollment Period, you will need to sign up for Medicare from January 1st-March 31st. Your Medicare benefits would then begin on July 1st.

Medicare typically covers only 80% of approved cost after deductibles have been satisfied by the Medicare beneficiary. So, in most cases, individuals will enroll additional coverage to help offset the cost left behind.

The 4 basic parts of Original Medicare are: Part A, Part B, Part C and Part D.

  1. Part A– Hospital Coverage(Typically no premium based on Medicare taxes paid. Otherwise, average monthly premium is $413 in 2018)

  2. Part B– Medical Coverage (Average monthly premium is $134 for 2018 and can vary based on income.)

  3. Part C– Medicare Advantage Plans (Optional coverage through private insurance companies, premiums vary.)

  4. Part D– Prescription Drug Coverage (Optional coverage to assist with costs of Rx’s. If applicable, late enrollment penalty could apply.)

Medicare does not cover visits and procedures pertaining to vision and dental care, including eye glasses or hearing aids.

In most cases, you will not have to pay a monthly premium for Medicare Part A if you or your spouse paid Medicare taxes while working. If you aren’t eligible for “premium-free” Medicare Part A, and you don’t enroll when you’re first eligible, the monthly premium for Part A may go up 10%. The average premium for Part A in 2018 for beneficiaries that did have to pay was $413/month.

The average premium for Part B in 2018 for beneficiaries $134, but can vary based on household income. If you don’t sign up for Medicare Part B when you’re first eligible, the monthly premium may go up 10% annually.

You will not be covered if you have Original Medicare with no secondary coverage. However, there are some Medicare Supplement Insurance Plans that are designed to help with foreign travel coverage.

In most cases when our advisers speak with individuals that are eligible for Medicare with group insurance, they find it more advantageous for the person to go full Medicare with a Medicare Supplement Insurance Plan. However, before our team ever jumps to conclusions, there are several things to take into consideration for you and our specialists to determine which plan is best for you.

Our licensed advisers will compare pricing, coverage, deductibles, co-payment, co-insurance and flexibility of choosing your own doctors. We also take into consideration if there are any other members on the current group policy, as this could affect premiums for other individuals on your current plan.

Keep in mind, that if you are becoming Medicare eligible and determine its best for you to keep your group insurance, you will still have Medicare Part A. However, it is important that you delay your Medicare Part B benefits; otherwise, you are simply paying for benefits you are not utilizing and furthermore it could have an effect on your guaranteed coverage rights when the group coverage ends.

Medicare Supplement (Medigap) FAQs

A Medigap (also called “Medicare Supplement Insurance”) is offered through private health insurance carriers such as AARP, Mutual of Omaha, Blue Cross Blue Shield and Humana to name a few. These plans are designed to supplement Original Medicare. This means it helps pay some and sometimes all of the health care costs (“gaps”) that Original Medicare doesn’t cover such as: co-payments, coinsurance, and deductibles.

Depending on the Medicare Supplement plan the client has enrolled in, will determine out of pocket expense. There is Medicare Supplement plans offered that cover all gaps left by original Medicare, leaving the client to pay nothing, except the monthly premium. If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any premium for a client to receive a Medicare Supplement policy and some states have a cap on Medigap cost).

Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost and rating is usually the only difference between Medigap policies with the same letter sold by different insurance companies. In Massachusetts, Minnesota, and Wisconsin, Medigap plans are designed as “a la carte” where consumers can choose specific benefits and design a plan specifically for their needs.

You will not be covered if you have Original Medicare with no secondary coverage. However, there are some Medicare Supplement Insurance Plans that are designed to help with foreign travel coverage.

Medicare Supplement Insurance Plans are designed to cover some to all of the cost left behind by Original Medicare Parts A and B, including: co-payments, coinsurance, foreign travel and deductibles.

Depending on the Medigap Insurance Coverage you choose, will depend on how much out of pocket cost you incur. Currently, the Best Medigap Coverage that an individual can enroll in is Medigap Plan F then Medigap Plan G. Another popular plan among Medicare beneficiaries is Medigap Plan N.

Coverage such as prescriptions drugs, vision and dental care, including eye glasses, hearing aids and private-duty nursing are not covered. Long-term care such as nursing homes is not covered.

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In most cases, insurance companies use these common factors to determine price/premium for Medicare Supplement Insurance Plan:

  1. Age
  2. Gender
  3. Location
  4. Health
  5. Tobacco Use

There are also other parameters that insurance companies and/or states require the use of, such as:

  1. Community Rating (also referred to as “no-age” rating)
  2. Issue Age Rating (also referred to as “entry-age” rating)
  3. Attained Age Rating

Each of the ratings may affect the premium of the Medigap Plan. To see a detailed example of each of the ratings CLICK HERE. Keep in mind that depending on your enrollment period, some or all of these factors can be a factor when calculating premium. In order to determine your Medigap Insurance Rate, call one of our licensed advisers today by dialing 1-866-MEDIGAP (633-4427). Or, simply CLICK HERE and complete the contact form and one of our specialists will be in touch.

We have thought of a few simple steps to take after determining you need a Medigap (Medicare Supplement) Plan:

Typically, the best time to enroll in a Medicare Supplement Insurance Plan is during your open enrollment period (this period typically begins 3 months before your Medicare Part B effective date, the “month of”, and 3 months after your Medicare Part B effective date). Some consumers wait until after this period, in which premiums may become more expensive, or depending on health conditions, the client may not be able to qualify for coverage.

Unlike Medicare Advantage plans that restrict you to certain enrollment periods, in most cases, you can change or enroll in a Medigap Insurance Plan anytime throughout the year. You can choose benefits that best fit your needs by choosing 1 of the 11 standardized Medigap Plans, labeled A though N. Most of our clients find it appropriate to enroll in Plan F or Plan G however, there are scenarios in which we find our clients a more suitable plan for their specific needs and/or wants.

Determine which Medigap (Medicare Supplement) Insurance Carriers offer plans in your state and try to get a rate (premium) comparison. By contacting us, one of our licensed Medigap Specialist will run all available carriers and plans for you in a matter of minutes- saving you time, money and peace of mind! We take out all the guessing and provide the rate and plan comparison for any carrier(s) of your choice!

Apply for your Medigap (Medicare Supplement) Plan through our agency. We make it easy for our clients by enrolling over the phone or online

If you have any questions, we're just a phone call away. Simply call us at 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed specialists will take the time to make sure that all your questions are answered.

More than likely you have recently experienced rate increases that have made your coverage no longer affordable. Our agency will always provide our potential and current clients with the best rate available. We can do this by being an independent agency that allows us to gather rate information on just about every carrier in the market and still be able to offer you the same plan for less!

An advantage to contacting our agency when shopping rates is that we can advise you which companies to stay away from or look further into based on health condition and affordability. Just because your currently enrolled, does not mean that you can automatically enroll to another plan. However, we work with some of few carriers in the market that limited underwriting (less health questions) when switching plans.

  1. You will pay a lower premium
  2. You will receive a new policy card with different company logo
  3. Continue to see the same doctors
  4. Medicare still makes claims decisions, not the insurance carrier
  5. Enjoy the savings!

Our agency makes the process of enrolling into a new company and/or plan simple. Most of it can be done over the phone in a matter of 15 minutes. We always encourage our the people we speak with to shop new rates, as you really have nothing to lose by switching, if it can save you money and you still receive the benefits you need and/or want! Call us today and see how easy we make it to save money on your Medigap Insurance Plan!

A Medigap (Medicare Supplement) Plan does NOT replace original Medicare and is designed to pay for cost (or fill “gaps”) not covered by traditional Medicare. Medigap plans typically have a monthly premium that can vary depending on age, gender, location and health to name a few. Medigap (Medicare Supplement) clients are NOT restricted to a network of doctors and in most cases will experience very little to zero out-of-pocket expenses after the monthly premium has been paid.

Medicare Advantage plans replace and in some cases enhance original Medicare. Medicare Advantage plans typically have little, to no premium. In most cases, clients of a Medicare Advantage plans are limited to a “network” of doctors and hospitals they must attend for their plan to work accordingly and minimize out-of-pocket expenses. If a client of a Medicare Advantage plan travels outside the network, it is very likely they will incur higher out-of-pocket expenses.

If you have any questions, we're just a phone call away. Simply call us at 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed specialists will take the time to make sure that all your questions are answered.

In most cases when our advisers speak with individuals that are eligible for Medicare with group insurance, they find it more advantageous for the person to go full Medicare with a Medigap Insurance Plan. However, before our team ever jumps to conclusions, there are several things to take into consideration for you and our specialists to determine which plan is best for you.

Our licensed advisers will compare pricing, coverage, deductibles, co-payment, co-insurance and flexibility of choosing your own doctors. We also take into consideration if there are any other members on the current group policy, as this could affect premiums for other individuals on your current plan.

If you have any questions, we're just a phone call away. Simply call us at 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed specialists will take the time to make sure that all your questions are answered.

Medicare Advantage FAQs

There are several plans available nationwide through a variety of companies. Depending on the plan you choose and where you live, will determine how much you pay for your plan. In most cases, there are $0 premium plans available to choose from top recognized companies, such as: Aetna, Humana, Blue Cross/Shield and United HealthCare, to name a few.

If you can’t find a $0 premium plan, chances are you can still find a Medicare Advantage plan for less than $100/month.

If you are new to Medicare for the first time, you will have an Initial Election Period (IEP). This period begins three months before the entitlement to both Medicare Part A and Part B and ends on the last day of the third month after entitlement to Part A and Part B.

Beyond your IEP or SEP, the Annual Enrollment Period occurs each year from October 15th-December 7th. At this time, all Medicare Advantage and Part D eligible beneficiaries to enroll and/or change plans. Or, beneficiaries can change back to Original Medicare and, if chosen, can enroll in a Medicare Supplement (Medigap) plan and/or drug plan.

The most common difference between an HMO and PPO plan is that by having an HMO plan, one must use the network provided by the insurance company. If the HMO enrollee decides to seek care outside of the plans network, he/she will out of pocket cost to the maximum Medicare allowed amount.

Having a PPO will allow you to seek care at any provider that accepts Medicare. However, you may pay more out of pocket for not using the plans “preferred” network. Compare Medicare Advantage Plans Here.

Unless you qualify for a special election period, you are locked in your Medicare Advantage plan from February 14th-December 31st. Some examples of qualifying for an SEP are: Change in residence, involuntarily loss of credible coverage, gaining or losing Medicaid eligibility.

No, you don’t need both kinds of coverage. In fact, it’s against the law for an insurance agent to knowingly enroll you into both plans. If you have a Medicare Supplement plan and would like to change to a Medicare Advantage plan, you would have to wait for the Annual Enrollment Period that runs from October 15th-December 7th.

Medicare Advantage Plans replace and in some cases enhance original Medicare. Medicare Advantage plans typically have little, to no premium. In most cases, clients of a Medicare Advantage plan are limited to a “network” of doctors and hospitals they must attend for their plan to work accordingly and minimize out-of-pocket expenses. If a client of a Medicare Advantage plan travels outside the network, it is very likely they will incur higher out-of-pocket expenses.

A Medicare Supplement Plan does NOT replace original Medicare and is designed to pay for cost (or fill “gaps”) not covered by traditional Medicare. Medicare Supplement Insurance Plans typically have a monthly premium that can vary depending on age, gender, location and health to name a few. Medicare Supplement clients are NOT restricted to a network of doctors and in most cases will experience very little to zero out-of-pocket expenses after the monthly premium has been paid.

To compare Medicare plans in your area, call one of our licensed advisers today. We take the time to review your needs for healthcare and use that information to find the plan in your area that best fits your needs and budget.

If you have any questions, we're just a phone call away. Simply call us at 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed specialists will take the time to make sure that all your questions are answered.

Medicare Part D FAQs

There are several companies and plans to choose from. The average premium in 2018 is about $35.02/month with the lowest cost plan costing $16.80/mo. Deductibles, co-payments and co-insurance also vary depending on the plan you choose, prescriptions you take and pharmacy you use.

The “donut hole” is also known as the coverage gap. This occurs when you and the insurance company have reached a spending limit of $3,750. Once this happens, the cost for you prescriptions will increase 40% for covered brand name and 49% of covered generics.

That depends if the coverage is considered credible by Medicare. If the coverage is considered credible, then you are not required to enroll in a Medicare drug plan.

If you don’t enroll while eligible for Part D and don’t hold credible drug coverage, Medicare will charge a 1% late enrollment penalty each month until you do enroll. This would be applied to the future plan chosen and would be applicable to the average monthly premium for that year. Monthly premium can also vary based on household income.

Depending on the plan you choose, you may have to pay a deductible, co-pay and/or co-insurance.

If you have any questions, we're just a phone call away. Simply call us at 1-866-MEDIGAP (633-4427) or complete our Contact Form and one of our licensed specialists will take the time to make sure that all your questions are answered.

As with any insurance we purchase, we have it for the “what if” reasons. Furthermore, Medicare will charge a penalty for not enrolling in a prescription drug plan; so long you are eligible to enroll.