If you’re looking to make the most of your entrance into Medicare, or if you’re considering making a change to your existing coverage, one of the best things you can do is make a clear plan for your coverage. If one of the chief goals for your coverage is saving money, then you’ll want to consider Medicare Supplement Insurance. In this article, we’ll review the key facts to keep in mind as you consider Medicare Supplement Plans in Maine.
You might wonder if you really need any additional coverage beyond Original Medicare - Parts A and B. There is no requirement to do so, but most people do add extra coverage. They do so because of the out of pocket costs associated with Original Medicare.
The Medicare program was designed with the expectation that you would pay for part of the cost of care. One kind of cost that you’ll face is premiums for coverage. You’ll pay Part A premiums in the form of payroll taxes during your working career. Once you enter Medicare, usually at age 65, you’ll begin paying Part B premiums.
Besides these costs, you’ll also have to pay when you use your benefits:
The costs that you’ll pay are broken down into deductibles and co-insurance. There’s a deductible for Part A and B as well as co-insurance for Part B services. The biggest expenses you’re likely to face come from the Part A deductible and Part B co-insurance.
One other thing to keep in mind is that with Original Medicare, there is no cap on your spending each year. Your costs are potentially unlimited if you have a bad health year. Medicare Supplement Insurance was designed to protect you from these costs.
Medicare Supplement Plans, which are also known as Medigap plans, are supplemental insurance policies issued by private insurance companies. They are designed to work with Medicare; that is their only function. A Medigap plan will only pay benefits after Medicare has paid.
Medigap plans are subject to state and federal regulation. Most of the laws governing them are set by congress, but some are set at the state level. The Centers for Medicare and Medicaid Services (CMS) is authorized to regulate some aspects of these plans.
Medicare Supplement Insurance plans have been standardized throughout most of the United States. 47 of the states, plus Washington, D.C. have adopted standardized Medigap plans. In these states, the benefits of 12 distinct plans are standard; Massachusetts, Minnesota, and Wisconsin have their own rules and plans.
Because the plans are standardized, the benefits are identical throughout all 47 states. Medigap Plan G (one of the 12 standardized plans) in Arizona offers the exact same benefits as Plan G in Wyoming. This means that the plans are standardized between insurance companies, too, so Plan G with insurer A has the same benefits as insurer B.
This standardization is a huge help to consumers. It makes it much easier to select a plan and then compare coverage based on price.
Medigap plans are designed to pay the costs that Medicare doesn’t pay for you. Primarily that means the Part A deductible and the Part B co-insurance. Part B co-insurance is 20% of the Medicare-approved cost for every Part B service and procedure you receive after meeting the Part B deductible.
When you visit a provider, you’ll give them your Original Medicare card, and your Medigap card. The provider will bill Medicare for their services. In the case of a Part B service, Medicare will pay the first 80% of the cost. Your provider will also bill your Medicare Supplement Plan. Depending on which standardized plan you have, your plan will pay most, or all, of the remaining 20% of the charges.
Medicare Supplement plans only cover Medicare-approved services and procedures, and then only as the secondary payer.
While there are a total of 12 standardized plans, two in particular are very popular today. Medigap Plan G and Plan N are among the most frequently chosen plans. They have similar coverage details.
Plans G and N both cover these costs:
There are two main differences between these plans. With Plan N, you will pay a small co-payment of no more than $20 per Part B office visit. You also have to pay any Part B excess charges with Plan N (these are fairly rare).
There are no co-payments with Plan G, and it also pays any excess charges. As you might expect, Plan G is generally more expensive than Plan N, because it is more comprehensive.
You are responsible for meeting the Part B deductible with both Plan G and Plan N. Since Part B excess charges are rare,the only meaningful difference between them is the $20 co-payments. Since $20 is a relatively small amount for an office visit, many people opt for this Plan because of the value it represents.
You must be active in both Part A and Part B in order to enroll in Medicare Supplement Insurance. In addition to this, you must continue to pay your Part B premiums for your coverage to remain in effect.
For people who enter Medicare at age 65 or later, enrolling in Medicare Supplement plans in Maine is simple. While many states don’t require insurance companies to offer Medigap coverage to people under 65, Maine does. Not only that, but Maine also prevents insurers from charging higher premiums for people under 65.
No. You will need to add a standalone Part D drug plan to get help with the cost of your medications.
Yes. You can end your Medigap coverage and enroll in a Medicare Advantage plan during the Annual Election Period (AEP) which runs from October 15th to December 7th each year.
No. Medigap plans don’t cover routine dental, vision, or hearing. You’ll need to consider adding standalone coverage for those services.
You may be able to in some cases. However, if you are outside of your Medigap Open Enrollment Period, this is not a guaranteed process.
During your Medigap Open Enrollment Period. This period lasts for six months. It opens when you are BOTH age 65 or older AND active in Part B. During this window, your coverage is guaranteed; you can’t be turned down or charged higher premiums based on your health status.
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Participating sales agencies do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options.
Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP]organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a special enrollment period.
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