The start of your Medicare benefits should be a cause for excitement: this health insurance coverage is usually the beginning of your retirement years. However, many people have anxiety about Medicare because of the complexity and costs of the program. One of the primary tools available to help lower your costs and streamline your coverage is Medicare Supplement Insurance. This article will give you a thorough primer on Medicare Supplement Plans in Maryland.
Medicare Supplement Insurance is a product offered by private insurance companies that is designed to help pay for some of the costs associated using your Medicare benefits. It reduces or eliminates them entirely in some cases.
These plans are also frequently called Medigap plans, and they come in twelve standardized coverages known by letter. The available Plans include: A, B, C, D, F, High Deductible F, G, High Deductible G, K, L, M, and N. Each one of these plans offers a different level of coverage; they each cover a different mix of the costs of Medicare.
Medigap plans have been standardized through federal and state legislation across 47 of the United States, including Maryland. This means that the benefits of each of the available plans are identical in the standardized states. In other words, you can easily choose a level of coverage based on your unique needs, and compare prices from different insurers based on the exact same benefits, no matter which state you reside in (as long as you’re in one of the 47 standardized states).
As the name indicates, these plans are a supplement to Original Medicare. They do not replace it. When you have this coverage, Medicare Parts A and B are your primary coverage; Medigap is the secondary payer. This means that they work together to help pay for your care.
When you see doctors or other providers, you’ll use both coverages. The provider will bill Medicare in accordance with standard billing practices. For Part B services like doctor’s visits, outpatient procedures,and lab work, Medicare will pay the first 80% of the cost (assuming that you’ve met the Part B deductible for the year). Normally, you’d be responsible for the remaining 20%. But, with Medigap coverage, your provider will bill the remaining amount to your Medigap plan. Depending on which of the 12 standardized options you chose, your plan will pay most, or all of the remaining 20%.
If you choose one of the Medigap plans that covers the Part A deductible for you (all of them except Plan A cover this in whole or in part, Plan A provides no coverage for it), your Plan will start paying for your hospital or skilled nursing stay right away. This is a huge improvement over Original Medicare; the Part A deductible is $1,556 for 2022, so having this coverage is an easy way to protect against the high cost of hospitalization.
Because Medigap insurance pays most of what Medicare doesn’t it is an excellent way to manage your out of pocket spending on Medicare.
Medigap coverage is totally different from Medicare Advantage Plans (which are also known as Part C of Medicare). Remember that Medigap supplements your Medicare benefits. Medicare Advantage Plans, on the other hand, are an alternative way to receive your Medicare benefits.
Part C plans combine Part A (hospital insurance), Part B (medical insurance,), and in many cases Part D (prescription drug coverage) in one private health insurance plan. Instead of paying what Medicare doesn’t, Medicare Advantage plans pay your providers directly, and you’re normally responsible for paying co-payments as you receive care.
An important difference between these two coverages is that Medicare Advantage plans are usually network based; they tend to be either HMOs, with strict network requirements, or PPOs, which have less restrictive rules. Not every provider accepts Medicare Advantage plans, and you often need to get referrals to see specialists.
With Medicare Supplement Insurance, you remain in Original Medicare, which means that you have the freedom to see any provider in the country that accepts Medicare patients (most do). Many people value the freedom that Original Medicare and Medigap provide. With Medicare Supplement Insurance you don’t have to worry about your doctors being “in-network.”
To enroll in a Medicare Supplement plan you have to first be enrolled in both Part A and Part B of Original Medicare. For most people, you’ll have this chance at age 65. This is often called ageing into Medicare. When you gain eligibility in this way, you will have a seven month enrollment period during which you can enroll:
You can enroll in Parts A and B at any time during this window if you’re not automatically enrolled. You will be automatically enrolled if you elect to receive Social Security benefits on or before you turn 65.
But, what if you want to delay taking Medicare because you plan to keep working? This isn’t a problem; as long as you work for an employer with more than 20 employees, you can safely delay taking Part B (you’ll likely need to enroll in Part A) without fear of penalty. Whenever your employer coverage comes to an end, you’ll have a Special Enrollment Period to get your Part B coverage. In either case, entering at 65, or later, you can add Medigap coverage at the same time.
However, if you get Medicare before age 65, you might find it difficult to find affordable Medicare Supplement Plans in Maryland. Federal law doesn’t require insurers to offer Medigap coverage to people under 65. Maryland does, but they don’t restrict how much insurers can charge. As a result, premiums for people under 65 years old can be much higher than for people 65 and older.
It is best to enroll during your Medigap Open Enrollment Period. This enrollment window starts when you are BOTH age 65 or older, AND actively enrolled in Part B. It lasts for 6 months. During these 6 months, you can’t be declined or charged higher premiums based on your health history.
You may be able to change Medigap plans. But, if you do so outside of your Medigap Open Enrollment period, you’ll probably have to answer health history questions. In this case, you could potentially be declined or charged higher premiums.
Yes. You can do this during the Medicare Annual Election Period (AEP), which takes place from October 15th to December 7th. You’ll need to drop your Medicare Supplement Insurance to do so.
No. You will have to also enroll in a Part D drug plan to get drug coverage.
No. To get dental or vision coverage, you’ll need to consider adding standalone coverage.
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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.