Did you know that Medicare won’t cover 100% of the costs for your medical care? It’s true - there are many costs that you’ll be expected to pay out of pocket. Do you have a plan to cover these expenses? Whether you’ve been planning for a while, or if you’re just starting out on your plan, Medicare Supplement Insurance should be part of your considerations. In this article, we’ll guide you through the details of the costs for Medicare as well as Medicare Supplement Plans in Missouri.
The most important fact to know, when it comes to making your plan for Medicare coverage, is how much you’re likely to spend on your medical care once you’re in Medicare. While there is a common misperception that Medicare is free, that’s definitely not the case.
Medicare was created in a way that requires people to help pay for some of the costs for care. The costs that you’re on the hook for are:
The Part A deductible and the Part B co-insurance are the most likely changes you’ll face, as well as the biggest. You need to know that Medicare doesn’t come with a cap or limit on your spending, something else that surprises people. Under Original Medicare, you keep paying these costs all year long, no matter how much money you’ve spent.
Obviously, this is a major unknown that can cause anxiety for people, especially those with fixed incomes or limited savings. Medicare Supplement Insurance Plans can help reduce your out of pocket costs and give great peace of mind to people on Medicare.
Medicare Supplement Insurance (also called Medigap) is a private health insurance coverage that is designed to directly limit your spending on the costs of Medicare. These policies only work with Medicare. They provide no benefits on their own - they are not health insurance, but rather a supplemental benefits policy.
Medigap plans are regulated by the federal government as well as by all of the individual state governments. 47 of the U.S. states have standardized their Medigap plans and regulations. Missouri is one of these.
In these 47 states, there are ten standardized Medigap plans available, and they’re identified by letter: A, B, C, D, F, G, K, L, M, and N. There is also a high deductible version of Plans F and G. Each one of these plans offers a different level of coverage. For instance, some of them will pay all, or part, of the Part A deductible, and others won’t. Some will provide international coverage, and others will not. However, since the benefits of each of the standardized plans are standard, it is very easy to choose a level of coverage and then compare the cost for coverage across many insurance companies to find the best blend of coverage and premium expense.
Medicare Supplement Plans charge a premium, usually monthly. While there is some regulation of these premiums, the individual companies are allowed to set their own premiums. They adjust each year, usually higher.
One of the chief benefits of Medigap coverage is that it allows you to see any doctor or provider who accepts Medicare patients. In other words, Medigap plans don’t impose a network; you retain maximum flexibility when it comes to seeing physicians. You also don’t have to get referrals to see specialists.
Your doctors and other providers will bill both Medicare and your Medigap plan for any services or procedures you receive. Medicare is the primary payer, and will pay most of the cost. Your Plan will pay for most of the rest; in many cases, depending on which specific Medigap plan you choose, your plan will pay 100% of the rest of the cost.
You must be actively enrolled in Original Medicare, both Parts A and B, in order to get Medigap coverage. This happens at age 65 for most Americans, and for those that enter at 65, there is a standard enrollment period that lasts for seven months. The window, or period, opens three full months before the month you turn 65, and closes at the end of the third month after your 65th birth month. You can enroll in Part A and B at any time during this enrollment window. Your enrollment may be automatic if you’ve decided to take Social Security retirement benefits on or before your 65th birthday. If your enrollment isn’t automatic, you can sign up online, over the phone, or at your local Social Security office. Once you’re active in Parts A and B, you can enroll in a Medigap plan.
If you delay taking Part B because you plan to keep working and you’ll be covered by a qualifying employer plan, you will be able to add Part B coverage whenever your employer coverage ends. Once you do that, you can also add a Medigap plan.
You might enter Medicare early, before turning 65, in some cases. It can be difficult for people who are under 65 to get Medigap coverage. Federal law does not require insurance companies to insure people under 65; each state is allowed to make its own rules. In Missouri, insurance companies are required to give Medigap coverage to people under 65. However, the premiums can be higher than for people aged 65 and over.
Once you’re active in both Parts of Medicare, you can enroll in whichever Medigap plan you prefer. You can easily do this with a paper application, online, or over the phone. You will need to have your Medicare card in order to enroll. One of the easiest ways to find a Medigap plan is by working with an independent insurance agent. An agent can help you shop for and compare plans, and also help you enroll in the plan of your choice.
The best time to do this is during your Medigap Open Enrollment Period. This enrollment opportunity starts when you are age 65 or older and active in Part B (it can’t start before both of these are true). It lasts for six months. During these six months, you can’t be declined for Medigap.
In many cases, yes. However, if you try to do this outside of Missouri’s guaranteed issue windows, you may be subject to medical underwriting, which means that your coverage could potentially be declined, or you could be charged higher premiums, based on your health status.
Yes. You can drop your Medigap plan and enroll in a Medicare Advantage plan during the Medicare Annual Election Period (AEP). AEP runs from October 15th to December 7 of each year.
No. You will need to enroll in a Part D drug plan to get prescription drug benefits.
No. To cover these services, you’ll need to consider adding separate, standalone coverage.
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