Many people are anxious about entering Medicare; they worry that they will make a wrong choice and get the wrong coverage. While this is a valid concern, these fears can be allayed by making a plan for your coverage. For millions of Americans, making a plan involves understanding the costs of Medicare, and choosing a Medicare Supplement Plan. In this article, we’ll share the details of how billing works with Medicare, and how Medicare Supplement Plans in Pennsylvania work.
You can’t make a plan if you don’t have all the facts on-hand. To be ready for Medicare, you need to clearly understand how your coverage will work, and especially how much your coverage will cost. While the benefits from Parts A and B of Original Medicare are very good, you will still have to pay out of pocket for the care you receive.
You’ll pay several different kinds of cost sharing when you use your Medicare benefits, including:
Like with most other health insurance coverage, you will need to satisfy the deductibles before Medicare will provide any coverage. Once you’ve met the deductibles, Medicare will pay for the vast majority of your medical expenses. However, it is possible to pay the Part A deductible more than once in a year, which is an unusual feature.
Part B co-insurance is 20%. After you meet the deductible, you’ll pay 20% of the cost of all Part B services for the rest of the year.
The most concerning aspect of Medicare is that you don’t have any kind of out of pocket spending protection. You keep paying your share of the cost all year long. This uncapped spending provision is one of the chief reasons that people choose to add Medicare Supplement coverage to their Medicare benefits.
Medicare Supplement Insurance, which you’ll often see referred to as Medigap coverage, is private insurance that complements your Medicare benefits. It works with Original Medicare by paying for many of the costs that you would otherwise have to pay out of pocket. By using Medicare Supplement Insurance, it is possible to limit your out of pocket expenses to a few hundred dollars per year, even if you receive extensie medical care.
Medigap Plans are standardized in 47 of the United States, including Pennsylvania. In all of these states, there are the same 12 plans, and they’re known by Plan Letter: A, B, C, D, F, High Deductible F, G, High Deductible G, K, L, M, and N. Every one of these plans has a unique benefit structure. They each cover a different amount of the costs you’d normally pay. If you choose one of the less comprehensive plans, like Plan A or B, you’ll be responsible for more costs than if you use a more comprehensive plan like Plan G or N.
You will use both of your coverages when you receive medical care. Medicare is your primary coverage, and your medical providers will bill Medicare first (once you’ve met any required deductible). Your providers will also bill your Medigap plan. Your plan will pay some or all of the remaining amount due, depending on which standardized Plan you enrolled in.
Having Medicare Supplement Insurance doesn’t impact your freedom to see any doctor that takes Medicare patients. In other words, you will not be restricted by any kind of provider network. You will also be free of the need for referrals. Medigap is frequently chosen by people who want maximum freedom and choice when it comes to seeing medical providers.
To help you understand exactly how these plans work in “real life,” we’ll review how Plan G, which is perhaps the most popular Medigap Plan, works.
When you have Plan G, you will be responsible for the Part B deductible. So, when you see a doctor for the first time in a year, you’ll have to pay this small amount first. Once you’ve done that, Plan G will pay 100% of the costs that you’d normally be responsible for for the rest of the year. This is the case even if you have very expensive medical treatments like chemotherapy. Plan G also covers you if you’re outside of the United States.
Plan G is the most comprehensive plan you can get if you become eligible for Medicare after December 31, 2019. The only downside to Plan G is that it is the most expensive of the standardized plans. Conversely, the less comprehensive plans have smaller costs for coverage.
You’ll have the chance to get Medicare Supplement Insurance when you enter Medicare for the first time. In most cases, this happens when you turn 65. When this is applicable, you will have an Initial Election Period, which lasts for seven months. During this time, you can enroll manually online, by phone, or at your local Social Security office. Once you have your Medicare number, you can sign up for your chosen Medigap plan.
You can also choose to delay your Medicare benefits during this time if you’re still working and will remain covered by your employer’s plan. You will be able to enroll in Medicare whenever you retire. You can add Medicare Supplement coverage at that time, too.
In some cases, though, you can enter Medicare early, before you turn 65. Federal rules don’t require Medigap Plans to cover people who are younger than 65. Instead, the individual states set their own rules about this. Medicare Supplement Plans in Pennsylvania are required to cover people who get Medicare before age 65. Additionally, Plans in Pennsylvania are prohibited from charging people under 65 higher premiums than people over 65. These generous provisions mean that people who get Medicare early in Pennsylvania have the maximum flexibility to customize their Medicare coverage.
This enrollment period begins when you are at least 65 years old and also enrolled in Part B. In Pennsylvania, you also have an Open Enrollment Period when you enter Part B, even if you’re younger than 65.
Yes. But, if you do this outside of your Open Enrollment Period, you may have to answer health history questions and your acceptance is not guaranteed.
Yes. This can be done during the Annual Enrollment Period in the fall each year.
No. If you choose Medicare Supplement Insurance, you will also need to enroll in a standalone Part D drug plan.
No. If you want dental and vision, or hearing, coverage, you’ll need to arrange for separate coverage.
Medicare Plan Carriers
Follow Us for Medicare Updates
MedicareConsumer.com is a non-government agency and is on a mission to help current and future Medicare recipients find the best Medicare supplement plan for their unique needs. Medicare insurance logos as seen on MedicareConsumer.com belong to the respected trademark owners in our available network of Medicare insurance carriers. Any and all rate quotes for Medicare supplement plans are free to consumers and you are not obligated to purchase any plan from any carrier.
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.