When you review your options for Medicare coverage it’s important to understand what kind of costs you’ll be facing when you use your benefits. By taking into account how much you might have to pay for medical care, you can make the best decision about a private option to limit your costs. One of the most frequently used private plans is Medicare Supplement Insurance. Read this article to learn all you need to know about Medicare Supplement Plans in South Carolina.
The first thing to know about your Original Medicare benefits (Parts A and B) is that you will have to pay for some of the cost for care when you use your benefits. How much you pay depends on which aspect of your coverage you’re using; Parts A and B have different user costs.
Medicare Part A comes with these costs:
You can potentially pay the Part A deductible more than once. You could also pay the daily co-insurance amounts for multiple hospital or skilled nursing stays, although this would be very unlikely.
For Part B, these are the costs that you’ll have to pay out of pocket:
You’ll only pay the Part B deductible once in a year. Once you’ve paid that, you’ll be responsible for paying 20% of the charges you incur for Part B services. You’ll pay this 20% for the rest of the year.
Medicare doesn’t limit your total spending in any way. You’ll continue to pay all the standard deductibles and co-insurance amounts all year long, even if you’ve already spent thousands of dollars for the year. This uncapped spending feature is perhaps the most worrisome feature of Original Medicare.
Medicare Supplement Insurance, which is alternatively called Medigap coverage, is a private insurance plan that is designed to integrate with your Part A and B benefits. Medicare Supplement Insurance is designed to pay for many of the costs that you’d normally be required to pay under the terms of Original Medicare. Medigap plans protect you from these costs. Since they pay most, or all, of your out of pocket costs, your true out of pocket expenses for medical care are strictly limited.
South Carolina is one of the 47 states that have enacted standardized Medigap plan provisions. In these states, there are ten standardized Medigap plans. There are also two high deductible variations. Each one of the standardized plans provides a different level of benefits; each one covers a different amount of the costs that you’d normally have to pay.
Since the Medigap plans are all standardized, this means that the specific coverage provided by each one is the same in all the standardized states. This makes comparing plans and prices very easy since the benefits are identical across states and insurance companies. It’s just a matter of selecting the specific Medigap plan you want and then comparing the prices from multiple insurance companies.
You’ll use your Medigap coverage when you visit the doctor or receive other medical care. When you pay, give them both your Medicare card and your Medigap Plan card. The provider will bill Medicare according to the prices that they have set; once you’ve paid your Part B deductible, Medicare will pay 80% of the cost. The provider will bill the other 20% to your Plan. Depending on which specific you’re enrolled in, your Plan will pay most or all of the balance. You can see how this kind of coverage can really limit your costs for medical care.
You may have heard about Medicare Supplement Plan F being done away with. This is not technically correct. The truth is that Plan F is no longer available for some Medicare Beneficiaries. Anyone who becomes eligible for Medicare after December 31, 2019 is ineligible for Plan F. However, if you were eligible for Medicare before that date, you can still get Plan F, even if you don’t currently have that Plan.
For those Americans who become eligible for Medicare after the cut-off date, Plan G is the replacement for Plan F. Plan G will cover everything that Plan F covers, with the exception of the Part B deductible. With Plan G, you’ll pay this small deductible before your Plan starts paying benefits. That’s the only difference between these two plans.
To enroll in a Medicare Supplement Plan, you have to be actively enrolled in both Part A and Part B of Original Medicare. In most cases, this happens when you turn 65 years old. If you’re one of these people, you will experience a seven month enrollment window called your Initial Election Period (IEP); your IEP will start three full months before the month you turn 65. It closes at the end of the third month after the month you turn 65.
You can sign up for Parts A and B during this window; once you have a Medicare number, you can enroll in your Medigap plan. In some cases, your Medicare enrollment might be automatic.
If you enter Medicare late, because you delayed your benefits since you were still working, you can enter Medicare and add a Supplement plan once your employer coverage ends.
You might even enter Medicare before you turn 65 if you gain eligibility due to illness or disability. Federal rules are silent on this point; there is no federal requirement that Medigap plans cover people under age 65. The individual states have the right to set this parameter. Some require people under 65 to be covered while others don’t. Medicare Supplement Plans in South Carolina are not required to give coverage to people under 65. Because of this most don’t, which makes it difficult to get Medigap coverage if you’re under 65.
When you are in your Medigap Open Enrollment Period (OEP). During this six month window, you can’t be declined for coverage. Your OEP begins when you are both age 65 or older and enrolled in Part B.
Yes, but it can sometimes be difficult. If you apply for a Medigap plan after your OEP, you will likely have to answer health status questions. In this case, the insurer can decline your application or charge you higher premiums if you don’t meet their health requirements.
Yes. This can be done during the Medicare Annual Election Period from October 15th to December 7th.
No. You will also have to enroll in a Part D drug plan to get drug coverage.
No. You should investigate standalone overage if you want dental benefits.
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