It may come as a surprise to you to learn that when you have Medicare, you could be exposed to thousands of dollars of medical costs. If this is news to you, or if you’re already aware of this, now is the time to make a plan to meet those expenses. One way you can do this is with Medicare Supplement (or Medigap) Insurance. In the rest of this article, we will review your exposure to out of pocket spending with Medicare as well as the details of Medicare Supplement Plans in Vermont.
Medicare is a very popular program that provides excellent coverage. It is very comprehensive in the sense that almost every potential medical service or procedure that’s medically necessary is covered by it. Not only that, but Medicare will pay for most of the cost for your care also. However, Medicare doesn’t cover 100% of the costs for your care. You will have a role to play here. The way that Medicare is designed, you are exposed to these costs when using your benefits:
The biggest costs you’re likely to face are the Part A deductible and Part B co-insurance. You have to pay the Part A deductible whenever you’re admitted to the hospital. Once you’ve done that, you can stay in the hospital for up to 60 days and in a skilled nursing facility (if you’re transferred to one) for up to 20 days. If your stay exceeds these amounts, you’ll have to pay daily co-payments.
On the Part B side, you have to pay the deductible first. After that, Medicare will start paying 80% of the cost for all of your outpatient care. You pay the other 20%.
While these costs are relatively tame, they can add up in years when you need a lot of medical care, or fight major illnesses like cancer. Unfortunately, your costs aren’t capped at all, so your potential liability can be very large. This is where Medicare Supplement Insurance can help you out.
Medigap coverage provides protection against large out of pocket expenses due to the costs of Medicare. These plans are offered by private insurance companies. They integrate with your Part A and B benefits. When you use a service or procedure, when you’d normally be expected to pay out of pocket, your Medigap plan steps in. By using a Medicare Supplement Plan, you can limit your out of pocket costs to just a few hundred dollars per year.
Medicare Supplement Plans are standardized in 47 of the U.S. states, including Vermont. In these states, there are ten standard plans to choose from. The benefits from each of them are slightly different from one another. But, each of the separate plans is the same from one state to another. In this way, the basic Plans: A, B, C, D, F, G, K, L, M, and N are uniform no matter where you live, making it easy to choose the coverage you want and shop compare prices from the insurance companies in your area.
You can choose a specific Medigap plan based on the costs you’d like covered. For instance, you can have total or partial coverage of the Part A deductible, or pick a plan that doesn’t cover it all. The same goes for the other costs like Part B co-insurance, excess charges, and so on.
Regardless of which insurance company and standardized Plan you choose, your coverage will work the same. Once you’ve met any required deductible for the year (almost all the Medigap plans require you to pay the Part B deductible), your providers will start billing both Original Medicare and your Medigap Plan. Medicare pays the bulk of the costs. The uncovered ones are billed to your Plan. In many cases, your plan will cover all of the costs for you.
When you have Medigap coverage, you remain in Original Medicare, so you are not restricted by plan networks or referral requirements. By combining Medigap with Part A and B, you have maximum protection for medical costs, and total flexibility to see doctors and other providers.
The main requirement to get Medicare Supplement insurance is that you need to be active in Part A and Part B. So, if you get Part A when you turn 65, but delay taking Part B because you’re still working, you won’t be able to get Medigap until you lose your employer coverage and add Part B.
If you don’t delay your coverage, and decide to claim Medicare A and B when you turn 65, you’ll have a seven month enrollment window to do so. It starts three months before the month you turn 65. You can enroll in Parts A and B any time during this window. Once you get your Medicare number, you can enroll in a Medigap plan.
In some cases it’s possible to enter Medicare younger than 65. This usually happens because of disability or the diagnoses of certain diseases. Federal law allows states to individually decide whether Medigap plans have to cover people who are under 65. Medicare Supplement Plans in Vermont must cover people under 65. However, the premiums that they can charge are not restricted, so coverage for people under 65 tends to be very expensive. However, when a person who gets Medicare younger than 65 turns 65 years old, they will have a chance to get Medicare Supplement coverage at the standard, more affordable, rates. Before this time, people who get Medicare early in Vermont might consider using a Medicare Advantage Plan until they turn 65.
This Open Enrollment Period (OEP) is your opportunity to get Medigap coverage without your health status being taken into consideration. During this six month window, you can’t be turned down or charged higher premiums based on your health.
Your OEP will only start when you are 65 or older and also enrolled in Part B. Vermont has a special OEP for people under 65; it begins when they become active in Part B, regardless of age.
Yes. This is possible during the Annual Election Period, from October 15th to December 7th of each year.
No, they don’t. You will have to get a separate Part D drug plan for this coverage.
Some of them do. Plans C, D, F, G, M, and N work internationally.
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