Finding the right Medicare plan requires investing a little time to research and learn how your Medicare coverage works, and also understanding your options for making the most of your benefits. In this article, we will highlight some of the key costs you need to be aware of when crafting your plan. We’ll also review how Medicare Supplement Plans in West Virginia can help you save money when using your basic Medicare benefits.
The most foundational thing you can do as part of your health care planning is understand what your costs will be as you use your Medicare benefits. It’s only when you have a firm grasp on these costs that you can make an effective plan to limit them.
Medicare Part A and B come with a variety of costs that you’ll have to pay. The Original Medicare program is known as Fee For Service (FFS). As the name implies, you pay fees when you receive services. With the exception of certain preventative services and screenings, there’s a cost associated with all the care you get during the year. While Medicare does pay most of the cost, the amounts that are left over can add up fast.
So, what are the costs of Medicare? Here are the costs that you will face:
You will need to pay Part A co-payments only when you experience a hospital stay longer than 60 days or a skilled nursing facility visit longer than 20 days. For 2023, extra hospital stay days start at $400 per day. Likewise, the skilled nursing facility co-payment is $200 per extra day for 2023.
For Part B services, the co-insurance costs will be your largest expense. Standard Part B co-insurance is 20% of the Medicare-approved cost.
The number one most important thing that you should keep in mind is that your costs are potentially unlimited. There is no provision in Original Medicare for a cap on your spending. You are responsible for paying these costs for all services, all year long.
Naturally, the prospect of high and unlimited expenses is a concern to many people, which is why they add Medicare Supplement Insurance to their Medicare benefits.
Medicare Supplement Insurance is a unique health insurance coverage that is sold by private insurance companies. This coverage, which you will see called Medigap, is added to your existing Part A and B benefits from Medicare. Medigap plans pay those costs we mentioned earlier for you. They help keep your out of pocket costs down and protect you from uncontrolled medical spending.
Medigap is an additional coverage, so it comes with a cost. In exchange for paying a monthly premium, which varies based on the level of coverage you choose, your plan will directly pay for many of the costs that you would normally be responsible for. Whenever you see a provider, you will pay with both your Medicare coverage and your Medigap coverage. As long as you have met your deductibles (if any are required), your Medicare and Medigap coverage will work together. Medicare pays first; for Part B services, they pay 80% of the cost. Your provider will bill your Medigap plan for the remaining balance. Your plan will pay at least 50% of the total, and in many cases 100% of it; it depends on which specific Medigap plan you enrolled in.
West Virginia is one of the standardized Medigap states (there are 47 of them). In these states, there are 12 standardized plans to choose from. The benefits for each one are unique. Also, each standardized plan is the same in all of the 47 standardized states. The 12 plans are indicated by letter: Plans A, B, C, D, F, G, K, L, M, and N. Besides these ten, there are also High Deductible Plans F and G. Note that you can only enroll in Plans C, F, and High Deductible F if you became eligible for Medicare before January 1, 2020. Each of these standardized plans covers a different mix of the costs that you’d normally have to pay. Since there are a total of 12 different options, you can find a plan that covers the costs you’re most concerned about.
When you use Medicare Supplement Insurance, you preserve all of your rights under Original Medicare. This means that you remain free to see any provider who takes Medicare. In addition, you can see specialists without getting a referral or using a network.
Medigap Plan G is the most popular plan today, especially with people who are getting Supplement coverage for the first time. Since it’s such a popular plan, we’ll review the benefits it provides.
Plan G covers every cost you will encounter when using your Medicare benefits except for the Part B deductible. Once you pay this small amount at the beginning of the year, Plan G will cover all of your costs for the rest of the year. Besides this, Plan G also extends your coverage outside of the United States.
The basic eligibility requirement for Medigap is that you need to be enrolled in both Parts A and B. In most cases this happens when you turn 65 years old. You can get Medigap coverage as soon as you are actively enrolled and have your Medicare number.
You might choose to delay taking Part B, though, if you’re still working. If you do this, you will be able to add Part B when your employer coverage ends. You can add a Medigap plan at that point.
In some cases it’s possible to enter Medicare before turning 65, even years before. This happens when you meet certain disability or illness stipulations. Medicare Supplement Plans in West Virginia are not required to cover people who are under 65. Because of this fact, people who enter Medicare early in West Virginia might want to consider Medicare Advantage plans when they enter Medicare.
This enrollment period is a six month window of time during which you can enroll in a Medicare Supplement Plan without answering health history questions. Your enrollment is guaranteed. This window opens when you are 65 or older and actively enrolled in Part B.
Nothing happens, but if you later decide to get Medigap coverage, you will have to answer health questions. In this case, your coverage could be denied if you don’t meet the Plan’s underwriting guidelines.
Yes, this can be done during the Annual Election Period from October 15th to December 7th.
No. If you want help with dental, vision, or hearing, you’ll need to consider adding separate coverage.
No. If you choose Medigap coverage, you will also need to enroll in a Part D drug plan to get drug coverage.
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