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MediGap Advisors explains how to be sure you’re covered.

How to Be Sure You’re Covered

We Make It Easy!

What troubles you about Medicare?  Are you worried a fractured hip could leave you to pay that $1,364 Part A deductible?  Did you know the Part A deductible is not an annual deductible?  You can incur that expense more than once a year.  However, there is a way to cover that expense, as well as others—with a Medigap plan.

Concerned about the cost of insulin that Medicare does not cover?  Medicare only picks up the cost if you use an external insulin pump, and even then you still pay the Part B deductible and 20 percent of the expense.  However, Medicare prescription drug coverage, known as Part D, can cover insulin, syringes and certain oral diabetes drugs.

Did you know there is no limit to the amount you might still have to pay for health care when you rely on Medicare alone?  There are Medigap plans, though, as well as Medicare Advantage plans, that establish an annual limit on how much you will spend for Medicare-related health care.

Medicare? Medigap? Medicare Advantage? What’s the Difference?

“How do I know what’s best for me?”  “How do I make the right choices to make sure I get all the coverage I need and still keep my expenses low?”

Here’s a brief overview of the various plans available to people eligible for Medicare:

(Original) Medicare:  This is the plan administered directly by the government.  You can choose to take Part A (hospital coverage) and/or Part B (medical coverage), and if you have A and/or B, you can also purchase Part D (prescription coverage).

Medigap:  This is private insurance that you can purchase to supplement your coverage, but only if you have Original Medicare, both Parts A and B.

These plans do what their name suggests:  they help cover the gaps between what Medicare will pay and what you would otherwise pay out of pocket, such as deductibles, copayments and coinsurance.  However, they do not cover gaps in prescription drug coverage.

Medicare Advantage:  This is also known as Part C, but rather than being administered by the government, it’s also private insurance. Medicare Advantage plans include the coverages of Parts A and B and usually Part D, and are similar in operation to an HMO or PPO in that you have a list of doctors to choose from.

Another difference with Medicare Advantage is that many of these plans offer coverages that Original Medicare doesn’t, including benefits for dental work, vision and hearing care, and prescriptions.  They also have a stop-loss to prevent unlimited medical costs from ruining you financially.

Medicare Part D:  This is the prescription drug part of the plan.  You can purchase this prescription drug coverage from a private insurer, but only if you don’t have that coverage in a Medicare Advantage plan.

You’ll want to choose either a Medicare Advantage plan, or a Medigap plan plus Medicare Part D prescription coverage.

When Can I Enroll?

For most people enrollment periods are relatively straightforward, but if you miss your initial enrollment opportunity, want to make a change, or your life circumstances don’t follow the same course as most other people, enrollments can get a bit more complicated.

To follow is a highly abbreviated version of how enrollment periods work.  Not addressed here are enrollment periods for those who need to purchase only Part D (prescription coverage), and not discussed in detail are exceptions.

MediGap Advisors welcomes your questions! Contact one of our professional, knowledgeable Personal Benefits Manager.  They’re ready to help.

Enrollment periods, simplified:

(Original) Medicare:  Most people will initially be eligible to enroll in Medicare around the time of their 65th birthday.  The initial enrollment window is seven months long: three months before their 65th birthday, the month of their 65th birthday, and three months after their 65th birthday.  There are a few exceptions, including for people who become disabled prior to turning 65.

For those people who do not enroll when they’re first eligible, there are also open enrollment periods from October 15 through December 7 of each year.

Medigap:  It’s best to sign up for Medigap coverage at the time you are first eligible to purchase it.  This is because during this first period of eligibility, you will not be asked to meet medical underwriting requirements (although you may have a pre-existing condition waiting period, usually six months).

The initial eligibility period for Medigap insurance is six months long and begins on the first day of the first month that both of the following are true: you are at least 65 and you are enrolled in Medicare Part B.

You can still purchase Medigap insurance if you decide after you are first eligible for it that you’d like a Medigap policy.  However, you’re likely to pay a premium penalty, and will usually have to meet the medical underwriting guidelines of the insurance carrier you've chosen.

Medicare Advantage: You can enroll in Medicare Advantage plans (Part C):

When you are first eligible for Medicare, usually at age 65, but sometimes at earlier or later dates due to disability, the fact that you’re still working and have work-provided insurance, or other circumstances

During open enrollment, which is October 15 through December 7 of each year (you can also change your plan from one Medicare Advantage provider to another)

During special enrollment periods, which are tied to certain life changes

How Do I Fit the Pieces Together?

We’re guessing it’s not on the top of your list to become an expert on Medicare plans.  Fortunately, you don’t have to in order to keep from being exposed to the gaps in coverage Medicare presents.

Depending on your situation, there may be several ways you can avoid medical bills that Medicare won’t cover.  Having a choice is great, but it can get confusing.  For example, you cannot use a Medigap plan to pay your out-of-pocket costs in conjunction with a Medicare Advantage plan.

Choosing Original Medicare and only Original Medicare is an economically risky decision, because under that plan, there is no limit on the amount of money that you would pay out of pocket for your yearly expenses.

If you have an expensive health crisis during the year or must manage a costly chronic disease, relying only on Medicare could be financially devastating.  As mentioned before, some Medigap plans, as well as some Medicare Advantage plans, will cap that annual limit, saving you money and worry.

If you need an expert, professional opinion on what kind of Medicare plan will offer you the most coverage at the least cost, we invite you to arrange a confidential consultation with one of our Personal Benefits Manager.  There’s no cost or obligation, and we’ll be happy to help you compare Medicare Advantage plans, Medigap plans and Part D prescription drug plans.

Learn about the five basic types of Medicare Advantage plans.  Neither Advantage plans nor Part D plans have standardized coverage, so we’ll research the ones that are available where you live and help you compare them.

Medigap plans do have standardized coverage that you can compare.  And if you have any questions at all, please request that one of our licensed Personal Benefits Manager speak with you to be sure you know what to expect from your chosen coverage.

If you already know you want a Medigap plan, you can run an instant quote.  Our quote system will instantly show you which plans are available in your state, which insurance companies offer them, and what the monthly premiums would be.

MediGap Advisors can help you find the lowest premium for the plan you want.  Even though Medigap plan benefits are standardized, insurance companies set different premiums for the same coverage.  Because our licensed Personal Benefits Manager are not compelled to represent any one insurance company over another, we can help you compare what all the leading companies offer in terms of both benefits and pricing.

By “leading,” we mean those companies with the highest ratings for financial stability based on the analysis of independent rating organizations like A.M. Best.  Some of those leading companies include Anthem Blue Cross and Blue Shield, HumanaOne and UnitedHealthcare, but there are many others.  These are companies that have been helping people with quality coverage for many, many years.

How Do I Know I’ve Made the Right Choice?

At MediGap Advisors, we believe our ideal client is a well-informed client, so we provide extensive educational resources right on our website. This is one of the features our many satisfied customers have told us they like most, as you can read on our testimonials Web page.  You may also want to check out our Better Business Bureau “A+” rating, and see the“No-Risk, Totally Thrilled, Money-Back Guarantee” issued by our president, Wiley Long.

Keeping informed about up-to-date information is your best tool in making smart health coverage decisions.  Visit our MediGap Advisors blog postings regularly for important information you can really use.

Once you begin working with your own Personal Benefits Manager, you’ll be able to call or email her or him directly.  We won’t make you waste your time navigating recorded phone menus, or force you to keep explaining your needs again and again to different staff.  You’re welcome to keep in touch with your Personal Benefits Manager for as long as you are our valued client.

And don’t miss the smart ways we’ve found to help you save money on everything from free will preparation to professional medical bill negotiators who are very good at talking doctors and hospitals into trimming down bills.

We’re ready to make your Medicare supplement insurance shopping experience as easy as it can possibly be, and look forward to speaking with you soon...and getting to work!

A Message from Our President, Wiley Long

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Disclaimer: Medigap Advisors is not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on this website. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.