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Medicare Advantage Plans

Medicare Advantage plans may provide additional supplemental benefits while helping to reduce healthcare costs. It includes hospital and outpatient coverage and may have additional benefits such as: Routine Vision, Dental, Hearing, and Fitness Benefits. There are many different Medicare Advantage plans with varying cost structures and benefits.

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Medigap (Medicare Supplement)

Medigap fills in the gaps in coverage for Original Medicare, Part A and Part B, by paying the hospitals directly for cost-sharing expenses such as coinsurance, deductibles, and copayments for covered services you receive. There are ten different Medicare Supplement plans named by letters: A, B, C, D, F, G, K, L, M, and N.

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Frequently asked questions

Medicare Advantage FAQs

Medicare Advantage, also known as Medicare Part C, includes both Medicare Part A (for inpatient and hospital expenses) and Part B (for outpatient medical expenditures) benefits. Medicare Advantage plans are offered by private insurance companies who are approved by the Centers for Medicare and Medicaid Services (CMS).  These companies follow the rules set by Medicare.

If you choose to buy a Medicare Advantage plan and still have Original Medicare, you will get most of your Part A and Part B coverage from Medicare Advantage, not Original Medicare.

To get Medicare-covered services, you will need to use your card from your Medicare Advantage plan. However, you should also keep your blue, red, and white Medicare card just in case you need to switch back to Original Medicare.

Medicare Advantage plans cover services typically covered under Original Medicare Parts A and B, and may include additional benefits. For example, most Medicare Advantage plans also include Part D (prescription D coverage). Medicare Advantage plan benefits include:

Hospital Costs

Medicare Advantage has the same hospital care benefits as Medicare Part A, including coverage for medically necessary nursing home care and at least 90 days of inpatient care. Depending on the length of your stay, your plan may require a copayment.

Medical Care

Medicare Advantage, like Medicare Part B, covers two types of services:

  • Medically necessary services, such as care or supplies needed to treat or diagnose a medical condition
  • Preventive services, such as routine health screenings and patient counseling

Examples of services covered by Medicare Part B include:

  • Mental health care
  • Medical equipment such as walkers, wheelchairs, etc.
  • Routine doctor’s visits
  • Ambulance services

Depending on the specific care needed, your plan may require a copayment.

Prescription Medications

In contrast to Original Medicare, most Medicare Advantage plans include Medicare Part D, which provides prescription drug coverage.

If you have Original Medicare, Part D must be purchased separately for coverage.

Note that not everyone will be eligible for a Part D plan.

If you have a Private Fee-for-Service medical savings account or plan, you can join a Part D plan. But if you have a health maintenance organization (HMO) or preferred provider organization (PPO), you  will not be eligible to join a Part D plan.

Out-of-pocket costs

Most Medicare Advantage plans require copayments for prescription medication. The copayment amount depends on the type of drug and the plan. Some Medicare Advantage plans also feature a deductible for prescription drugs, which is paid out of pocket until it is met and your drug coverage activates.

Other benefits of Medicare Advantage

Some Medicare Advantage plans may also include services that aren’t covered under Original Medicare or Part D in some areas. These include:

  • Over-the-counter allowance for medical-related items, such as vitamins and bandages
  • Routine dental care
  • Fitness benefits
  • Regular hearing services, including hearing aids
  • Routine vision services, including contact lenses and eyeglasses
  • Post-hospitalization meal delivery services (in certain circumstances)

Medicare Advantage, like Original Medicare, does not cover the following:

  • Most long-term care placements for custodial care, which includes help with eating, using the restroom, bathing, and dressing. 
  • Medically unnecessary services, including most cosmetic surgeries.
  • Out-of-country medical insurance. If you need health services outside of the United States, a Medigap policy may cover you for limited care in foreign countries.

Although Medicare Advantage plans do not cover most long-term care placements, it does cover long-term care if you need skilled and specialized nursing services for a qualifying medical condition. To be eligible, patients must be recovering from a covered hospital stay and have inpatient benefit days remaining.

Some Medicare Advantage plans do not cover services or providers outside of the plan’s network or service area, which could limit your options.  In contrast, with Original Medicare, you can go to just about any doctor or hospital that accepts Medicare in the United States.

Medicare Advantage plans may include: 

  • Medicare Part A (hospital insurance) 
  • Medicare Part B (medical insurance) 
  • Medicare Part D (drug coverage), which is typically included but not always

It’s important to keep in mind that Medicare Advantage plans only add services. This means that if you join a Medicare Advantage plan and still have Original Medicare, your Original Medicare plans won’t be affected.

You’re eligible for Medicare Advantage if both of the following apply:

  • You have Original Medicare Part A and Part B
  • You live in your chosen plan’s service area for at least six months of the year 

If you aren’t sure what service area you live in, ask your plan carrier to define their service areas for you. 

There are four enrollment periods during which you can either enroll, drop, or switch a Medicare Advantage plan: 

Initial Enrollment Period

This begins when you first become eligible for Medicare and  begins

three months before your 65th birthday, includes the month you turn age 65, and ends three months after your 65th birthday month.  Your Initial Enrollment Period lasts a total of seven months.

Medicare Advantage Open Enrollment Period

If you are already enrolled in a Medicare Advantage plan, you can switch plans (subject to some restrictions), or switch back to Original Medicare  between January 1 and March 31 every year. Your plan coverage will begin on July 1 if you decide to get Medicare Advantage during this period. If you have Medicare Part A and sign up for Part B for the first time during this period, you will be able to sign up for a Medicare Advantage plan between April 1 and June 30 during the same year.

Medicare’s Annual Enrollment Period

Medicare’s Annual Election Period occurs every year between October 15 and December 7. During this time, anyone with Medicare can add, switch, or drop a Medicare Advantage plan. If you join a Medicare Advantage plan during this period, your coverage will begin on January 1 as long as your plan provider receives your request to join by December 7.

Special Enrollment Periods

If you did not utilize one of the enrollment periods above, you may be eligible to join a Medicare Advantage plan or switch coverage under certain circumstances. These include, but are not limited to: 

  • A current plan dropping its contract with Medicare 
  • Loss of existing coverage, including drug or COBRA coverage 
  • An address change that affects your coverage 

Medicare Advantage plans can have varying costs since each plan can charge different out-of-pocket costs, including deductibles, coinsurance, and copayments. They may also have different rules for how you get services, such as:  

  • Whether you need referrals to see specialists  
  • Whether you must seek services from facilities, suppliers, or doctors that belong to the plan’s network for non-urgent or non-emergency care  

These rules can change every year, so review any updates from your plan carrier. If you feel that your plan no longer fits your needs, Assurance can help you shop for a better one.

Medigap FAQS

Medigap plans, also known as Medicare Supplement, are designed to help fill in the “gaps” in coverage for Original Medicare policies.

Medigap Insurance carriers pay hospitals directly for covered cost-sharing expenses. These can include the coinsurance costs and copayments that are the beneficiary’s responsibility to pay after Original Medicare has covered its portion of the expenses.  By paying these costs, Medigap plans may help you to save money. Note, however, that each of the standard ten plans cover different cost-sharing amounts under varying circumstances. Review your plan documents and reach out to your insurance agent if you aren’t sure what is covered or not covered under your Medigap policy. 

Please note that Medigap is designed specifically to work with Original Medicare Part A and Part B, so you cannot get Medigap if you have a Medicare Advantage plan. Unless you’re switching back to Original Medicare, it is illegal for anyone to sell you Medigap if you already have Medicare Advantage. 

If you are eligible for Medigap and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for the covered services. After that, your Medigap policy will pay its share for the covered services.

Each Medigap policy only covers one person, so if you and your spouse both want Medigap coverage, each of you will have to buy a separate policy. 

All standardized Medigap policies are renewable, even if you have health issues. This means that insurance companies can’t terminate your Medigap policy as long as you pay the premium. 

Medigap covers some of the out-of-pocket costs you may incur for services covered by Original Medicare. This may save you money since you would otherwise be responsible for paying the out-of-pocket costs you incurred for any covered medical or hospital care that you received under Original Medicare.  

In 2022, the deductible for Part A is $1,556, and you won’t have to pay coinsurance for the first 60 days of your hospital stay. If your hospital stay is longer than 60 days, you’ll pay $389 per day for days 61 to 90, and for every day after day 90, you will pay $778 a day.

To summarize, Medigap helps cover any Medicare-approved expense, including some or all of: 

  • Medicare Part A coinsurance and hospital fees 
  • Medicare Part A hospice coinsurance or copayment costs 
  • Medicare Part A deductible 
  • Medicare Part B coinsurance or copayment costs 
  • Medicare Part B deductible 
  • Medicare Part B excess charges 
  • Blood transfusion costs up to the first three pints 
  • Emergency medical costs during international travel 

Some Medigap policies cover services that Original Medicare doesn’t cover.  

For instance, standard Medigap Plans C, D, F, G, M, and N give you access to medical care when traveling outside of the United States. Plans C, D, E, F, G, H, I, J, M, or N will do the following: 

  • Cover foreign emergency care if Medicare doesn’t cover the care and the need for emergency care starts during the first 60 days of your travel 
  • Pay 80% of the charges for some medically necessary emergency care outside of the United States after you meet a $250 deductible for that year 
  • Note that there’s a lifetime limit of $50,000 for foreign travel emergency coverage with Medigap policies. 

Please note that Plans E, H, I, and J are no longer on the market for purchase. However, if you had purchased one of these Medigap plans prior to June 1, 2010, you may continue to use it.

Medigap does not cover: 

  • Prescription drugs 
    • Note that Medigap policies purchased prior to January 1, 2006 may have included prescription drugs; however, policies purchased since this date now exclude prescription drug coverage.
  • Transportation services or health perks 
  • Dental, hearing, or vision services

If you want to get coverage for these services, consider a Medicare Advantage plan. However, keep in mind that Medicare Advantage plan benefits vary, so it is important to review the services, limitations, and exclusions that may apply.

You should also note that your Medigap plan won’t cover the Part B deductible if you’re newly eligible for Medicare (i.e., eligible for Medicare on or after January 1, 2020). As a result, Plans C and F will also be unavailable if you’re newly eligible for Medicare.   

However, you can keep your plan if you already have Plan C or F or Plan F high deductible version before January 1, 2020. If you were eligible for Medicare before January 1, 2020, but you weren’t yet enrolled, you may be able to get a plan that covers the Part B deductible. 

Each Medigap policy comes with a monthly premium, which varies according to the individual policy due to the following factors: 

  • Age 
  • Location 
  • Gender 
  • Smoking status 
  • Marital status 
  • Multiple-policy discounts 
  • Inflation 

To be eligible for a Medigap plan, you need to: 

  • Be enrolled in Original Medicare, have both Medicare Part A and Part B, and have both Part A and B remain active for the duration of your Medigap plan. This is because Medigap is intended to work with Parts A and B. 
  • Not be enrolled in a Medicare Advantage plan. 
  • Pay a monthly premium for Medigap. This premium will vary depending on residential location and what plan you choose. Individual carriers set the rates.   
    • If you fail to pay monthly premiums, your coverage will lapse and you’ll be subject to standard medical underwriting criteria. You may also have to pay a higher premium. 

NOTE: If you’re new to Medicare, you may not have access to Medigap Plans F and C if you’re applying for Medigap.

You might not be eligible for Medigap if: 

  • You’re not the right age since age is a Medigap eligibility requirement in most states.  
    • Federal law doesn’t require insurance companies to sell Medigap to people under 65. However, some states require Medigap to be available to people under 65, including people with specific disabilities and medical conditions. These states are Arkansas, California, Connecticut, Indiana, Maryland, Michigan, New Jersey, North Carolina, Oklahoma, and Texas.  
  • Note that not all policies are available to Medicare recipients under 65. 
  • You have pre-existing conditions that are not accepted by the insurer (only applicable in some circumstances). Each insurance company has its own policies on health screenings and eligibility, so be sure to check with your carrier. 

The Medigap open enrollment period is six months and begins on the first day of the month you turn 65 or older and enroll in Medicare Part B. 

During this period, you can buy any available Medigap insurance plan without being turned down or charged because of a health condition.  

Outside of this enrollment period, pre-existing conditions and health problems may disqualify you from Medigap. 

Depending on what state you’re in, you may be able to enroll in Medigap during other times of the year, although there may be medical underwriting. 

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