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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.
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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Medicare Part A and B, also known as Original Medicare, covers many medical and hospital benefits. But Original Medicare doesn’t cover hefty expenses such as deductibles and copayments.
You can avoid paying such expenses if you get Medigap (Medicare Supplement) along with Original Medicare. Doing so will enable you to bridge the gaps in Original Medicare coverage and may save money each month. Medigap is not the same as Medicare Advantage and can only be combined with Original Medicare.
Alternatively, you may consider getting a Medicare Advantage Plan. Also known as Medicare Part C, a Medicare Advantage Plan works in place of Medicare Part A and B. Some of the Medicare Advantage plans may include prescription drug coverage with routine dental, vision, and hearing benefits.
Assurance can help determine whether Original Medicare and a Medicare Supplement Insurance Plan or a Medicare Advantage Plan is the right choice for you.
Frequently asked questions
Medicare Advantage FAQs
Medicare Advantage, also known as Medicare Part C, is another way to get Original Medicare or Medicare Part A (for inpatient and hospital expenses) and Part B (for outpatient medical expenditures). They are offered by Medicare-approved companies that 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 has everything that Original Medicare has, with a bit more in some cases. Most Medicare Advantage plans also include Part D (prescription D coverage) and extra benefits such as:
Medicare Advantage has the same hospital care benefits as Medicare Part A, including eligible nursing homes and inpatient care.
Since Medicare Advantage has to give you the same amount of coverage that Original Medicare offers at minimum, you will get a minimum of 90 days of inpatient care. This may also come with a copayment, the amount of which depends on the length of your stay.
Medicare Advantage, like Medicare Part B, covers two types of services:
- Medically necessary services, which include care or supplies needed to treat or diagnose a medical condition
- Preventive services, which is care given to detect or prevent illnesses so future treatment will be more effective
These services include:
- Mental health care
- Medical equipment such as walkers, wheelchairs, etc.
- Doctor’s visits
- Ambulance services
As with hospital costs, services in this category may require a copayment, the amount of which will depend on your plan.
In contrast to Original Medicare, most Medicare Advantage plans will include prescription drug coverage.
If you have Original Medicare, you will have to pay separately for a Part D plan to get this kind of 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 won’t be able to join a Part D plan.
Most Medicare Advantage plans come with a copayment for prescription medication. The amount depends on the type of drug and the plan.
You may also have to pay a prescription drug deductible, which you have to pay out-of-pocket before your drug coverage activates.
Other benefits of Medicare Advantage
Finally, Medicare Advantage may also cover services you can’t get under Original Medicare or Part D. These include:
- Over-the-counter allowance for medical-related items like vitamins and bandages
- Routine dental care
- Fitness benefits
- Regular hearing services, including hearing aids
- Routine vision services including contact lenses and eyeglasses
- Meal delivery services (in certain circumstances)
Medicare Advantage, like Original Medicare, does not cover the following:
- Most long-term care placements, including what insurers call “custodial care.” Custodial care 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, you may want to look into getting a Medigap policy that covers foreign care options.
Although Medicare Advantage does 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. You will need to come out of a covered hospital stay and have remaining inpatient benefit days to use for most cases to qualify.
You may also have to look for doctors who are in your plan’s network and service area if you go with Medicare Advantage. This is because some plans don’t cover services from providers that are outside the plan’s network or service area. 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 plans, 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 join, drop, or switch a Medicare Advantage plan:
Initial Enrollment Period
This begins when you first become eligible for Medicare and starts three months before the month you turn 65. This period lasts for a total of seven months.
Medicare Advantage Open Enrollment Period
This period lasts 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 Fall Medicare Advantage Annual Enrollment Period
Medicare plans are open to enrollment 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 have to go to 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 you need to review any updates from your plan carrier. If you feel that your plan doesn’t fit you anymore, you may shop around for a better one. We at Assurance can help.
Medigap plans, also known as Medicare Supplement, were designed to help fill in the gaps in coverage for Original Medicare policies, such as Part A (for inpatient and hospital expenses) and Part B (for outpatient medical expenditures). Both parts have cost-sharing components such as coinsurance, copayments, and deductibles, which you have to pay every month.
By paying hospitals directly for any cost-sharing expenses so the policyholder doesn’t have to seek reimbursement from the insurance company, Medigap plans may help you to save money. Note, however, that each of the standard ten plans covers 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 can’t get Medigap if you have a Medicare Advantage plan. Unless you’re switching back to Original Medicare, it’s actually 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
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 out-of-pocket costs for services covered by Medicare. This may save you a lot of money since you’ll be responsible for paying all out-of-pocket costs that Original Medicare doesn’t pay for any covered medical or hospital care you receive.
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 3 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 E, H, I, and J also provide healthcare services outside of the United States. Although these plans are no longer on the market for purchase, if you currently had purchased on prior to June 1, 2010 you may continue to use it.
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.
Medigap doesn’t cover expenses that aren’t covered by Medicare Parts A and B. These include:
- Prescription drugs
- 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
If you want to get coverage for all of these services, you should consider a Medicare Advantage plan.
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.
A Medigap plan’s monthly cost can range from $50 to $300, with the average monthly premium around $155 as of 2020.
Each Medigap policy comes with a monthly premium, which varies according to the individual policy due to the following factors:
- Smoking status
- Marital status
- Multiple-policy discounts
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.
Additionally, you may 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 don’t have medical underwriting (only applicable in some circumstances). Each insurance company has its own policies on underwriting 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 cannot use medical underwriting, and you can also 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.
Look to these online resources for more information on related topics: