MEDICARE SUPPLEMENT INSURANCE
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These policies fill in virtually all the gaps in coverage not offered by Medicare, accept for prescription benefits, (covered by Medicare part D) dental and vision.Effective 2006 there are 3 parts to Medicare, with the advent of Medicare Part D prescription drug coverage. Part A, which is basically the hospital portion, comes for free included with social security. Part B is the doctor portion. There is a monthly premium for part B. For 2006 it will be $88.00 a month. This amount is automatically debited from recipients' social security. CLICK HERE FOR MORE INFO ON MEDICARE PART D
Upon turning age 65 or qualifying for social security disability, part B will be automatically awarded unless the recipient opts out. This is a very important clause to understand, because if the individual has some other type of viable alternative insurance to Medicare, he/she should opt out until part B is needed. By doing this one will not only save the part B premium but also retain the right to open enrollment into a Medicare Supplement plan later on in time.
Open enrollment means that no insurance company can turn an individual down for their best possible rate regardless of health. This can prove truly significant to those individuals on social security disability. After 2 years on social security disability, an individual becomes eligible for Medicare part B. Once any individual goes on Medicare part B, they have 6 months of open enrollment. After this 6 month period, no insurance company is mandated to covering an individual. Therefore, in most cases (accept for open enrollment) Medicare Supplements are medically underwritten and individuals can be turned down. This is not the case for Medicare Advantage plans. Medicare Advantage plans accept all qualified Medicare applicants accept for those individuals with end stage renal failure. CLICK HERE FOR MORE ON MEDICARE ADVANTAGE PLANS.
Another term which is often confused with open enrollment is guaranteed acceptance. While guaranteed acceptance is different from open enrollment, it has the same positive affect for an aspiring member in that it forces the insurance carrier to offer Medicare Supplement membership to the member regardless of health. There are numerous ways to attain guaranteed acceptance. We will touch on some the main ones here.
If you are on an employee sponsored health plan, whether you or your spouse is a current employee or retiree, if you are disenrolled for any reason, you qualify for guaranteed acceptance. If the employer discontinues their current plan and decides to pick up a lesser plan, this does not constitute guaranteed acceptance.
If a prospective member moves from one area to another, be it from another state or another part of the same state and the former insurance carrier does not offer coverage in the new area, the prospective member qualifies for guaranteed acceptance.
If a member chooses a Medicare Advantage plan during his / her initial open enrollment period (at age 65) and decides within one year's time that he /she is dissatisfied, he /she qualifies for guaranteed acceptance. If you are not sure if you qualify for guaranteed acceptance, you may check the federal guide to Medigap policies under guaranteed acceptance or call our office at (800) 314-9706. PLEASE CLICK HERE FOR THE FEDERAL GUIDE TO MEDIGAP POLICIES.
There are 10 traditional Medicare Supplement plans plus the advantage plans. The plans are differentiated alphabetically from A through G. There is also a high deductible version of F along with the brand new K and L plans. Both K and L are high deductible plans as well.Prior to the advent of the new prescription Medicare part D, there were also three plans with limited drug coverage, plans H, I and J. These plan are being phased out, yet are still grandfathered for those choosing to keep the old policies. We recommend that members with these older policies consider the prescription coverage through part D as a more affordable alternative to these plans.
Medicare Advantage plans are an alternative to Medicare Supplements, discussed in entirety in another section of this website. CLICK HERE FOR A FULL DISCUSSION OF MEDICARE ADVANTAGE PLANS.
Now let's evaluate the plans. Plan A is the only plan that does not cover the Medicare part A hospital deductible which is $952 per hospital admittance for 2006. This is one plan that is virtually worthless and should be done away with. Part B does not pay for days 21 through 100 of skilled nursing. For the year 2006 the skilled nursing deductible is $119 per day. While the average stay in skilled nursing is only 23 days, this benefit is quite inexpensive. Therefore it might be prudent to stay away from the plan B as well. The differentiation between plans C, D, E, F, & G are truly not as relevant. Plans C & F do pay the Medicare part B deductible, which is $124 for 2006. Generally we evaluate each situation for the best value.
All Medicare Supplements are accepted by all doctors and institutions across America, as long as the doctor accepts Medicare assignment. The positive caveat to this is that no senior should be seen by a doctor whom refuses Medicare assignment. Therefore Medicare Supplements are not HMO's, PPO's or PFS's (private fee for service). There are never restrictions because of lack of participation in a given network. Medicare Advantage plans offer these types of policies. CLICK HERE FOR MORE ON MEDICARE ADVANTAGE.
A chilling caveat to all Medicare Advantage plans is that they are and have been subject to annual changes controlled by the insurance carrier. One year a carrier may charge no premium; the following year they may charge $50. One year the deductible may be $250; the next year it could be $500. Characteristic to 2006 is the addition of prescription coverage to most plans which in prior years had none. Beware! In most case these prescription plans that are more or less hidden in the plan are not the best available. Stand alone plans are usually better. CLICK HERE FOR MORE ON PART D PRESCRIPTION PLANS.