Health insurance is a central and important concern for most Americans, especially seniors since aging increases the likelihood of need for medical intervention. Because of this, programs have been developed to help keep seniors insured and give access to affordable care.

When it comes to Medicare, there are many plans available and each provides different levels and costs of coverage. In addition, the government also offers Medicare supplement plans to cover additional costs. Because of this, the process of picking the proper plan can sometimes create more questions than answers.

In this quick guide, we will explain and unpack some of the basics of Medicare and outline the best supplemental insurance options for those with additional needs.

What is Medicare?

Medicare is a government-subsidized insurance plan with certain eligibility restrictions. An individual is eligible for medicare if one or more of the following apply:

• They are over the age of 65
• They suffer from an end-stage renal disease
• They suffer with disabilities

In the case of persons with disabilities, Medicare can potentially offer coverage to younger individuals. Coverage is withheld until after a 2-year waiting period has elapsed and the individual seeking coverage can produce 2 years’ worth of Social Security Disability Insurance (SSDI) checks.

Medicare Plans: Original vs. Advantage

Individual coverage needs and financial ability is often the guiding factor in choosing between the different medicare plans. There are two “types” of Medicare offered: Original Medicare and Medicare Advantage. Both types are federal programs, but each have different covered services and thus different monthly premium costs.

Keep in mind that monthly premiums and deductibles change on a yearly basis. While updated information can be found on cms.gov, premiums can vary based on income and some plans may require a high deductible.

Original Medicare is separated into the following three plans:

Part A: Hospital Coverage

This plan covers inpatient hospital stays, skilled nursing facilities, some forms of home health care, and hospice.

Part B: Medical Insurance

This plan covers outpatient care, certain doctor’s services, preventative care, and medical supplies

Part D: Prescription Drug Coverage

This plan covers prescription drug costs to any of the original medicare plans in addition to potential coverage on some Medicare Cost Plans, Private Fee-for-Service Plans, and Medical Savings Account Plans.

Please note that Part D is offered by Medicare approved private insurance companies. As such, exact prices and extent of coverage may vary between plans and individuals.

Medicare Advantage 

The skip from Part B to Part D is intentional– Part C is reserved for Medicare Advantage. As such, the Advantage plan includes everything in Parts A, B, and D.

Advantage functions as an insurance bundle offered by private insurance companies contracting through the federal Center for Medicare and Medicaid Services (CMS).

What is a Medigap Plan?

Even when an individual utilizes a Medicare health insurance plan, there are certain expenses such as copayments, coinsurance, and deductibles that the individual is required to pay out-of-pocket. Keeping track of these amounts can be burdensome and the expenses may add up. Therefore, to help with these out of pocket costs, an individual can apply for supplemental insurance, also known as Medigap. These supplemental plans may also include additional coverage such as dental care, vision care, and more.

Medicare Supplement plans are sold by private companies but each plan offered must follow federal and state guidelines. Insurance companies do not have to sell them but if supplement plans are offered, they must include standardized coverage.

It is important to note that all 50 states have standard coverage laws but Massachusetts, Minnesota, and Wisconsin are the only states that have their own state standards that differ from federal policies.

How Much Does Medigap Cost?

The cost of Medigap is difficult to broadly estimate because costs depend on the chosen plan, the company you choose, the state you live in, and your zip code.

Though companies must offer federal standardized coverage, rates may vary per insurance company based on age, gender, health condition, discounts, and more.

Remember: premiums paid for Medigap are fees paid in addition to Original Medicare premiums.

How to Purchase a Medigap Plan

If you have decided a Medigap plan is right for you, there are a few steps that need to be taken before purchasing a plan.

1. Eligibility

You must ensure that you are eligible and currently enrolled in Original Medicare. Once this has been determined, you can begin the process of looking for individual insurance companies that offer a Medigap plan.

2. Research

While the research process might take a little time, information about insurance plans can be found through internet searches, calling customer service phone numbers, or even contacting your state’s insurance assistance program. The government also provides a free to use Medicare provider lookup tool.

While close friends or family can also be a resource, it is important to take into consideration the potential differences in their health and living situation from your own. Choosing the right insurance supplement is ultimately about choosing what is right for you.

3. Compare

Once you have begun the process of gathering information, you can begin the comparison. Important items to consider in your comparison are: monthly premium rates, the option for high-deductible plans, and whether or not you will receive aid with matters such as part b deductibles, part b coinsurance,or prescription drug plans. 

4. Purchase

Finally, it is time to purchase the plan itself. This is completed by contacting your chosen insurance company and purchasing your coverage directly through them.

Best Supplement Insurance Plans for 2021

In 2021, there are currently 10 Standard Supplement Insurance Plans available. The best plans are those that balance coverage and cost. Unfortunately 2 of these plans, Plan C and Plan F, are no longer available to new enrollees, therefore if you have not yet purchased supplement insurance, you have 8 to choose from in 2021.

Plans that offer more comprehensive coverage will incur higher premiums and vice versa. These plans can range from $62-$784 per month in 2021.

Below we have outlined our Top 3 Recommended Choices for Supplement Insurance in 2021:

Best Comprehensive Plan: Plan G

Plan G has one of the higher monthly premiums of up to $473, but this plan includes all coverages except for the Medicare Part B Deductible. This means that you are responsible for paying the $203 deductible in 2021 before costs are covered, but after that all coinsurance, other deductibles, and excess charges are covered.

Best Cheaper Plan: Plan N

Plan N is very similar to Plan G except, in addition to not covering the Part B deductible,  it does not cover Part B excess charges. These charges can add up due to Part B covering routine care such as outpatient procedures and preventative care. If you are relatively healthy and do not foresee needing much additional care, this may be a good plan for you.

Best Cheapest Plan: Plan K

This plan is much cheaper than any other supplement insurance plan but that does come at a cost. This plan differs from all the other plans in that Medicare Part A coinsurance is covered at 100% but everything else is only covered at 50% or not at all. Therefore if you need outpatient procedures, blood, preventative care or skilled nursing, only 50% of these costs are reimbursed. This is a great plan if you only need assistance with coverage to offset costs, not to cover costs.

Special Considerations

Like the Medicare Advantage Plan, Medigap is purchased from private insurance companies. However, it is illegal for an insurer to sell you a Medigap plan if you already own Medicare Advantage. Medigap is only offered to those on the Original Medicare plan.

In addition, Medigap policies are specific to the individual. This means that if both you and a spouse would like the additional coverage, you will both need to purchase separate policies.

Furthermore, even with the addition of medigap, there are still some fees that might go uncovered. Unless otherwise specified, these generally include costs for vision and dental, prescription glasses, hearing aids, long term care, and private-duty nursing.

Another factor to consider when selecting your Medicare and Medigap coverage is based on doctors who accept medicare, most offices will accept the coverage but it is always a good idea to confirm before selecting a plan.

Selecting Your Insurance

Making sure your healthcare needs are met is an important necessity that should not be rushed but should also not be put off for later.

Choosing the right policy is not only a matter of knowing what you need today, but knowing what you may need in the future. This, in addition to the difficulty often involved in changing Medigap policies once one has been instated, is the main reason to choose a plan you can grow into as you age.

There are many factors to consider when making the right choice for yourself and we know it can seem overwhelming, but you do not have to do it alone. Our insurance agents are well educated on the major insurance companies plans when it comes to Medigap insurance, these companies include Blue Cross Blue Shield, AARP, Humana and more.

The Gebhardt Insurance Group offers years of experience in understanding the country’s most respected insurance providers to help individuals find the coverage they need when it comes to Medicare insurance, auto insurance, life insurance and more. Call us to discuss your options at (502) 836-3244.

American’s as a whole already have staggeringly high rates of individuals who lack health insurance. There are many reasons for this: plans are often too expensive, while eligibility thresholds for government benefits are too low. Furthermore, many individuals cannot afford traditional, privately bought plans. Couple this with the mass job loss resulting from the Covid-19 pandemic and there is a recipe set for disaster.

The above in combination leaves individuals in a bind: we are in a time when we need health insurance more than every but are in a uniquely challenging spot to receive or afford it.

Below, we outline the most accessible ways for individuals to regain coverage while they are unemployed and qualifications of special coverage groups such as Medicare, Medicaid, and CHIP.

The Options That Work for Most

Across the board, Special Enrollment plans and COBRA coverage is the preferred option for most individuals experiencing job loss.

The Marketplace

Many individuals don’t realize that losing a job triggers a Special Enrollment Period for marketplace coverage. As the name suggests, this is an enrollment window outside of when the health insurance marketplace is ordinarily open. The period lasts for 60 days after losing your job, giving you time to find an alternative and affordable healthcare plan.

Job loss is not the only trigger for such a period, however.

• Marriage that can result in a change of coverage
• Death of another member on the same marketplace plan
• Adopted a child
• Lost health coverage after a divorce or legal separation
• Lost health coverage due to job loss, being furloughed, or a reduction of working hours

For more information on how to qualify, see our article on it, here.

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federally mandated safety net for employees who depend on their employers for health insurance coverage. Through this program, you can elect to maintain the same plan coverage you had through your employer for up to 18 months after your employment ended.

However, for individuals experiencing unemployment, COBRA comes with some marked downsides in pricing.

Because employee provided plans are subsidized (your employee pays for part of it), enrolling in COBRA can be more costly than many can afford. The reason for such a significant jump in price is that employers typically subsidize 75% of the total cost of your plan. Additionally, they pay for a 2% administrative fee. Through COBRA, all these added expenses become your responsibility.

However, there is an upside: you may elect to enroll in COBRA coverage and still have the option to cancel later if you find the cost is not feasible.

The Options that Work for Some

While the above two options work for many, if you qualify for other health insurance options, there may be more cost-effective ways of continuing your medical benefits.

Short Term Health Insurance

Short-term health insurance plans are designed to bridge gaps in coverage for individuals who are unemployed, between jobs, or those suffering from other circumstances that caused a lapse in coverage. These plans often offer less extensive coverage for individuals who can’t, or don’t want, to pay for major medical coverage.

While short-term may seem appealing for the chance at low premiums at first, this type of coverage often lack-luster for most individuals.

The expense of short term plans varies greatly depending on your provider and the type of coverage you select. While some plans can have low monthly premiums, it is common for short-term plans to have higher deductibles or a significantly reduced scope of coverage.

Unfortunately, individuals with pre-existing conditions may not be covered at all. This creates a variety of challenges as nearly half of all Americans have some form of a pre-existing condition.  Furthermore, since short-term plans require you to re-apply at the end of each term— developing a pre-existing condition now loses your coverage later.

Medicaid, Medicare, and CHIP

These three government programs are all federally subsidized forms of health insurance that help individuals or families who meet specific enrollment requirements. These programs allow disabled and low-income individuals to find affordable health insurance and potentially provide long-term coverage.

Medicaid is a needs-based program supposed by social security tax payments. For individuals below a certain income threshold and asset cap, they can apply for this type of insurance policy. To find out if you qualify for Medicaid coverage, look to medicaid.gov for more.

Medicare, while similar, is based on entitlement and need. As such, individuals over the age of 65 of those with a qualifying disability are eligible to apply for this kind of coverage. For more information on Medicare eligibility, see the eligibility requirements on hhs.gov.

CHIP, also known as the Children’s Health Insurance Program, is for families who earn too much for Medicaid but too little to afford health insurance for their children through other means. CHIP has a strong connection to the Medicaid program, thus, more information about the program is located at medicaid.gov.

Casa Grande Insurance Agents

With the constant changes in the landscape as the coronavirus pandemic, ensuring you and your family have health insurance coverage is critical.

At the Gebhardt Insurance Group, we offer a variety of coverage from a host of major insurance carriers with an experienced staff that can help you determine the coverage you need. We can help everyone from individuals looking for a basic health policy to families, persons with pre-existing conditions, and even those looking to purchase life insurance.

If you have any questions, give us a call at 520-836-3244 to get a quote and make an appointment to take the final steps in insuring yourself and your family.