A benefit period starts on admission to a hospital or skilled nursing facility as an inpatient, and ends at the termination of care in either facility for 60 consecutive days.
In 1985, Congress passed a bill called the Consolidated Omnibus Budget Reconciliation Act, better known as COBRA. Under COBRA, an employee (and possibly his/her spouse and dependents) have the option to continue group coverage for a set amount of time, often at his/her own expense.
Community-rated, issue-age-rated, and attained-age-rated
With Medicare Supplement plans, the rates increase over time. Other than inflation, age is the main factor in how rates are set and how they can go up. Here are the three ways plans can be priced based on age:
With this type of policy, the insurer will price the policy based on your age when you bought the plan. The premium will increase in small increments as you age.
Your premium is based on your age at issue and the will go up only when the carrier has a “state-wide increase.” You don’t get an annual age increase.
With these plans, the base premium is priced the same for everyone in the area, regardless of age.
Individual health insurance, employer or union-sponsored health insurance, TRICARE (military retiree benefits), and more are considered creditable, i.e. legitimate, forms of coverage.
Custodial care is nonmedical assistance help with daily routines such as bathing, dressing, eating, or using the toilet, provided at home or in a nursing or assisted-living facility.
Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,900 per year. To qualify for the Extra Help, you must be enrolled in Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
To be exempt or exonerated from a new law or regulation.
Guaranteed issue rights
Guaranteed issue rights, known also as “Medigap protections” are rights you have in certain situations that protect you from being denied a Medigap policy. In these specific scenarios, an insurance company has to sell you a policy, must cover all pre-existing conditions, and can’t charge you more for a Medigap policy because of health issues both past and present.
These special situations include:
You get a percentage savings on your Medigap premium, ususally for 2 spouses simultanously enrolled in the same plan with the same carrier. These discounts will vary state to state and among insurers.
The loss ratio is calculated by dividing all insurance losses incurred by the total number of insurance premiums collected. The lower the ratio, the healthier the insurance company is financially (and vice versa.)
Medicare Part D
Part D is the part of Medicare that provides prescription drug coverage for outpatients. It is only offered through private insurance companies that have contracts with the federal government. You need to enroll in a private Medicare prescription drug plan (PDP) or a Medicare Advantage Plan with drug coverage (MAPD) during approved enrollment periods to avoid penalties. Typically, you should sign up for Part D when you first become eligible to enroll in Medicare.
Medicare Select is a type of Medicare supplement (Medigap) plan which has a limited network of doctors and facilities. It can be any of the lettered Medigap plans and is one of most inexpensive types of Medicare insurance.
Medicare Summary Notice
The MSN is a summary of health care services and supplies you’ve gotten over the past 3 months. They are typically sent 4 times a year (quarterly) and have a breakdown of the charges billed to Medicare, the amount paid, and the amount you’re responsible for.
Medigap Open Enrollment Period
This begins the first day of the month you turn 65 and extends for 6 months after that.
Original, or Traditional Medicare consists of Part A (inpatient) and Part B (outpatient) coverage. It is managed by the federal government, offering Medicare-eligible individuals with coverage for costs incurred from doctors, hospitals, or other health care providers who accept Medicare.
Part B Excess Charge
This is the difference between what Medicare pays for a medical service and what your doctor might charge you. In most cases, a doctor will accept the Medicare-approved amount, but some will want to charge more, and this extra charge is your responsibility to pay.
Part B Surcharges
Since 2007, Medicare members with income in excess of $97,000 for individuals and $194,000 for married couples have been required to pay an income-related monthly adjustment surcharge, in addition to their monthly Medicare premiums. In 2023, most of the 60 million beneficiaries in Medicare will pay the standard Part B premium of $164.90 per month, but about 3 million high-income retirees will pay additional monthly surcharges ranging from $65.90 to $395.60 per month per person for Medicare Part B this year.
The Centers for Medicare and Medicaid Services defines a pre-existing condition as an illness or injury that you had before enrolling in the health plan. These could be cancer, heart disease, diabetes and asthma, for example.
Medicare Supplement plans are standardized, i.e. have identical benefits no matter where you buy them or from which insurance company. For example, Plan F in New York offered by Aetna is exactly the same plan offered by Mutual of Omaha in Oregon. The other ways they are standardized are:
Trial rights allow seniors to try a Medicare Advantage (MA) plan for a time with the option of switching to a Medicare Supplement plan. Your trial right applies when you’re trying a Medicare Advantage plan for the first time, and if you decide you don’t want the plan within the first 12 months, you have the right to dis-enroll from the plan and switch back to the Medicare supplement plan you had previously.
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Table of Contents
- Best overall Medicare supplement for new enrollees: Plan G.
- Best overall Medicare supplement before 2020: Plan F.
- Best low cost Medicare supplement: Plan K.
- Best alternative to Plan G Medicare supplement: Plan N.
Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.
Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.
The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.
Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.
For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.
It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.
Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.
Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.
The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.
The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.
Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.
It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.
Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.