Scenario: Switching from Medicare Advantage to Medigap Plan
In-depth Case Study
Scenario: Switching from Medicare Advantage to Medigap Plan
As you age and enter the Medicare system, there are lots of unknowns, variables, and above all, choices. You may be in a plan that’s working great — the benefits meet your health needs, your premium is affordable, and your insurance company is reliable and responsive. Then your situation changes (if there’s one guarantee in life, it’s that your situation is going to change). You may have an accident or an old health condition that flares up out of nowhere. Your financial stability may be shaken by an unforeseen event. Or less dramatically, your COBRA coverage may come to an end and you need to sign up for Medicare or risk a late penalty. In Cathy’s case, the company managing her Medicare Advantage plan merged with another insurer, and her policy was cancelled.
Instead of creating a problem for her, an opportunity opened up. Cathy realized her Medicare Advantage plan had too many restrictions: she needed referrals to see specialists, and the provider network was limited compared with Original Medicare. What she wanted now was the affordability and versatility of the right Medicare Supplement plan. But how to enroll? And what about her diabetes, which could prevent her from getting coverage? Cathy decided to call medigapcoverage.com powered by pollen to find out what she should do.
The Medicare specialist had good news. One of the upsides of Medigap insurance is that it offers everyone what are known as guaranteed issue rights. These are a set of situations which allow seniors to get an exemption from medical underwriting, the process insurers use to determine if an applicant is eligible for a plan based on his or her medical record. These situations could be anything from having an employer-sponsored health care plan that comes to an end, to losing your Medicare Advantage plan because it leaves your service area. In Cathy’s case, there was a clear guaranteed issue right since her Medicare Advantage plan had been cancelled — something she had nothing to do with. She was free to apply for any Medigap plan she wanted with none of the possible consequences of her pre-exisiting condition, which could be denial of coverage, a higher premium, or a 6-month delay in the treatment of her diabetes once the plan started. Since she knew she would continue to have regular doctor’s visits, Cathy was advised by the medigapcoverage.com powered by pollen specialist to go for Plan F, the most popular plan in the Medigap universe, with no out-of-pocket costs — all deductibles, copayments, and coinsurance covered. She was just 65, a non-smoker, and happened to live in one of the states with the lowest Plan F premiums. In hindsight, losing her Medicare Advantage plan couldn’t have worked out better.
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Table of Contents
FAQs
What are the best Medicare supplement plans?
- 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.
What is a Medicare supplement plan?
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.
What is the most expensive Medicare supplement 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.
Why is Plan F being discontinued?
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.
Is Plan G better than Plan F?
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.
What is the best and cheapest Medicare supplement insurance?
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.
Is Medicare supplemental insurance worth it?
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.
Do I really need supplemental insurance with Medicare?
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.
What is the most popular UnitedHealthcare Medicare Supplement plan?
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.
How much does Medigap insurance cost?
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Who qualifies for Medigap?
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.
Is Medigap insurance worth the cost?
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.
How Much Is Medigap per month?
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.
Is Plan G the best Medigap plan?
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.
Is it better to have Medicare Advantage or Medigap?
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.
What is the most popular Medicare supplement plan?
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.
Does Medigap cover prescription drugs?
Since January 1, 2006, no Medigap policy came with prescription drug coverage. You have two options to get covered, enrolling in either a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage plan.