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  • What If My Doctor Does Not Accept Medicare?

    When you visit a doctor that does not accept Medicare, your Medicare supplement (Medigap) plan generally does not cover those services. Medigap plans are designed to supplement what Original Medicare (Parts A and B) pays. So if your doctor does not accept Medicare, it will affect your out-of-pocket costs and protection. Here’s how it typically works:
    1. Doctors who don’t accept Medicare won’t file claims for the services they provide. Direct payment to your doctor for the full cost of your healthcare would be required.
    2. Medigap Coverage: Medigap plans only cover services Medicare approves and pays for; therefore, they don’t cover services outside Medicare’s payment system. Therefore, if a doctor does not accept Medicare, your Medigap plan wouldn’t cover those costs because there’s no Medicare-approved amount for the service.
    3. Exceptions: Some Medigap plans like Plan F, High-Deductible Plan F, and Plan G cover “excess charges” which occur when a doctor does not accept Medicare assignment but still treats Medicare patients. These excess charges can be up to 15% more than Medicare’s approved amount for participating providers. However, this only applies if the doctor accepts Medicare patients but does not accept assignment, not if they outright do not accept Medicare at all.
    4. Out-of-Pocket Costs: If you see a doctor who does not accept Medicare, you would pay 100% of the bill out of pocket. There would be no reimbursement from either Medicare or your Medicare Supplement plan.
    5. Finding Alternatives: It’s advisable to find doctors who accept Medicare assignment to ensure your Medigap plan can function as intended. Tools like Medicare’s Physician Compare can help you locate such providers.

    When your doctor does not accept Medicare, you will be responsible for all costs

    There are other concerns you need to be aware of if your doctor does not accept Medicare, including:

    1. Higher Out-of-Pocket Costs: Without Medicare coverage, you’ll have to pay the full cost of services, which can be significantly higher than what you would pay if the provider accepted Medicare. This could lead to substantial financial strain.
    2. No Medigap Coverage: As previously mentioned, Medigap policies only cover expenses associated with services that Medicare has approved. If a doctor doesn’t accept Medicare, your Medigap plan won’t cover those costs, leaving you with no insurance support for those visits.
    3. Quality of Care Concerns: Medicare has standards and processes for provider participation, including credentialing. Doctors outside of this system might not adhere to the same quality control or oversight. Although not all non-Medicare providers offer lower quality care, there’s less assurance of meeting Medicare’s standards.
    4. Managing Multiple Health Issues: Care coordination is vital when dealing with multiple health problems. Doctors outside the Medicare system might not have access to your Medicare-related health records or communicate effectively with other providers who are within the Medicare network, potentially leading to gaps in care.
    5. Medication Management: If you’re on medications covered by Medicare Part D, a doctor not accepting Medicare might not be as familiar with formulary restrictions or how to manage your prescriptions within the Part D framework, which could affect your medication regimen or costs.
    6. No-Cost Preventative Care: Medicare covers a wide range of preventive services at no cost for its beneficiaries who see participating doctors. Non-Medicare doctors might charge for what would otherwise be free under Medicare, reducing your access to preventive care which can be crucial for health maintenance.
    7. Future Healthcare Needs: If your health condition worsens or you require more complex care, having a network of providers who accept Medicare can be beneficial for referrals, specialist consultations, and hospital affiliations that are covered.
    8. Potential for Billing Disputes: Since there’s no standard pricing or billing oversight from Medicare, you might encounter higher charges or billing practices that you wouldn’t if the provider was within the Medicare system.
    Using a doctor who doesn’t accept Medicare might make sense in some situations, like if this doctor has unique expertise or if you’re willing to pay out-of-pocket for specific treatments. However, these concerns highlight the importance of considering the broader implications on your healthcare management and finances.
    In summary, your Medicare supplement will not pay for services at a doctor who does not accept Medicare, as these plans are meant to cover expenses that Original Medicare covers but doesn’t pay in full, such as deductibles, coinsurance, and copayments.
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  • Choosing Plan N: What About Medicare Part B Excess Charges?

    You’re delving into Medicare and considering Plan N, but what about Medicare Part B Excess Charges? They’re sneaky little fees that can pile up if your provider doesn’t accept Medicare‘s set rates.

    Don’t let confusion reign – we’re here to help you understand these charges and find out if they even matter for you.

    It’s time to become an informed health care consumer, ready to navigate Medicare and Plan N with confidence. Let’s get started.

    Key Takeaways

    • Medicare Part B excess charges can be avoided by choosing a Medigap plan that covers them, such as Plan G.
    • “Medicare assignment” refers to the assigned prices for every medical charge under Medicare. Every procedure has a code, and every code has a price assigned by Medicare that the doctor can charge. Less than 4% of physicians have opted out of Medicare assignment. This makes excess charges uncommon.
    • Eight states have made it illegal for providers to charge Part B excess charges, providing protection for residents in those states.
    • Patients can avoid excess charges by asking healthcare providers if they accept Medicare reimbursement for payment in full and finding providers who won’t charge Part B excess charges.

    Understanding Medicare Part B Excess Charges

    How well do you understand Medicare Part B excess charges and the impact they could have on your medical bills? If you’re not quite sure, let’s dive into understanding Medicare Part B excess charges.

    When a doctor doesn’t accept Medicare’s approved amount for a service, they can charge up to 15% more. This is the excess charge, and it’s important to know, it’s you who’s responsible for it.

    Now, you might think, what about choosing Plan N? Good question. While Plan N is a great option, it doesn’t cover these excess charges. So, if you often see doctors who don’t accept Medicare’s approved amount, you might face these additional costs. However, don’t be too alarmed. More than 96% of doctors do accept the approved amount, and certain states even prohibit these charges.

    The Prevalence of Medicare Excess Charges

    You’ll often find that Medicare excess charges aren’t as prevalent as you might think, but it’s essential to stay informed and plan accordingly. As part of your planning, you might be considering choosing Plan N, which may leave you wondering about the prevalence of Medicare excess charges.

    1. First, it’s essential to understand that Medicare excess charges only apply if you visit a doctor who doesn’t accept Medicare. These doctors can charge up to 15% over the Medicare-approved amount.
    2. Most doctors, however, do accept Medicare assignment. In fact, only about 4% of doctors nationwide opt out of Medicare assignment.
    3. It’s also worth noting that several states have laws prohibiting excess charges. If you live in one of these states, you’re protected from this potential cost.
    4. Lastly, remember that even if you do encounter excess charges, they’re often relatively small.

    In August 2016, Aetna reported that 99.34% of the claims they process have no excess charges. Of the 0.66% of claims that do have Medicare excess charges, the average amount of the charge is less than $20.

    Tips to Evade Medicare Part B Excess Charges

    To evade Medicare Part B excess charges, it’s crucial that you’re proactive in seeking healthcare providers who accept Medicare assignment. It’s important to ask your healthcare providers if they accept Medicare before receiving services to avoid any surprise bills.

    If your provider doesn’t accept Medicare assignment, you might be subject to an excess charge, which could be up to 15% more than the Medicare-approved amount. Because of the difference in how Medicare pays non-participating doctors, it actually comes out to 9.25%. This is from our article on whether you should be concerned at all about excess charges:

    Non-participating (non-PAR) physicians are limited to how much they can charge you for services. This amount is set at 15% above the Medicare-approved amount for any given service. Because the Medicare-approved amounts for non-PAR physicians are 95% of the rates for PAR physicians, the 15 percent limiting charge is effectively only 9.25% above the PAR-approved amounts for any given service.

    Remember, you have the power to control your healthcare expenses. By choosing providers who accept Medicare assignment, you can protect your budget while receiving the care you need. In doing so, you’ll not only serve yourself but also contribute to a sustainable healthcare system.

    Medigap Options for Covering Part B Excess Charges

    While exploring Medicare supplement insurance options for covering Part B excess charges, you’ll find that Plan G, by providing coverage for these charges, can help you avoid unexpected medical costs and offer you greater peace of mind. Plan G is comprehensive coverage and will spare you from any out-of-pocket expenses related to Part B excess charges.

    However, you might be considering Plan N. It’s a cost-effective alternative, but it doesn’t cover Part B excess charges. So, what can you do to protect yourself?

    1. Understand the risks: Only a small percentage of doctors charge Part B excess charges, but it’s crucial to be aware of the potential for unexpected costs.
    2. Do your research: Before receiving treatment, ask if your doctor accepts Medicare assignment to avoid excess charges.
    3. Consider your lifestyle: If you travel frequently or live in a state where excess charges are allowed, Plan G might be more suitable.
    4. Review your budget: Can you afford potential excess charges? If not, the peace of mind offered by Plan G might be worth the additional premium.

    Are Medicare Part B Excess Charges Covered by Medigap Plan N?

    Medicare Part B excess charges are not covered by Medigap Plan N. If you want comprehensive coverage that includes these charges, it’s crucial to compare the different Medigap plans to find the best Medicare Supplement plan that suits your needs.

    Extra Guidance and Available Resources

    Don’t worry, there’s plenty of extra guidance and available resources to help you navigate through Medicare excess charges. You’re not alone in this journey.

    If you’re worried about possible excess charges, one resource you should definitely utilize is your provider. Ask them directly if they accept Medicare assignment. They’re required to provide this information.

    Additionally, there are numerous online resources available to further guide you in understanding Medicare excess charges and choosing Plan N. Websites such as Medicare.gov provide comprehensive information, and you can always seek advice by contacting us through the form or the phone number on the right side of the page. We are experts in their field and can provide personalized guidance based on your specific needs and circumstances. We have been helping people with Medicare plan choices since 1996.

    Identifying States Do Not That Permit Medicare Excess Charges

    In your research for states that allow Medicare excess charges, you’ll find that only eight states, including Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, do not allow for providers to charge Part B excess charges as of the writing of this article. This means that in these states, providers must accept the Medicare-approved amount as full payment.

    However, you’ll discover that in the remaining states, providers may impose Medicare excess charges, which are amounts above the Medicare-approved payment. These can be up to 15% higher than the approved amount. It’s essential to understand the laws in your state when choosing a healthcare provider or planning for healthcare expenses. It helps you make informed decisions about where to receive medical care and how to budget for potential excess charges.

    Frequently Asked Questions

    How Does a Medicare Part B Excess Charge Differ From a Regular Medical Bill?

    A Medicare Part B excess charge differs from a regular medical bill in that it’s an additional fee that some doctors who don’t accept Medicare’s approved amount might charge. It can be up to 15% more than the approved amount.

    Your regular medical bill is what Medicare agrees to pay for a service, but you’re still responsible for a portion of it.

    Excess charges can add up, so it’s essential to be aware of them.

    Are There Any Penalties for Doctors Who Charge Medicare Part B Excess Charges in States Where It’s Prohibited?

    Yes, there are penalties for doctors who unlawfully impose Medicare Part B Excess Charges in states where it’s prohibited. If caught, these providers can face fines, penalties, or even exclusion from the Medicare program.

    Therefore, it’s crucial for you to verify whether your state allows these charges, and if your provider accepts assignment, to prevent unwanted costs.

    What Happens if I Can’t Afford to Pay the Medicare Part B Excess Charges?

    If you can’t afford Medicare Part B excess charges, it’s important to communicate with your provider about payment options. They may offer a payment plan or, in some cases, waive the fees.

    Also, consider getting a Medigap plan that covers these charges. Medigap Plan G is a great choice. It’s your health and finances, so you’ve got options.

    Can a Provider Decide to Stop Accepting Medicare Assignment After They Have Already Started Treatment?

    Yes, a provider can decide to stop accepting Medicare assignment even after starting treatment. However, they’re required to inform you first.

    If this happens, you’re responsible for paying the Medicare Part B excess charges. To avoid surprises, always check with your provider about their Medicare assignment status before starting any treatment.

    How Can I Find Out if a Potential Healthcare Provider Has a History of Charging Medicare Part B Excess Charges?

    To find out if a potential healthcare provider charges Medicare Part B excess charges, you’ll need to ask directly. Call their office, explain you’re a Medicare recipient, and specifically inquire as to whether they accept “Medicare assignment.”

    It’s your health and your budget, so don’t hesitate to ask questions.

    Conclusion

    In conclusion, understanding Medicare Part B excess charges is essential, especially when considering Plan N. Although only a small fraction of doctors impose these charges, being aware could save you from unexpected costs.

    Utilize the tips provided to evade these charges and consider Medigap options that cover them. Remember, some states outlaw these charges.

    By educating yourself, you’re in a better position to make informed decisions about your healthcare coverage. Stay empowered, stay informed.

    Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their insurance and financial needs since 1996.

     

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  • The Medigap Birthday Rule Applies to Certain States

    When is Medigap Open Enrollment?

    medigap birthday ruleFor the first six months after enrolling in Medicare Part B, you have an Open Enrollment Period. When a person turns 65 and enrolls in Medicare Part B, they become eligible for Medigap plans and are guaranteed to be accepted. Enrolling in Medigap during this Open Enrollment Period guarantees acceptance, making it the best time to do so.

    Some states allow for annual opportunities to enroll during an annual open enrollment period. These states may have a special Medicare birthday rule or other special open enrollment opportunities. We will cover these in detail.

    The Open Enrollment Period for Medicare Supplements should not be confused with the commonly mislabeled “open enrollment” for Medicare that takes place every fall. Surprisingly, even the Centers for Medicare and Medicaid Services (CMS) inaccurately labels the fall period as “open enrollment.” It is named as the Annual Election Period, or AEP. Incorrectly labeling AEP as “open enrollment” is the primary cause of confusion each year among Medicare beneficiaries. CMS itself could easily rectify this, but they choose not to.

    Who Qualifies For Medigap Open Enrollment?

    Each year, Medicare Advantage enrollees can review and modify their coverage. Medicare Advantage and Medicare Part D have an enrollment period every year. The Annual Election Period we referenced above (Oct 15-Dec 7 each year) gives enrollees of those plans a chance to change companies and coverage each year. Medigap only has one guaranteed Open Enrollment period during your lifetime.

    Outside of that period, you will need to qualify medically to be accepted into a Medicare Supplement plan. In some states, Medigap enrollees can now switch plans each year around their birthday without underwriting.

    Medigap special enrollment may be available for certain enrollees.

    If you have guaranteed issue rights, you could be eligible for a special Medigap enrollment period. During this time, insurance companies are prohibited from charging you more based on your medical conditions, imposing waiting periods, or denying coverage.

    The Centers for Medicare and Medicaid has established a list of seven situations that grant you a guaranteed issue right to sign up for or switch Medigap plans without undergoing medical underwriting. While this list is somewhat restricted, there may be additional options available to you depending on your state of residence.

    Starting in 2023, twelve states offer guaranteed issue rights that surpass those mandated by the federal government. This includes opportunities for annual enrollment or plan changes. In fact, more than half of all states exceed the federal requirements by providing guaranteed-issue Medigap plans to beneficiaries under the age of 65.

    Annual Guaranteed Issue and Open Enrollment By State

    But there are some states that have annual guaranteed-issue opportunities to enroll in Medigap or at least switch to a different plan:

    • In New York and Connecticut, Medigap plans do not require medical underwriting, regardless of the enrollment timing.
    • Every year in Massachusetts, there is a guaranteed-issue Medigap open enrollment period from February 1 to March 31. During this time, individuals have the opportunity to secure coverage without being subject to medical underwriting.
    • In Maine, Medigap insurers are required to allocate a specific month annually wherein Plan A is guaranteed to be issued, irrespective of the applicant’s medical history.
    • In Missouri, people can easily switch their Medigap insurance between companies during a certain time period.. You can only enroll in the same lettered plan, like Plan G to Plan G. You can switch during the 30 days before or after your plan’s purchase anniversary for guaranteed coverage..
    • Seven states, including California, Idaho, Illinois, Kentucky, Louisiana, Nevada, and Louisiana, have implemented a Medigap birthday rule for Medicare Supplement enrollees. These rules provide a time-limited window around their birthday each year, This allows them to easily switch to another Medigap plan with the same or reduced benefits without the need for medical underwriting. Illinois and Louisiana, limits a change to a plan offered by the existing Medigap insurance company. Starting in 2024, Kentucky will also adopt similar rules. However, plan changes will be limited to the enrollee’s same lettered plan, offered by a different insurer.
    • Washington and Oklahoma Medigap enrollees have the flexibility to switch to another plan at any time, provided they have maintained coverage for at least 90 days. In Washington, individuals with Medigap Plan A are limited to switching only to another Plan A. However, those with Medigap Plans B through N have the freedom to switch to any Plan B through N. In Oklahoma, enrollees have the option to switch to any plan that offers equal or lesser benefits.

    What Is The Medigap “Birthday Rule?”

    The Medicare Supplement birthday rule provides an annual safeguard for Medicare beneficiaries in select states. During a specific timeframe around your birthday, you have the opportunity to purchase a Medigap policy without the need for underwriting or a waiting period.

    The time frames in which the birthday rule applies may vary from state to state. There may also be limitations on the insurance companies you can choose, which can impact your coverage. Additionally, your state may have age requirements that affect when the Medicare Supplement birthday rule applies to your benefits.

    Among the twelve states mentioned, the Medicare Supplement “birthday rule” is implemented in seven.. This period varies by state. To be eligible for a plan change under the “birthday rule ” you must already be enrolled in a Medigap plan.

    Which States Offer a Medigap Birthday Rule?

    • California: Starting on the first day of your birth month, you have 60 days to change your Medigap plan with no underwriting requirements. You must switch to a Medigap plan that offers the same level or lower benefits. However, you may also change insurance carriers.
    • Idaho: Medigap policyholders will be eligible to enroll in any plan of equal or lesser benefit. Additionally, you may switch to any insurance company. This rule lasts 63 days, beginning on the policyholder’s birthday..
    • Illinois: The birthday rule exclusively pertains to beneficiaries aged 65 to 75. This open enrollment period commences on your date of birth and extends for 45 days. Within this timeframe, you have the opportunity to enroll in a plan offered by your existing carrier. However, the benefit level of your new plan must be the same, or be lower than, that of your current plan.
    • Kentucky (effective starting in 2024): Individuals enrolled in Medigap can conveniently switch to another insurer’s Medigap policy within 60 days of their birthday, maintaining the same benefits as their existing plan.
    • Louisiana: You have a window of 63 days following your birthday to switch to a Medigap plan with equal or lesser benefits. This option applies solely to plans offered by your present insurance carrier. Notably, legislation being deliberated in 2023 may broaden the scope to encompass affiliates of your current insurer.
    • Nevada: You have a 60-day window, starting from the first day of your birth month, to switch to another Medigap plan that offers the same or lower level of benefits. During this timeframe, you also have the flexibility to change insurance companies.
    • Oregon: You are eligible to switch to another Medigap plan, with the same or lower level of benefits, during the 30-day period starting from the first day of your birth month. Additionally, you have the option to change insurance carriers.

    Living in one of these states? You might benefit from these birthday regulations if you know how to use them..

    Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their Medicare insurance and financial needs since 1996.

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  • How to Save Money on Your Medicare Supplement Insurance Premiums

    Looking to cut down on your Medicare Supplement insurance premiums? If so you’re, in the place. In this article, we’ll explore how you can save money without compromising on the coverage you need.

    We will cover everything from the cost of Medigap plans to choosing the policy, eligibility and enrollment details, and practical ways to reduce your premiums. Armed with this knowledge you’ll be able to make an informed decision and learn how to save money on your Medicare Supplement insurance premiums.

    Introduction

    Medicare Supplement insurance (commonly known as Medigap) is a way to minimize your out-of-pocket expenses for healthcare. By complementing Original Medicare coverage, Medigap policies help cover co-payments, deductibles, and coinsurance. These policies are regulated by the government and sold by insurance companies.

    The price of a Medigap policy varies depending on factors such as the chosen insurance company, location, and your specific plan. To help you save money on premiums while still enjoying coverage, we’ve compiled effective strategies.

    To maximize savings potential, enrolling during your Medigap Open Enrollment Period is highly recommended.
    Once you reach the age of 65 and have enrolled in Medicare Part B there is a six-month period known as the enrollment period. You also get this one-time open enrollment period if you continue working and delay Part B enrollment until you are no longer working. Your 6-month period begins on your Part B effective date. During this open enrollment period, insurance companies are required to accept you without any underwriting regardless of your health or age. In some states, there are protections and guaranteed issue rights, for Medigap enrollment.

    To save money it’s advisable to compare the Medigap policies in your area. The price ranges for each type of plan can vary depending on factors like your age, location, and overall health. You can use resources and tools to compare policies and pricing options. It is also recommended to consult with an insurance agent or broker who can provide guidance based on your specific needs. They can help you review the benefits and limitations of each plan before making a decision. Best of all their services are included in the plan’s premium, so it costs you nothing. They can shop the entire market for you in one shot for free.

     

    Understand Your Medicare Supplement Plan

    Understanding your Medicare Supplement plan is crucial in order to optimize its benefits while saving money. Different Medigap plans offer varying levels of coverage so it’s important to evaluate which coverage aligns best with your needs. Familiarize yourself with the benefits, limitations, and associated costs of each plan before making a decision. When comparing policies consider aspects such as coverage quality, cost implications, and customer service satisfaction. Lastly don’t forget to be aware of the pricing methods in your area.

    How to Save Money on Your Medicare Supplement Insurance PremiumsMedigap policies can be priced using methods like community-rated, issue age-rated, or attained age-rated approaches. These methods mostly vary by state, not by the insurance companies themselves. Additionally, it’s worth checking for any discounts offered by insurance companies, such as those related to households’ online applications or prepayments. Many plans offer a discount just by having a roommate for more than a year. There are deeper discounts with other companies if both people in a household have a policy with the same company. Your independent agent can and should help you find any available discounts.

    Compare Plans and Providers

    When searching for a Medicare Supplement insurance policy it is crucial to compare plans and insurance companies. Prices can vary significantly among plans and providers. Thus it is important to explore options to find the most suitable deal. An independent insurance agent can assist you in comparing plans and providers to identify the policy that meets your needs.

    The Importance of Shopping the Entire Market

    Have you thoroughly explored all options in the market when comparing plans and providers for your Medicare Supplement Insurance policy? It is essential to consider all possibilities in order to secure coverage at a price. Exploring the market can help you discover a suitable plan that aligns with both your needs and budget.

    When comparing Medigap policies it’s important to take into account factors like coverage, cost, and customer service. You also need to be aware of the company’s financial strength and ratings. Utilize resources and tools to compare the policies in your area and their pricing. Additionally, it’s beneficial to seek guidance from an insurance agent or broker.

    Remember to review the benefits and limitations of each Medigap plan before making a decision. By exploring all options in the market you can ensure that you select the policy for your needs.

    Medigap Plans Are Identical From Company to Company

    It’s worth noting that Medigap plans remain consistent across companies by law. However, it is still crucial to compare both plans and providers in order to find the policy for your situation.

    To reduce premium costs;
    1. Compare Medigap policies offered in your area and select one that aligns with your requirements.
    2. Take into consideration factors such as coverage, cost, and customer service.
    3. Seek guidance from an agent or broker who can offer tailored assistance.

    By conducting research and understanding the benefits as well as limitations of each Medigap plan you can make an informed decision that suits both your needs and budget.

    Plan Premiums Vary From Company to Company

    Please note that prices for these plans may vary depending on the company offering them. When you’re comparing Medigap policies it’s crucial to keep in mind that the prices of plans can vary between companies. So it’s important to assess and compare the plans and providers to find the policy that suits you best.

    The cost of Medigap premiums can be influenced by factors such as age, location, health condition, insurance company, and plan type. Moreover, certain companies offer discounts on premiums such as household discounts, online application discounts, or automatic/prepayment discounts.

    Make sure to review all the benefits and limitations of each plan before making a decision.

    Consider Plans with Co-pays or Higher Deductibles

    Consider exploring Medigap plans that include co-pays or have deductibles. These options can help you save on premiums without compromising on coverage.

    If you’re seeking a balance between coverage and cost, Plan N could be a choice for you. On the hand if cost-effectiveness is your concern a high-deductible Plan G might be the best option.

    It’s crucial to compare plans and determine which one suits you best.

    Why Plan N is the Best Medicare Supplement Plan Value

    Plan N stands out as a value among all Medicare Supplement plans when considering options. Here are some reasons why Plan N is worth considering;

    1. Premiums; Monthly premiums are significantly lower compared to other Medigap plans,
    2. Plan N necessitates copays, for office and emergency room visits.
    3. Plan N encompasses services that Original Medicare provides.
    4. The plan offers payment options such as check or automatic withdrawals providing flexibility to the subscribers.

    Plan N combines premiums, copays, and comprehensive coverage to present a choice for individuals seeking a cost-effective way to complement their Original Medicare. Rest assured that with Plan N you will have coverage for the services you require at a price that suits your budget.

    Consider High Deductible Plan G

    If you are searching for an approach to save money on your Medicare Supplement insurance premiums, it may be worth considering High Deductible Plan G (HDG). This plan offers reduced premiums and copays for services. It requires meeting a $2,700 deductible (in 2023) before the Medigap policy contributes towards expenses.

    Here are some details from our full article detailing High Deductible Plan G:

    1. You need to pay an annual deductible before the plan pays for any of your medical care.. In 2023, that deductible is $2,700. Any payment towards your Part B deductible also applies to this High Deductible Plan G deductible.
    2. Once you meet the annual Part B deductible, Medicare Part B covers 80% of your expenses. On High Deductible Plan G, you’ll need to cover the remaining 20% until you reach the total annual deductible.
    3. Once you meet the annual deductibles, High Deductible Plan G covers the rest of the Part B co-payments for Medicare-approved care for the rest of the calendar year.

    You can read the full article here – High Deductible Plan G (click)

    The monthly premiums for this plan are significantly lower than regular Plan G. And that is why you don’t hear much about it from agents. We are paid a percentage of your premium as our commission. You pay the same rate whether you use an agent or go directly to the insurance company, so our services are in essence free to you. But since the premiums are so low on HDG, most agents don’t want to present it as an option. They are doing people a disservice and looking out for themselves if they don’t offer this option.

    If you’re seeking a cost-effective option that still offers the coverage High Deductible Plan G might be the ideal choice for you.

    The Significance of Utilizing an Independent Agent

    Using an agent is valuable when comparing plans and providers because they can assist in finding the suitable policy at the best price. An independent agent can;

    1. Offer personalized advice on which plan and provider will meet your needs.
    2. Present you with a range of Medigap policy options from carriers.
    3. Compare plans and providers to identify the balance between price and coverage.
    4. Explain any differences, between plans thoroughly.
    5. Help you grasp all the details.

    An independent agent can be an ally when it comes to finding how to save money on your Medicare Supplement insurance premiums. They offer guidance and information that can help you make the decision based on your needs. With their assistance, you’ll be able to save money and secure the coverage for a stable retirement. These services are FREE.

    Review Your Coverage Annually

    It’s important to review your Medigap coverage every year to ensure it still suits your needs and that you’re taking advantage of any discounts or savings opportunities.

    Shopping for Medigap policies can feel overwhelming. It’s crucial to compare premiums and coverage levels in order to find a suitable plan.

    You might also qualify for discounts or savings programs such as household discounts, online application discounts, or automatic/prepayment discounts. Furthermore, if you and your spouse or roommate hold policies with the company there’s a chance you could receive a multi policy discount. Your agent can and should help stay on top of these important issues.

    Taking the time to review your Medigap coverage on an annual basis will ensure that you’re getting the value for your money and that your coverage aligns with your specific needs.

    In summary

    By making an informed decision when selecting a Medicare Supplement insurance policy, you can save money on premiums. Keep these five points in mind to maximize your Medigap coverage;

    1. Compare the Medigap policies in your area to find the one that suits your needs best.
    2. Consider paying for more services out of pocket to keep premiums lower. Plan N and High Deductible Plan G are great choices.
    3. Utilize your trusted independent agent to compare Medigap policies and their pricing.
    4. Take advantage of discounts like household discounts, online application discounts, and automatic or prepayment discounts.
    5. Make use of Medigap Open Enrollment Periods to avoid undergoing underwriting and potentially facing premiums.

    Conclusion

    You now possess the knowledge and tools to save money on your Medicare Supplement insurance premiums. When it comes to finding the coverage for your needs it’s important to compare plans and providers. Consider looking into plans that have co-pays or higher deductibles.

    To make sure you’re getting the value, for your money take the time to understand your plan and review it on a basis. By doing you can have peace of mind knowing that you’ll have costs, with Medigap. Start your research now.

    Most importantly, find a trustworthy agent who can show you how to save money on your Medicare Supplement insurance premiums. As mentioned earlier, this service costs you nothing. Yet, it can save you many hours of researching on your own. I have been helping people transition onto Medicare since 1996. I know the pitfalls to avoid and what to look for in a strong, dependable company. You don’t want to enroll in a plan and have to abandon it and start your search over again every couple of years. We can help you find coverage that benefits you and your situation.

    Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their Medicare insurance and financial needs since 1996.

    Thank you for sharing!




  • 5 Things You Need To Know Before You Enroll In Medicare

    Medicare eligibility opens a whole new world of healthcare options. Whether you are turning 65 or leaving employer coverage, there are some important things to know before you enroll in Medicare. Here are five things you need to know before enrolling.

    1. How To Enroll In Medicare Part A and B

    For most people, Medicare eligibility begins on the first day of the month of your 65th birthday. If you are born on the 1st, your Medicare coverage will begin on the first of the month preceding your 65th birthday. However, if you’re leaving your employer’s coverage and already signed up for Part A, you can align your Part B start date with the end of your employer coverage..

    The method you use to enroll in the Medicare program depends on a couple of factors:

    If you are already receiving Social Security withdrawals, you will automatically be enrolled in Medicare on your eligibility date. About 8-10 weeks before the effective date, you should receive your Medicare coverage card in the mail. They will automatically deduct Medicare Part B premiums from your Social Security payments.

    If you are not receiving Social Security withdrawals, you will need to enroll yourself in Medicare. There are three ways you can enroll:

    1. Call Social Security at 1-800-772-1213 (open 24 hours a day)
    2. Apply online at https://www.ssa.gov/benefits/medicare/. If you are within three months of age 65 or older, you can use this link to enroll with Social Security.
    3. Visit your local Social Security office.

    SEE OUR ARTICLE ABOUT MEDICARE COSTS AND PREMIUMS (click)

    2. Choose Whether To Continue Employer Coverage

    If you are already retired or are retiring before your Medicare eligibility, you can move on to the next section.

    If you are planning on working beyond age 65, you have some choices to make about whether to enroll in Medicare. Your options will depend on the size of your employer. Here is some helpful information from the Medicare.gov website:

    If you aren’t getting benefits from Social Security (or the RRB) at least 4 months before you turn 65, you’ll need to sign up with Social Security to get Parts A and B. However, depending on the size of the employer, you may be able to delay Parts A and B without having to pay a penalty if you enroll later.

    The employer has fewer than 20 employees.

    You should sign up for Part A and Part B when you’re first eligible. In this case, Medicare pays before your other coverage.

    Note

    If you don’t enroll when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.

    The employer has 20 or more employees.

    Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65.

    If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you’re eligible for Medicare).

    If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.

    When the employment or employer/union coverage ends

    Once the employment (or your employer/union coverage) ends, 3 things happen:

    1. You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan (in most cases for only 18 months) and probably at a higher cost to you.
    2. You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you’re employed or during the 8 months after employment ends, complete an  Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don’t wait until your COBRA ends to enroll in Part B. If you don’t enroll in Part B during the 8 months after the employment ends:
      • You may have to pay a penalty for as long as you have Part B.
      • You won’t be able to enroll until January 1–March 31, and you’ll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.
    3. If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you’re already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD).

     

    3. Medicare Costs and How They Affect You

    The federal Medicare program provides two parts of coverage under Medicare – Part A and Part B. Those two parts of Medicare are listed on your Medicare card. Actually, there are four parts to Medicare in all. Medicare Part C and Part D are coverages that come from private insurance companies.

     

    Cost for Medicare Part A

    Medicare Part A for most people is usually free. There is no premium if you have worked 10+years (40 quarters) in the US. Payroll taxes collected from you during those years qualify you to have Part A at no charge. A pro-rated premium is available if you worked less than 40 quarters work experience but more than 30 quarters.

    Cost for Medicare Part B is Based on Income

    Medicare Part B (and Part D) premiums are based upon your Modified Adjusted Gross Income. Medicare will check your latest IRS tax return and use that to determine what you’ll pay for Parts B & D. Your Modified Adjusted Gross Income (MAGI) includes any money earned through wages, interest, required minimum dividends from investments, capital gains, Social Security benefits, and tax-deferred pensions. Distributions from Roth IRAs and Roth 401(k)s, life insurance, reverse mortgages, and health savings accounts do not count in the MAGI calculation.

    Social Security will send you a letter around the end of each year to tell you what your costs are for the upcoming year. Most Americans fall into the standard income bracket.

    To see the current year Medicare Part A and Part B premium, as well as the high-income Medicare costs, go to this page – https://integritysenior.com/medicare-costs/

     

    4. Which Medicare Plan Should I Choose?

    I mentioned that there are four parts to the Medicare program. They are:

    • Part A – Inpatient care
    • Part B – Physician services and outpatient care
    • Part C – Medicare Advantage plans from private insurance companies
    • Part D – Prescription drug coverage from private insurance companies

    Medicare Advantage Plans (Medicare Part C)

    There are generally two types of plans to choose from. The first option is Medicare Advantage plans. These plans have become very popular over the years. Most have low to zero premiums in exchange for using a limited network of providers and paying co-pays for many services. However, out-of-pocket costs can get very high if you are diagnosed with a serious illness or need chemotherapy and radiation because of a cancer diagnosis. Enrolling in a Medicare Advantage plan replaces Medicare Part A and Part B. I won’t get into the pros and cons of the Medicare Advantage plans here. I have a very detailed article comparing Medicare Advantage plans to original Medicare with a Medicare supplement, or Medigap, plan.

    CHECK OUT THIS ARTICLE FOR AN IN-DEPTH COMPARISON OF MEDICARE ADVANTAGE VS MEDICARE SUPPLEMENTS

    Original Medicare with Medicare Supplement

    Your second option is to stay on original Medicare and enroll in a Medicare supplement plan. Under the Medicare Advantage plans mentioned above, your Medicare Part A and Part B are replaced with coverage from a private insurance company. This makes it fall under Part C of Medicare. However, with a Medicare supplement plan, you stay on Medicare Part A and Part B and choose a Medigap plan from a private insurance company.

    There is a difference between the Parts and Plans of Medicare. The Medicare program is divided into Part A through D. Medicare supplements, or Medigap, plans are divided into plans. These are lettered A through N.

    Medicare supplement plans offer no drug coverage. Therefore, you will want to also enroll in a Part D prescription drug plan.

    Here is a YouTube video that explains the pros and cons of Medicare Advantage plans as well as Medigap plans:

     

    5. An Independent Agent Brings Value

    Yes, I know promoting independent agents sounds a little self-serving. But the service of a trustworthy independent insurance agent is free. Also, by shopping all the plans, they can save you money. I know many times people think of insurance agents and immediately picture someone pressuring them and shoving a pen in their face to sign on the line. Although I have seen that happen, it will never happen here. My job is to help you understand how Medicare and the various plans work. Your job is to take that information and make an informed decision.

    We would love to earn your business. But we will never pressure you to make a decision. You can take the information here and take your time with it. No one is looking over your shoulder. No one is threatening to not leave your house until you sign up. We can help you enroll in the plan of your choice quickly and easily over the phone. With some companies, online enrollment is an option while still having me as your agent working on your behalf. You can enroll online by following this link -> CLICK HERE

    I want you to see the value of our knowledge and how it will help you now and in the future with Medicare changes.

    Benefits of Using an Independent Agent:

    1. Customer service – A trustworthy independent agent will not treat you like a number. A trustworthy agent is going to take care of you. Their livelihood depends on it.
    2. Value – We will find the best deals possible for you. The possibility of losing your business motivates independent agents to find you the best deal. And with rates ranging widely from company to company, we can use our knowledge and resources to find more options than you can on your own. This is what we do every day.
    3. Knowledge – Insurance is a complicated subject and having someone that deals with it day in and day out can benefit you. Every day, independent agents help people avoid pitfalls they may not even know to exist. We work with Medicare daily, and we have updated information that could help you avoid choosing the wrong plan or company. People without insurance knowledge often choose what they think is best without realizing there is a better option. Using an independent agent can save you money by avoiding those pitfalls. And best of all, it is FREE.
    4. Trust – If you have an independent agent with integrity, you have someone whom you can consult now and into the future.
    5. Claims – An independent agent deals directly with the insurance company for you. After all, the independent agent works for you. We have a dedicated claims department to help you deal with any claims that may slip through.
    6. Unbiased advice – Working with an independent agent can also provide you with much needed, unbiased advice. When you work with a captive agent who can only represent one company and their subsidiaries, they will want you to believe that they are the best option for you. In reality, they may not even be one of the top three or even top ten choices that you should be looking at. We can help you choose among all the best insurance companies in the market.
    7. Education – There is a lot of information on Medicare.gov, but it can be confusing. And there is no information on individual Medigap policies there. You should understand at least in basic terms what your insurance will do for you. Your agent should make sure you understand the differences between different kinds of coverage. We have many YouTube videos that teach you the ins and outs of how Medicare works.

    Contact us today a 1-888-228-6119 or fill out the form with your questions to take advantage of our free plan comparison service.

    Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their Medicare insurance and financial needs since 1996.

    Thank you for sharing!




  • Medicare Open Enrollment Confusion

    I received this email from a policyholder today concerning the so-called Open Enrollment period every fall. It is a reminder that there is so much misinformation and confusion being pushed through TV commercials and other advertising venues.

    Medicare Open Enrollment ExpertMedicare.com

    The Annual Election Period (AEP) runs from October 15 through December 7 of each year. This is NOT Open Enrollment. The use of that term is very confusing to Seniors and others on Medicare, especially to those on original Medicare with a Medicare Supplement. The AEP is a time when people who have a Medicare Advantage plan or a Part D prescription drug plan can change plans. Since those plans change from year to year, it is good to reassess them. The coverage under a lettered Medicare Supplement Plan, such as Plan G or Plan N, never changes.

    Open Enrollment actually is the period time when you first enroll in Medicare and choose a Medicare supplement policy with no underwriting or pre-qualification. Here is an excerpt from our article about the various enrollment periods and how they work:

    Medigap Open Enrollment Period (OEP)

    Medicare Supplement plans, also known as Medigap, have an Open Enrollment Period that runs concurrently with the Initial Election Period. This Open Enrollment Period, as it has long been known, lasts for 13 months. It begins 6 months before your 65 birthday, includes the month of your 65 birthday, and continues for 6 months after your 65 birthday.

    This Open Enrollment period also occurs if you delay your enrollment in Medicare Part B because you stayed on an employer plan. In this case, it gives you guaranteed acceptance that lasts until 6 months after your Part B effective date. During the Medicare Supplement OEP, you can apply for a Medicare Supplement plan without having to go through medical underwriting. This is your one chance to go with any company and any plan that you choose. In other words, you cannot be denied acceptance into a Medigap plan of your choosing based on your health conditions.

     

    Below is the email from a policyholder and my response where I went into a lot of detail explaining the answer. I felt that it would be good for others to have this information as well, so I posted it here for you.

    Keith

    I am curious about 2 Items:

    I notice on the many commercials currently on TV, there is a big push to persons on Medicare who may wish to change their companies.  If they choose to do that, wouldn’t they be subject to having to qualify for coverage to include pre-existing issues? (Most seniors have a few). And if so, how would that make financial sense?

    Second question. 

    I gather that if someone wants to leave a “Medicare Advantage” plan and get a regular medigap policy like I have, they would be subject to applying and hopefully qualifying but at a higher rate than if they had done so at the beginning. But would the same financial hurdles apply if you want to leave a regular Medigap policy and get an Advantage at a later date?

    G.B.

    My reply:
    Yes, there is a ton of advertising and pushing people to Medicare Advantage plans this time of year. It is the Annual Election Period (AEP), which many on TV and in government incorrectly call Open Enrollment. AEP runs from Oct 15 through Dec 7. During that time, people with Medicare Advantage and Part D drug plans can change plans for the upcoming year. This does not apply to people like yourself with original Medicare and a Medicare Supplement plan.

    To answer the last question in your first paragraph, it makes no financial sense. As long as you stay healthy, the Medicare Advantage plans are a great choice. As soon as you need to use it, you find out how lacking the coverage is.

    For your second question, the answer is yes, unless they qualify for an Open Enrollment Period because of being new to Medicare or are leaving a Medicare Advantage plan within the first 12 months and utilizing the Trial Right benefit, they would be subject to underwriting. Also, with most companies and states, for every year older they will have a higher rate because of being a higher age classification.

    Annual Election Period (AEP) Confusion

    You can actually change your plan at any time of year that you want to. It is very confusing and considering what a big money-maker it is for the companies, maybe intentionally confusing. I cover some of that scheming and the disadvantages of the Medicare Advantage plans in this YouTube video :

    Medicare Advantage – Does it Benefit You, or the Company??

     

    Medicare Advantage plans have one underwriting question. That question is – do you have end-stage renal failure? People with pre-existing conditions are able to move in and out of Advantage plans pretty easily. But people don’t stop to consider why that is. The reason is that the coverage is not that good.

    We get several calls a week from people looking to leave their Advantage plan for original Medicare with a Medigap policy. The Medigap policies like yours DO require underwriting unless there are special circumstances such as being new to Medicare or if someone has been on an Advantage plan for less than 12 months, they have a Trial Right to leave that plan and go back to a Medigap plan with no underwriting. Once these people are diagnosed with something serious, they find out how bad their coverage is.

    On almost all Advantage plans, they have to pay the 20% co-pay for chemo and radiation. I can tell you that when my son had cancer, he had one drug that he took 3-4 times a month that was over $10,000 per dosage. In less than a month, someone could meet their maximum out-of-pocket cost allowed by Medicare of $7,550 in-network ($10,000 out-of-network). And when a new calendar year rolls around, that out-of-pocket maximum resets. We have lots of calls from people who end up paying $15,100 out of pocket in a matter of weeks because of chemotherapy and radiation co-pays. One other note about these calls – many have learned that there are many top-tier treatment centers that do not accept ANY Medicare Advantage plans, only original Medicare with a Medicare Supplement like yours. These include Mayo Clinic, John Hopkins University, and the M. D. Anderson Cancer Clinic among others.

    In addition to all of that, these folks have to hope and pray that the best oncologists are on their network. When a cancer diagnosis comes, you don’t want to have to choose among the doctors that are in your network to see where you can go. You want to find the absolute best doctor around and go to them without worrying about if they will take your insurance or not.

    The Advantage plans have the same premium for all enrollees regardless of age or gender. Many Medicare Advantage plans have no premium. It can be very enticing on the surface.

    Here is one of my most popular videos where I go into detail about the pros and cons of both the Medicare Advantage program and Medicare Supplement coverage:

    Medicare Advantage vs Medicare Supplement 2019 Comparison | ExpertMedicare.com

     

    Thank you for sharing!

  • Medigap Plan N – The Best Plan for 2025 and Beyond

    Since its introduction in 2010, the Medigap Plan N has steadily grown in popularity. The lower premium and option to still go to the doctor of your choice without network limitations makes it a great alternative to restrictive Medicare Advantage plans. And now with the huge changes to Plan F and Plan G because of the Medicare Access and CHIP Reauthorization Act (MACRA) law going into effect on January 1, 2020, Plan N is now the best Medicare supplement plan for your long-term financial goals. We look at the reasons why in this article.

     

    Mutual of Omaha is our preferred provider for Plan N.
    Click here to find premiums for your area and enroll online.

     

    Medicare Guaranteed Issue Plans Changed in 2020

    We mentioned above that MACRA changed Plan F. Since the beginning of the Medicare lettered, standardized plans in 1991, Plan F has far outsold all the other plans combined. It covered every deductible and co-payment under original Medicare.

    But as of January 1, 2020, Plan F was no longer available to people who were new to Medicare. If you have a Plan F, I would highly recommend that you consider a different plan. You will need to be medically qualified to change from Plan F. If you are not sure, call us and we can help you determine if you can make a change. Since there are will be no new, healthy enrollees coming into Plan F, we expect that Plan F rates will rise exponentially, just as other discontinued plans have in the past.

    Read our article – Why We No Longer Recommend Plan F

    Another way that MACRA affected Medicare coverage is in how it handles Guaranteed Issue enrollees. New Medicare enrollees starting in 2020 have a choice of Medigap Plan D, Plan G, or the new High-Deductible Plan G.

    Differences Between Open Enrollment and Guaranteed Issue

    Open Enrollment refers to the period when I person is first eligible for Medicare coverage under Part B. For most people, this is when they turn 65 years old. People who continue to work past the age of 65 can postpone their enrollment in Part B in many cases. For these workers, Open Enrollment will begin when they leave group coverage and enroll in Part B.

    Guaranteed Issue enrollees are generally people who are losing creditable coverage through an employer. It also includes certain people who are moving out of a Medicare Advantage plan’s coverage area or whose Medicare Advantage plan is being discontinued. These enrollees are eligible to enroll in certain Medigap plans with no underwriting.

    Plan Choices Are Limited For Guaranteed Issue

    Until 2020 brought new changes, they could enroll in Medigap Plan A, B, C, F, K, or L. Today, when a person qualifies for a Guaranteed Issue plan, Medicare will limit them to Plan D, G, or HDG unless they can qualify for another plan like Plan N through underwriting.

    If they are not medically qualified to go with the plan of their choice, this limitation will apply. That means that – just as it was with Plan F under the old Guaranteed Issue rules – Plan G will be taking on enrollees who are sicker or have pre-existing conditions. This will lead to higher claims for Plan G across the board, which leads to higher premiums.

    Click on the video to see why I recommend Plan N over other Medigap plans:

     

    Coverage Under Medigap Plan N

    So the big question becomes – how is Medigap Plan N different from Plan G? Here is a chart from the official Medicare and You booklet. It shows the coverage of each lettered plan:

    There are three primary coverages that Plan N does not offer compared to Plan F or Plan G:

    • Like Plan G, the Medigap Plan N does not cover the Part B deductible
    • You may have an office visit co-payment of up to $20 per visit and a $50 co-payment for emergency room visits that do not result in a hospital admission
    • Plan N does not cover excess charges

    Medicare supplement Plan N does not cover the Part B deductible. After you meet your Part B deductible, Medicare covers 80% of Part B covered charges. Plan N covers the other 20% for you.

    Plan N Co-pays

    You will be responsible for a co-payment of up to $20 per office visit to a physician. This co-payment does not apply to physical therapy or occupational therapy visits, as well as some other visits. 

    There is also a $50 co-payment for emergency room visits. Being admitted to the hospital within 24 hours of this ER visit means that Part A will cover all charges. In that case, you will not be required to pay the $50 co-payment. If the hospital treats and releases you from the ER, you will owe the $50 co-pay.

    Medigap Plan N Does Not Cover Excess Charges

    Not covering Excess Charges really is not as bad as it sounds. Medicare has assigned prices for any procedure that a physician performs on your behalf. Every procedure has a Medicare code and a price that Medicare approves for that procedure or visit. If your doctor accepts “Medicare Assignment,” or in other words the assigned price, they will accept the predetermined amount from Medicare as payment in full.

    Less than 4% of doctors choose to not accept Medicare Assignment. When they do not accept this payment, they can charge the patient 15% more than the Medicare-assigned price for that procedure. That extra amount is the excess charge. One way to avoid any excess charges is to ask your doctor if they accept Medicare assignment.

    **There are some states that do not allow any excess charges to be billed to the Medicare beneficiary. As of 2024, these states include Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. If you live in one of these states, you can enroll in a Plan N with no concern about having to pay excess charges.

    Here is a report about excess charges from one of the largest Medicare insurers:

    In August 2016, Aetna reported that 99.34% of the claims they process have no excess charges. Of the 0.66% of claims that do have Medicare excess charges, the average amount of the charge is less than $20.

    See our article for full details – Medicare Excess Charges, Should I Be Concerned

    To see what would be the best option for your personal situation, call us at 1-888-228-6119 or use the form to send a request.

    Stanley Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has been working with Seniors to meet their insurance and financial needs since 1996. 

    Thank you for sharing!

  • How MACRA Will Affect Your Medicare Coverage

    There a lot of rumors circulating about MACRA this year. Some are true, some are not. MACRA is an acronym for The Medicare Access and CHIP Reauthorization Act of 2015. We will address some of the frequently asked questions about MACRA and how it affects Medigap coverage.

    MACRA Plan F

     

    What is MACRA?

    The Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law in 2015. The law affects Medigap plans. It goes into effect on January 1, 2020

    What Does MACRA Do?

    There are two major changes that are coming under the new law:

    1. It eliminates so-called “First dollar” coverage. Medigap plans that pay for the Part B deductible cannot be sold to “newly eligible” Medicare beneficiaries. This will eliminate Plans C, F, and High Deductible F for these newly eligible individuals.
    2. It changes which plans are eligible for guarantee issue status. For specific scenarios where Guarantee Issue status may apply, see the Medicare.gov website. The available GI plans starting in 2020 are Plan D, Plan G, and a new plan for 2020 – Plan High Deductible G.

    Is Plan F Going Away?

    No, it is not. If you have a Plan F, you can keep it after January 1, 2020. You can even apply to get a Plan F with a different company. The Plan F will not be available to those “newly eligible” to Medicare after that date. Even though you can keep it, there are several reasons to consider making a change away from Plan F. We recommend you change to a different Medigap lettered plan if you are able to.

     

    SEE OUR ARTICLE ABOUT WHY YOU SHOULD LEAVE PLAN F

     

    What is a “Newly Eligible” Medicare Beneficiary?

    Someone who is eligible for Medicare due to turning age 65 or who becomes eligible due to age, disability, or end-stage renal disease on or after January 1, 2020

    How Does MACRA Affect Those Currently Enrolled in Plan C, F, or HDF?

    Those currently enrolled in one of the discontinued plans will be able to keep their plan. They can also apply for a Plan C, F, or HDF with a different company after January 1, 2020. However, if applying with a new company, you will likely need to go through underwriting to make a change. They can also choose to apply for a Plan High Deductible G.

    How Does MACRA Affect High Deductible Medicare Supplements?

    You can continue your High Deductible Plan F coverage beyond January 1, 2020 if you so desire. However, there is a new Plan High Deductible G that will be available starting in 2020. Both “newly eligible” Medicare beneficiaries and current beneficiaries will be able to buy the new Plan High Deductible G.

    What will happen to Guaranteed Issue requirements?

    Plans D and G will become two of the guaranteed issue plans for “newly eligible” Medicare Beneficiaries on or after January 1, 2020. These will replace Plans C, F, and HDF for “newly eligible” beneficiaries going forward.

    Because of Plan G taking on the bulk of the Guaranteed Issue enrollees from now on, we expect to see larger rate increases for those on Plan G going forward. This was the case with Plan F for many years. It is one of the main reasons we recommended Plan G over Plan F. There was a large difference in premium for very little difference in coverage between those because of Plan F taking on more people with pre-existing conditions. That will shift to Plan G starting in 2020. Therefore, our recommended going forward is Plan N.

    Current enrollees can remain with Plans C, F and High Deductible F. Medicare beneficiaries who are not defined as “newly eligible” will still be able to purchase Plans C, F and High Deductible F from a different company pending underwriting requirements..

    For more detailed information, you can review the NAIC implementation guidelines for MACRA.

    To see if moving from Plan F is right for you and how the rates for any plans compare in your area, call us at 1-888-228-6119 or use the form to send us a question.

    Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 22 years of experience working with Seniors to meet their insurance and financial needs.

    Thank you for sharing!

  • Best Medicare Supplement Plan for 2025

    Back in 1990, Congress passed a law the Omnibus Budget Reconciliation Act. The new law required all Medicare supplement lettered plans to conform to predetermined benefits according to the letter of the plan. This means that Medigap plans are identical from company to company. Any company that offers a Plan G or Plan N, or any lettered plan, must by law offer the exact benefits assigned to that letter by the government. This made it easier to comparison shop for the best Medicare supplement plan.

    Even with many companies offering identical coverage, most consumers look to the big-name brands that they are familiar with – UnitedHealthcare, Aetna, Cigna, Mutual of Omaha. But there are more important factors to consider when looking for the best Medicare supplement plan for your situation. Those factors include:

    • Price
    • Rate stability and history of increases
    • Financial ratings
    • Customer service and claims departments

     

    See our article on Why Your Medigap Company’s Financial Ratings Matter

     

    Here is a listing of a few of the well-known companies we work with and recommend. Click on the link on each name for an in-depth review:

    • Mutual of Omaha
    • Cigna
    • Humana
    • Aetna – Due to recent events, we are withholding our endorsement of Aetna at this time

    These companies spend a lot of money on advertising. You have likely seen them all over the place for years. You may have even had coverage under some of their group plans with an employer in the past.

    There are many other companies that should not be overlooked when considering the best Medicare supplement plan and company. These companies are financially strong and, as mentioned before, the coverage is identical to the plans from the bigger name companies.

    Here are a few of the lesser-known companies we work with. We consider these to be some of the best Medicare supplement companies available, but you just may not have heard of them before. 

    Finding the Best Companies for Medigap

    We get asked often if we represent all of the available companies in a particular area. While we do offer most companies, we have found that some companies do not meet our high standards on their rate increase history or customer service. We only want the best for our customers. We are contracted with over 30 of the best Medicare supplement companies in the United States.

    Our Recommendation

    The top three companies that we recommend in our office are below. We recommend them because we have had a positive experience with their stability and customer service over many years. We can help you enroll in these companies over the phone, but for your convenience, two of these companies at the links below provide the option to get a price for your area and to enroll online. 

    Mutual of Omaha

    Cigna

    Manhattan Life

    If you enroll online, Integrity Senior Solutions and Stanley Keith Murray will be your independent agent to help with any issues. There is no difference in premium if you go directly to an insurance company or enroll through our agency links. However, you get all the benefits of having an independent agent work for you.

    When you enroll through our agency – which costs you nothing – we will be here when you need help down the road. Whether you need a replacement ID card or help with a claim or any other issue, you don’t have to call the insurance company and wait on hold. We do that for you. It is one of the many benefits of having an independent insurance agent who works for you, not the insurance company.

    See our article and video on How an Independent Agency Brings Great Value For No Additional Cost

    There are many very strong, very well-known companies that have a long history, including reasonable rate increases from year to year. If you have a history of or have been diagnosed with a chronic health condition, you will want to find a company that fits that criteria for long-term rate stability. Even if they are a few dollars more in the beginning, in the long run, it could save you substantially.

    Call Stanley Keith Murray today at 888-228-6119 or use the form to send us a quick message!

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  • Why We No Longer Recommend Plan F

    Why We No Longer Recommend Plan F

    **UPDATE** If you were first eligible for Medicare on or after January 1, 2020, you cannot enroll in a Plan F.

    Ever since Congress standardized the Medicare supplement plans according to their letter name in 1990, Plan F has been the top-selling plan. The reason is quite simple. When you look down the Medicare chart of the plan coverage below, you see that Plan F covers every deductible and co-pay for every Medicare-approved service. With Plan F, you pay your premium for the plan, and Plan F picks up every deductible and co-pay. But we at Integrity Senior Solutions will no longer make a Plan F recommendation because of upcoming changes.

    Here is the chart from the official Medicare and You book showing how each plan covers Medicare’s deductibles and co-pays:

    Plan F Looks Great On Paper

    Many people will get an advertisement through the mail from a Medicare supplement company. When you open the letter, many companies will include this chart to show how the plans work. Most of those people will see that there is “complete” coverage under Plan F and decide to go with that plan. They then call the insurance company and enroll. By doing so, those people have made the first mistake in shopping for coverage – trying to do it on their own without the free services of an independent agent.

    One of the biggest reasons to use an independent agent is to avoid pitfalls like that. Even today (and for the last several years), Plan F has not been the best bang for your buck. Plan G is the better option. I explain this in great detail in this blog post and video. And using an independent agent does not cost you one penny more than going directly to the company to enroll. That company will not tell you their competitor’s prices. Nor will they tell you of their upcoming premium increases as an independent agent will. Their only Plan F recommendation is that you buy from them. An agent who works for you and not the insurance company shops the entire market – not just one company.

     

    Our Plan F Recommendation For 2020 and Beyond

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) calls for – among other things – discontinuing the sale of Medicare supplements that pay for the Part B deductible. This includes Plan F and Plan C. It only applies to people who are new to Medicare on or after January 1, 2020.

    If you keep a Plan F or Plan C after 2019, you can stay on your current plan. You will even be able to buy a Plan F or Plan C from another company if you are currently enrolled in a Plan F or C at that time. But for people that are newly eligible for Medicare, Plan F and Plan C will not be an option. That is the main reason we are no longer recommending Plan F.

     

    Is Medigap Plan N a Good Alternative to Plan F?

    When it comes to Medigap plans, many individuals wonder if Plan N is a viable alternative to Plan F. While both options provide valuable coverage, the best Medigap plans will ultimately depend on individual preferences and needs. Plan N offers comprehensive benefits, including coverage for coinsurance and deductibles, as well as foreign travel emergencies. However, it does not cover the Part B deductible or excess charges. Therefore, individuals should carefully consider their healthcare requirements and budget before choosing the most suitable Medigap plan for their needs.

    Lessons From Obamacare

    There was one big issue with the Affordable Care Act, or Obamacare, that caused it to be doomed to fail from the start. There was little to no incentive for young, healthy people to take the coverage. The pool of beneficiaries was heavily weighted towards those with pre-existing conditions and major health problems. There were not enough young, healthy people enrolling in the plan to keep the premiums stable and leveled out.

    Many experts feel this will also be the case starting in 2020 for Plan F Medicare supplements. As we get older, we tend to need more medical care and attention. That equates to higher claims being paid out by the insurance companies. Without those younger, healthier people coming into the plan, the loss ratios (amount of claims paid versus the amount of premium the company brings in) are going to go higher and higher. If that happens, we can expect the premiums to go higher and higher to pay for those higher claims.

     

    History Says Plan F Rates Will Likely Go Up Substantially

    There is a lot of chatter in the Medicare insurance world that the Plan F rates are going to go up significantly. Many experts point to 2010 when Medicare discontinued the Plans H, I, and J. Before the Prescription Drug Plans came along, Plan J was a very popular plan. The medical portion was structured exactly like the Plan F. But it also paid for a lot of prescription drugs.

     

    What is the Best Medigap Plan Now?

    Our recommendation going forward is Plan N. For many years we have been touting the Plan G as the best alternative to Plan F. It has been a better value than Plan F since it first came into the market in 2010. The only difference in coverage between Plan F and Plan G is the annual Part B deductible. Plan F pays that deductible which is $226 for 2023. Plan G does not cover that deductible. Yet, the difference in premiums is anywhere from $300-$450 a year depending on where you live.

    One of the reasons that there was such a large difference up until 2020 between Plan F and Plan G premiums is the way Guaranteed Issue enrollees are handled by Medicare. These enrollees are generally people who are losing creditable coverage through an employer. It also includes certain people who are moving out of a Medicare Advantage plan’s coverage area or whose Medicare Advantage plan is being discontinued. These enrollees are eligible to enroll in certain Medigap plans with no underwriting. Until 2020, they could enroll in Medigap Plan A, B, C, F, K, or L. By far most people who are in this situation choose to enroll in Plan F. Starting in 2020, the available plans for Guaranteed Issue enrollees will be Plan D, Plan G, and High Deductible Plan G.

    Now that Plan G will be the new preferred plan for Guaranteed Issue enrollees, Plan N will be the best coverage for long-term rate stability. People who are healthy enough to pass underwriting will be able to choose whichever lettered plan they want. But those with pre-existing conditions and health issues will have to choose Plan D, G, or High Deductible G because those plans have to accept them without underwriting. Therefore, those three plans will have a higher percentage of people with pre-existing conditions. That will lead to higher claims paid under those plans, which in turn leads to higher premiums. This is why we will be recommending Plan N through our office.

    To get more detailed information on Plan N, how it works, and why it is the recommended plan, click on this link.

    To see how the rates for any plans compare in your area, call us at 1-888-228-6119 or use the form to send us a question.

    Keith Murray is an independent agent and the founder of Integrity Senior Solutions Inc. He has over 23 years of experience working with Seniors to meet their insurance and financial needs.

    Thank you for sharing!
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