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Making Changes to your Medicare During Open Enrollment
Medicare Plans

What is Medicare Part D

by Garrett Ball
written by Garrett Ball

Medicare Part D – What Is It, How Does It Work and How To Compare Plans

Most seniors are either already on, or will be on, prescription drugs. It’s just a part of getting older today. Fortunately, these medications help us to manage our medical conditions, prevent others and maintain general health. So once we go on Medicare, we absolutely must understand Part D and how it works. What is Medicare Part D

What Is Part D?

Medicare Part D is the prescription drug coverage portion of Medicare. This part of Medicare is completely optional; however, in order to have any coverage for prescription drugs, you will want to sign up for a Part D plan. What is Medicare Part D
Also, if you do not sign up for a plan when you are first eligible and then later sign up for one, you are subject to the Medicare Part D late enrollment penalty. What is Medicare Part D
Although Medicare itself oversees the Part D program and approves the plans annually, the plans are sold through private insurance companies. Most states have about 20-30 plans available, and the plans are renewed annually. In other words, the plans change each year in most cases, which is why it is important to compare Part D plans annually.
Part D is often referred to as the most confusing part of Medicare. This is primarily because there are so many variables involved, from premium, to co-pays/coinsurance, formulary, pharmacy choice, etc. There is a lot to consider when comparing the plans or considering Part D coverage. What is Medicare Part D

How Does Part D Work?

As mentioned above, Part D is sold through private insurance companies. So, when you sign up for a plan, you are covered by a specific insurance company’s plan. Most companies offer 2-3 coverage levels to choose from.
Each Part D plan has a different premium, different list of covered medications (formulary) and a different cost-sharing structure. If you have a lower premium plan, for example, you may have a larger cost-sharing portion for certain medications. Higher premium plans may give you a lower co-pay portion. What is Medicare Part D
Overall, though, each plan varies considerably and must be considered based on your specific situation.

How to Compare Part D Plans

It is highly advisable to compare Part D plans based on your specific needs and situation – what medications you take and which pharmacy you use specifically. Each plan varies considerably and this comparison can save you hundreds, in some cases thousands, of dollars a year.
Comparing Part D plans is a completely overwhelming task if you try to do it by contacting each individual company/plan. The more advisable way to do it is to compare using the tool on Medicare.gov, Medicare’s website.
On their plan finder tool, you can enter your zip code, your medication names and dosages and your preferred pharmacy to come up with a ranking of which plan would give you the lowest overall annual cost for the following year. It is a good idea to do this annually, or at the least, every two years. This ensures that you are in the most advantageous plan for your specific situation and allows you to compare in an unbiased way. What is Medicare Part D

What is Medicare Part D

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Explaining Medicare Part B Excess Charges
Medicare Plans

Explaining Medicare Part B Excess Charges

by Garrett Ball
written by Garrett Ball

Medicare Part B Excess Charges: What Are They and How To Avoid Them?

Medicare Part B is the part of Medicare that covers doctor’s visits and outpatient services. Medicare has a pre-defined fee schedule that most doctors that participate in Medicare use. This is called accepting Medicare “assignment.” Explaining Medicare Part B Excess Charges
However, doctors can choose not to accept that fee schedule and charge more than Medicare allows – these charges, over and above the Medicare payment schedule, are called Part B Excess charges. Explaining Medicare Part B Excess Charges

How Do Medicare Part B Excess Charges Work

When you go to a doctor that does not accept Medicare “assignment”, they have the option of “balance billing” above the Medicare payment schedule in most states. If you do not proactively ask the provider if they accept Medicare assignment, you may be surprised to receive a bill after services and after Medicare and your supplement insurance have paid their portions.
This bill will generally come to you 2-4 weeks after your visit to a non-participating provider in Medicare. The “excess charges” amount is limited to 15% above the Medicare-approved amount. Explaining Medicare Part B Excess Charges
Generally, we see these excess charges to occur with much more regularity at specialists as opposed to at primary care physicians.

How To Avoid Medicare Part B Excess Charges

There are two relatively easy ways to avoid Medicare Part B Excess charges altogether. The first is simply to make sure that you go only to doctors that participate in Medicare (i.e. accept Medicare assignment).
There is not a list of network providers maintained by Medicare, unfortunately. However, you can verify that your provider takes Medicare assignment by simply asking them. Anyone in the billing/insurance office should be aware of this practice and terminology and should be able to answer that question for you. Ideally, you would confirm this before seeing a doctor or receiving services.
The other way that you can avoid the excess charges is to be enrolled in a Medigap (Medicare Supplement) plan that covers those excess charges for you. Most of the more common Medigap plans do cover the excess charges; however, Plan N is one of the plans that does not.
If you have Medicare with a Medigap Plan N, you will still be responsible for the Part B Excess charges if your doctor does not accept the Medicare payment schedule. Other common Medigap plans – such as Plan G and Plan F – do cover the Part B Excess charges. Explaining Medicare Part B Excess Charges

Other Considerations Related to Medicare Part B Excess Charges

There are a few states which have prohibited excess charges from being executed – currently, these states are: CT, MA, MN, NY, OH, PA, RI and VT.
Nationally, Medicare Part B Excess charges are still relatively uncommon. Recent estimates show that patients get billed for excess charges on less than 5% of claims. Still, it is something that you should be aware of so that you can avoid this unneeded and preventable expense.
 

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Medicare Plans

Medigap G: A Solution to your Medigap F Problem

by Garrett Ball
written by Garrett Ball

One of the superstars of Medigap plans in the last five years has been Medigap Plan G. This plan is one of the more comprehensive Medigap plans and has been increasing in market share and favorability with Medicare beneficiaries. Medigap G: A Solution to your Medigap F Problem

What Does Medigap Plan G Cover?

Medigap Plan G is one step down from the “Cadillac” Medigap plan, Plan F. Plan G fills in all the gaps in Medicare with the exception of the Medicare Part B deductible. For 2017, that deductible is $183/year.
Plan G pays the Part A (hospital) deductible, as well as the 20% coinsurance that Medicare does not cover under Part A and Part B. So on a Plan G, your only out of pocket costs for Medicare-covered expenses would be the Part B deductible amount.

How Does Medigap Plan G Work?

Plan G works just like Plan F and the other Medigap plans. It is designed to work with Medicare and fill in the remaining gaps after Medicare pays. Medigap G: A Solution to your Medigap F Problem
You can use a Plan G at any medical provider that accepts your primary coverage, Medicare. There are no networks on any Medigap plans, including a Plan G (Does my doctor accept my Medigap plan?).
Different insurance companies sell Plan G. In some states, there are as many as 30-40 companies that sell this plan. Each company may charge a different price for their Plan G, although the coverage is the exact same with each of them.
In addition, all the Plan G’s, regardless of which insurance company sells it, pay claims through the Medicare “crossover. This is Medicare’s automated claims payment system that works for Medigap plans and coordinates payments from your secondary insurance (Medigap). Medigap G: A Solution to your Medigap F Problem

Is Medigap Plan G Right for Me?

That is the “64 million dollar question”. Or, maybe it’s the $183 question! The Part B deductible is the only difference between a Plan F and a Plan G. So if the premium savings on a Plan G is greater than the deductible amount, it certainly makes sense to consider a Plan G.
There are other considerations as well. If you have researched Plan F, you may be aware that Plan F is scheduled to end for new beneficiaries as of 2020. What this means for current beneficiaries in Plan F is uncertain, but most analysts agree that Plan F rates will not be as stable moving forward once no “new” beneficiaries are put into that plan. This makes Plan G an even more viable alternative.
Lastly, historically speaking, Plan G has been more stable over time than Plan F has. Plan F is offered in certain “guaranteed issue” situations whereas ‘G’ is not offered in those situations. Over time, this means the pool of Plan G policyholders is slightly healthier, and this has led to more stability over time for Plan G vs Plan F.

Medigap G: A Solution to your Medigap F Problem

Medigap G: A Solution to your Medigap F Problem Medigap G: A Solution to your Medigap F Problem Medigap G: A Solution to your Medigap F Problem Medigap G: A Solution to your Medigap F Problem Medigap G: A Solution to your Medigap F Problem Medigap G: A Solution to your Medigap F Problem

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3 Steps for Medicare Supplement Comparison
Medicare Plans

3 Steps for Medicare Supplement Comparison

by Garrett Ball
written by Garrett Ball

Doing a Medicare Supplement comparison is a crucial part of a sound financial plan for someone on Medicare. Premium rates and guidelines vary considerably from state to state and from situation to situation. But there is so much information out there, much of it contradictory, how do you know where to start? 3 Steps for Medicare Supplement Comparison

Step 1: Understand Medicare Supplement Standardization

Without a doubt, the first step in doing an effective Medicare Supplement comparison is understanding the most basic aspect of these plans – the plans are Federally-standardized. By this, I mean that the coverage is the exact same no matter what company sells you the plan. A Plan G, for example, is the same with one company as it is with a different company.
Not only is the plan coverage standardized, the claims payment process is also standardized, as all companies pay claims through the Medicare “crossover” system. Because of this plan standardization, “like” plans cover the same things and work the same way. So, once you understand this, you realize that Medicare Supplement plans are actually quite easy to compare.

Step 2: Study the Medicare Supplement Coverage Chart and Choose a Plan

The Medicare Supplement coverage chart shows exactly what each of the standardized Medicare Supplement plans cover.
You will see that Plan F is the most comprehensive plan. It pays everything that Medicare Parts A and B do not cover. On that plan, you have no out-of-pocket costs. Although it is the most comprehensive plan, it may not always make the most financial sense.
Every insurance company does not offer every plan. The three plans that most companies have focused on over the last five years are plans F, G and N. Those three plans represent a top, middle and lower level of coverage, within which most Medicare beneficiaries can find a plan that fits their specific situation and needs.
Once you narrow down a level of coverage that you want, or at least have a good idea of what the different plans cover, you can move to step 3 of the Medicare Supplement comparison.

Step 3: Gather Medicare Supplement Rates and Choose a Company

Now you understand the plan standardization and have a good idea of what the different levels of Medicare Supplement plans are, the next step is to look at some actual premium figures and insurance companies.
There are several options for doing this. Some states maintain online resources containing rates for that state. These can typically be found on the state’s department of insurance website; however, they should be verified for accuracy as rates change over time.
Another option is to use an independent broker or agent. This person can provide rates and information for all your options and answer your questions.
A final option would be to contact each of the companies that sell Medicare Supplement plans in your state to gather the rates and use those to make a comparison of your options.
Medicare Supplement rates are determined by your age, zip code, gender, and in some cases, tobacco usage and/or health. So, make sure you use accurate information when requesting and obtaining the premiums.
Once you have the rates for your zip code, you can compare the reputations and ratings of the insurance companies you are considering and pick a reputable company that has competitive rates. Keep in mind step 1 when you are doing step 3 – the coverage and way that the plans work. 3 Steps for Medicare Supplement Comparison

3 Steps for Medicare Supplement Comparison

3 Steps for Medicare Supplement Comparison 3 Steps for Medicare Supplement Comparison 3 Steps for Medicare Supplement Comparison

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Do All Doctors Accept Medigap
Medigap

Do All Doctors Accept Medigap

by Garrett Ball
written by Garrett Ball

If you are turning 65 and comparing Medicare Supplement or Medigap plans, you will probably ask “do all doctors accept Medigap plans?“. This is one of the most common questions for people turning 65 – it can seem complex, but the answer is actually very straight-forward. Do All Doctors Accept Medigap
Put simply, when it comes to accepting Medigap plans, it all depends on if your doctor accepts Medicare itself. Medigap plans “follow” Medicare. So, if a doctor or hospital takes Medicare, they will accept your Medigap plan. It does not matter which company or plan you have since Medigap plans themselves do NOT have networks. Do All Doctors Accept Medigap
If your doctor is a non-participating provider with Medicare itself (rare), then they will NOT accept your Medigap plan either. If Medicare is not accepted, there is nothing for the Medicare Supplement/Medigap plan to “supplement”.
This is not the case, obviously, with many other types of insurance which rely heavily on network arrangements to determine which doctors you can/can not see. For example, under-65 individual plans, group plans, and Medicare Advantage plans all typically use a PPO or HMO network of providers.

What If My Doctor Does Not Accept Medicare Assignment?

There is a difference in accepting Medicare and accepting Medicare assignment. Medicare “assignment” is the terminology that essentially means whether or not a doctor accepts the Medicare payment as payment in full. Medicare has a pre-defined payment schedule for each service or procedure. This is the amount that they will pay to a provider for a certain service or procedure, and it is based on where you are located (varies by location).
Most providers DO accept Medicare assignment (most estimates show that around 95-96% of doctors do accept assignment nationally). This means they accept the terms and conditions (and amounts) on the Medicare payment schedule.
If a physician does not accept assignment, however, he or she can charge up to 15% above the Medicare payment schedule. This is called a “Part B Excess charge”. This is typically billed to you after the doctor visit. There are a few states that have prohibited the charging of these excess charges, including CT, MA, MN, NY, OH, PA, RI and VT (as of early 2017). In those states, doctors can not charge above the Medicare payment schedule if they are going to accept Medicare patients.
Even when doctors do charge excess charges, many of the standardized Medigap plans cover these Part B Excess charges, including Plans F and G. Plan N is the most common plan among the plans that do not cover Part B excess charges.

Why Won’t My Doctor Accept My Medicare Supplement Plan?

We often get this question in January and February of each year. Inevitably, what has happened is the person is in a Medicare Advantage plan that they are mistakenly calling a Medicare Supplement. The Advantage plans all have networks and are typically PPOs or HMOs. Those networks change each year – sometimes even in the middle of a year – and if your doctor is not in network with the specific plan you have, you may have to find a new doctor.
This is one of many reasons why it is crucial to understand the differences in Medigap plans and Medicare Advantage plans.

Do All Doctors Accept Medigap Plans: The Bottom Line

So in summary, do all doctors accept Medigap plans? The short answer is “No”. However, if a doctor accepts Medicare itself, which is your primary coverage, then they will also accept your Medigap plan, regardless of what company sold you the plan or which Medigap plan you have. The key thing to remember is that Medigap plans “follow” Medicare. Do All Doctors Accept Medigap
Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

Do All Doctors Accept Medigap

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Understanding Medicare Plan N
Medicare Plans

Understanding Medicare Plan N

by Garrett Ball
written by Garrett Ball

Medicare Plan N is one of the 10 standardized Medigap plans that are offered to supplement traditional Medicare. Plan N is one of the options that is typically a lower premium with more cost-sharing. So, it can be a good fit for someone who is in relatively good health or who wants to go with a lower-premium option.
Plan N works just like other Medigap plans. Coverage is Federally-standardized, so one Plan N will be the exact same as any other Plan N in terms of coverage. In addition, you can go to any doctor or hospital that takes Medicare – there are no networks. Also, all claims under Plan N are paid automatically through the Medicare “crossover” system.

What does Plan N cover?

Plan N covers the Medicare Part A (hospital) deductible in full. It also pays in full for the hospital coinsurance, hospice coinsurance, and skilled nursing facility coinsurance (20%). So, it is essentially complete and full coverage under Part A charges, filling in the gaps in Medicare Part A.
The Part B (doctor fees and outpatient) charges are where Plan N differs from other, more comprehensive plans like Plan F, Plan C and Plan G. Plan N does not cover the Medicare Part B deductible, which is $183/year for 2017. Also, after that deductible is met, you have co-pays for doctor visits under Plan N – these co-pays are $20 per visit (primary or specialist) and $50 for a visit to the emergency room. Lastly, Plan N does not cover the Part B Excess charges. In short, Part B excess charges are when a doctor does not accept the Medicare payment schedule as payment in full. Under Plan N, you are responsible for paying these.
You must have Medicare Part A and B in order to purchase any Medigap plan, including Plan N. Rates vary considerably depending on your age and where you live. In some states, Plan N can be a very competitively priced plan and a great value. In other areas, the price difference between Plan N and more comprehensive plans is so small that it may not make sense.
It is advisable to research whether Plan N is right for you and how to choose a Medigap plan prior to turning 65 or selecting a plan. If you are in good health with minimal pre-existing conditions, it may make sense to go with a Plan N. However, it is always a good idea to think about your Medigap selection with a long-term perspective as you may have to “qualify medically” to change plans at a later time.
 
 

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