What is Medicare Supplemental Insurance?
Medicare supplements came into being shortly after Medicare was signed into law. Because you are required to pay for some things, like 20% of outpatient expenses, supplemental policies were created to pay those expenses for you. This allows people to feel less worry over how much each medical visit will end up costing them.
Some of the primary advantages of a traditional Medicare Supplement policy are:
Freedom to choose your own doctors and hospitals
No referrals required to see a specialist
Predictable out-of-pocket expenses for Medicare-covered services
Nationwide coverage – you can use it anywhere in the United States
Guaranteed renewability – the insurance company can never drop you or change your coverage due to a health condition Supplemental insurance for seniors with Medicare is the most predictable back-end coverage that you can buy. You will know exactly what’s covered for every inpatient or outpatient procedure based on which Medigap plan you choose.
Some other things to know about Medicare Supplement insurance:
You must have Part A and Part B to buy a Medigap policy.
Medicare Supplement plans cover only one person. Your spouse must have his or her own individual policy.
You can drop your supplement at any time. There is no annual election period for Medicare Supplement plans.
The Annual Election Period in the fall is for Prescription Drug Plans and Medicare Advantage. It does not apply to Medicare supplements in any way!
Many carriers offer household discounts on Medicare supplemental plans (each carrier has different criteria for discounts).
Plans do not include Part D, so you’ll add a separate standalone Part D drug plan.
When you purchase your Medicare Supplemental Insurance directly from an insurance company, you give up a lot of benefits.
Purchasing through MLA Insurance Group costs exactly the same, but we provide these FREE value-added services for our policyholders.
What is Medicare: We explain your basic benefits first!
Quotes for over 30 companies
Free rate-trend history report so you can see which company has had the lowest rate increases
Free financial ratings for each company
Annual rate shopping assistance to keep you paying the least amount possible
Free claims support and help with appeals if Medicare denies a claim
Full-time Client Service Team to answer your Medicare questions
Exclusive Clients-Only Webinars each fall to go over the upcoming Medicare changes for next year.
Medicare Part A
Medicare Part A is your hospital coverage. It provides you with affordable inpatient care. So what’s the definition of inpatient?
We tell our clients to think of it as “room and board” in the hospital. It’s going to cover a semi-private room with a bed for you, and all your regular meals while you are there. It will cover medications furnished to you by the hospital and any necessary lab services or medical supplies.
You may get your inpatient care at an acute care hospital, a critical access hospital, an inpatient mental healthcare hospital or at an inpatient rehabilitation facility.
What Does Medicare Part A Cover?
In addition to Medicare hospitalization coverage, Medicare Part A also covers post-hospital skilled nursing and short-term post-hospital home health care, as long as it is medically necessary. Part A covers hospice services which may include palliative care, Durable Medical Equipment, counseling, and social services. Medicare hospice coverage also provides short-term respite care for caregivers to have a rest.
Part A also provides for some home health care services received in the hospital or immediately following an inpatient stay. This includes skilled nursing care, medical social services, and physical therapy. Home health aid services are generally only covered when skilled nursing is also occurring.
Medicare does NOT cover long-term care, such as extended stays in a nursing home. Individuals can consider purchasing long-term care insurance if this is something they want to plan for.
There are some things that you might think would fall under Part A but sometimes fall under Part B, such as outpatient surgeries. When it comes to determining if something is inpatient vs outpatient, it’s always a good idea to consult your Medicare insurance broker for guidance.
However, in general, what is covered by Part A is generally hospital-related for immediate or acute care of an injury or illness.
Whatever your situation is, we can help find a plan to fit your lifestyle and needs.
How Much Does Medicare Part A Cost?
Is Medicare Part A free?
Well, not exactly. Most beneficiaries will pay nothing for Medicare Part A at age 65 though because they have already pre-paid it. You see, we all pay taxes during our working years that are specifically for our future Medicare hospital coverage during retirement. These taxes go to offset the cost of Part A later on.
As long as you have worked for 10 years in your lifetime in the United States, you will generally pay nothing at all for Part A. If you do not have this work history, you can purchase Part A as long as you have been a legal resident or green card holder for at least 5 years.
If you do not have 40 quarters, you can pay for Part A. Premiums in 2021 are $471 if you have less than 30 quarters or $259 for people with 30 – 39 quarters.
When do I enroll in Medicare Part A?
Enrolling in Medicare Part A is automatic for people already taking Social Security income benefits. When this happens, you’ll open your mailbox 2 – 3 months before you turn 65 and find your card waiting for you.
You’ll want to keep your eye on the mail for your card. It is a red, white and blue card printed on heavy card stock. It is okay to laminate the card when you receive it so that it will stay in good shape over the years of being in your wallet or purse.
If you are not already receiving Social Security income benefits or Railroad Retirement income benefits yet, then you will need to actively sign up for Part A at age 65. You can do this at the Social Security website.
What is my Medicare Cost-sharing under Part A?
Your Medicare Part A coverage will pay for a great deal. However, you will have some cost-sharing as well that you are responsible for.
Each year CMS determines the Medicare Part A deductible and coinsurance that you will be responsible for during the following year. These are the cost-sharing amounts that you must pay when using your Part A benefits. In 2021, you will pay:
A $1,484 deductible for each inpatient hospital stay when you have not been in the hospital during the previous 60 days.
$371 per day for days 61 – 90 of a consecutive hospital stay
$742 per day for days 91 – 150 of a consecutive hospital stay
Any and all costs past your lifetime reserve days
What are lifetime reserve days?
Unless you have a Medigap plan, Medicare Part A gives you 60 lifetime reserve days. You begin using these days if you have a hospital stay lasting more than 90 consecutive days. For example, if you have a hospital stay that lasts 100 consecutive days, you will have used 10 of your lifetime reserve days.
If you have another hospital stay the year after lasting 120 consecutive days, you will have used up 30 (10 + 20) of your lifetime reserve days total. Once you have used up all of your lifetime reserve days, you will be responsible for all Part A costs starting on day 91 for any hospital stay lasting longer than 90 days.
Skilled-nursing facility costs
For skilled nursing facility stays, Medicare covers the first 20 days. Your daily copay in 2021 for days 21- 100 will be $185.50. Fortunately, both Medigap policies and Part C Advantage plans will help cover these costs. Either type of plan will help you to significantly reduce your financial exposure.
Medicare Part B
What is Medicare Part B coverage? It is your outpatient medical coverage for medically necessary healthcare services.
What is Medicare Part B? What does Medicare Part B cover? Many people think of it as medical coverage, but it actually covers things both in and out of the hospital. Think of Part B coverage as any care administered by physicians.
What Does Medicare Part B Cover?
Medicare Part B coverage provides you access to a variety of outpatient medical services. Part B covers preventive care including flu shots, colonoscopies, mammograms and more. It covers ordinary outpatient things like doctor’s visits, lab testing, home health care, ambulance rides, and some chiropractic care too.
However, Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D.
Part B is optional, but if Medicare is your primary coverage, you definitely need Part B. You also cannot get Medigap supplemental coverage without it.
What costs does Medicare cover under Part B?
80% of approved costs after you first pay the annual deductible.
How much will I pay for Medicare Part B?
You must pay a monthly premium for your Medicare Part B benefits. The majority of Americans will pay the standard monthly amount set by the government. In 2021, the base rate for Part B is $148.50/month for people new to Medicare. However, you may owe more if your income is above a certain level.
You can find a chart showing the costs based on your income bracket here. If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.
Medicare will deduct your Part B premiums out of your Social Security check if you are already enrolled in your SS income benefits. If not, they will bill you quarterly. There is a credit card option at the bottom of the quarterly invoices. To pay for Part B by credit card, just complete the bottom portion of the payment coupon and mail it into the Medicare Premium Collection Center. You also have the option to use Medicare Easy Pay, a free autodraft service that will deduct your premium payments monthly from a checking or savings account.
How Do I Sign Up for Medicare Part B?
People who are already taking Social Security income benefits at age 65 do not need to enroll. The Social Security office will automatically enroll you. Your card will arrive in the mail 1 – 2 months before your 65th birthday.
Everyone else needs to apply for Medicare Part B themselves at age 65. Applying for Medicare Part B can be done online, over the phone or in person at your local Social Security office. After you apply, it will take 2 – 3 weeks before your card will arrive, so you should plan to apply several weeks prior to when you will need the coverage.
As you can see, it’s easy to sign up for Part B. It’s important to enroll in Part B during your Initial Enrollment Period unless you have other creditable coverage. Otherwise you would be subject to a penalty!
For more information on each of these application options, visit our Helpful Resources page.
A good way to think of Part B is coverage for any care administered by physicians and deemed medically necessary.
Does Medicare Part B Cover Everything Outpatient?
Part B covers usually anything that is deemed medically necessary. So, if a doctor documents your need for a certain procedure, it will usually be covered. If Medicare disagrees with the doctor on medical necessity, there might be some additional documentation required.
What Doesn’t Part B Cover?
Part B does not cover hospital expenses covered by Part A. It also does not cover cosmetic procedures, routine dental, vision or hearing, or routine foot care. It also does not cover drugs that you pick up yourself at a retail pharmacy. For those you will need a Part D drug plan.
In general, Part B doesn’t cover things that are not reasonable and necessary. Your doctor usually will know the rules for what is covered and what isn’t.
What is my Cost Sharing Under Medicare Part B?
You will pay a percentage of the costs of your medically necessary Part B services. Generally, these costs are:
the annual Part B deductible ($203 in 2021)
20% of the remaining costs, with no limits or cap
any excess charges that a provider or facility may charge beyond what Medicare reimburses.
What is most significant is the 20% that you will owe for outpatient medical care. For services like surgeries or chemotherapy, your expenses can add up to thousands of dollars. For this reason, most Medicare beneficiaries purchase Medicare Supplemental Insurance. It’s always a good idea to consult your Medicare insurance broker for guidance and plan recommendations.
Medicare Advantage
Medicare Advantage plans were created under the Balanced Budget Act of 1997. These plans are commonly called Part C of Medicare. Advantage plans for Medicare fall under Part C. These plans often have networks and some plans may require you to get referrals to see a specialist. Congress designed this program to give Medicare beneficiaries a lower-premium option than Medigap. They also have very little Medicare underwriting. This means they are a coverage option for people who missed their open enrollment window for Medigap and now cannot qualify for Medigap due to health conditions. Medicare Advantage plans are NOT similar to Medigap plans – they are different! Members get their benefits from a private insurance company instead of original Medicare. How Medicare Advantage Works A Medicare Advantage plan is a private Medicare insurance plan that you may join as an alternative way to get your Medicare benefits. When you do, Medicare pays the plan a fee every month to administer your Part A and B benefits. You must continue to stay enrolled in both Medicare Part A and B while enrolled in your Medicare Advantage plan. Medicare pays the Medicare Advantage company on your behalf to take on your medical risk. This is how Medicare Advantage plans are funded. You will present your Advantage plan ID card at the time of treatment. Your providers will bill the plan instead of Original Medicare.
Each Advantage plan has its own summary of benefits. This summary will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, lab work and so on. You might pay $10 to see a primary care doctor. Specialists will often be more – a $50 specialist copay is quite common. Some of the higher copays may come in for diagnostic imaging, hospital stay, and surgeries. You can usually expect to spend several hundred on copays for these items. However, this varies greatly between states, so review plans in your area to get the specifics. One different thing about Medicare Advantage plans is that some of them offer minor benefits for routine dental, vision or hearing. Some plans include gym memberships. When searching for Medicare Advantage plans with dental and vision, our experts here at MLA Insurance Group can help you compare those ancillary benefits between carriers.
Medicare Part D
Medicare Part D Medicare Part D is a federal program that began in 2006. It provides Medicare beneficiaries with access to retail prescription drugs at affordable copays. Prior to 2006, people on Medicare paid mostly out-of-pocket for their medications for over 40 years. Medicare Part D is coverage for retail prescription drugs that you obtain from a retail pharmacy. This voluntary program allows you to access medications at a more affordable rate. It also provides insurance against catastrophic drug costs. You do not enroll in Medicare Part D via Social Security. Instead, you will choose a Medicare Part D plan offered by a private insurance company in your state.
Is Medicare Part D Right for Me?
There are dozens of drug plans offered in most states. Fortunately, we can assist you with evaluating each plan based on your individual medications. We’ll help you determine which drug plans offer the specific medications you need at the lowest copays. At MLA Insurance Group, we will happily offer assistance with Part D when you choose to enroll in a Medigap plan through us.
Give us a call at (410) 458-0888 or to request for help, click here.
How Do I Enroll in Part D?
You must enroll in a Medicare Part D plan in the service area where you live. You can enroll in Part D directly with a Medicare Part D insurance provider or through an agent that specializes in Medicare products. Enrolling through an agent means you will have an extra resource for help when you have questions or problems with your drug plan. You can also enroll in Medicare Part D via Medicare’s website or by calling Medicare at 1-800-MEDICARE. Some Medicare Advantage plans also include built-in Part D drug coverage. It’s important to check exactly which medications a Medicare Advantage plan includes before enrolling. Be sure that your plan covers the medications you need. You can only be enrolled in one Part D plan at a time. You cannot be enrolled in both Medicare Advantage and Part D at the same time.