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3 Most Important Factors to Choose a Medicare Supplement Plan

If you already have Original Medicare, you might be considering getting a second Medicare Supplement coverage. To better comprehend the coverage possibilities of Medigap policies, Medicare guide helps to become familiar with it beforehand.

 

Easy & Comprehensive Guide to Choose a Medicare Supplement Plan

When deciding a Medicare Supplement, there are 3 important factors to consider. These are the rating of the company, how long they’ve been selling Medicare supplements, and the average rate increase history. Premium of the plan is actually one of the least important factors as premiums can change rapidly over time. Below, we outline the details of each important facet.

 

Understanding Medicare Supplement Plan 

A Medicare Supplement plan is different from a Medicare Advantage plan in that it is secondary to Original Medicare. It can assist with covering some of the medical expenses that Original Medicare does not, such as coinsurance, copayments, and deductibles. 

In total, 48 states provide 10 different types of standardized Medicare Supplement insurance policies.

Medicare supplement plans, also known as Medigap plans are federally standardized. That means that Medicare enacted the same coverage rules for all Medigap plans. For example, one carrier’s Plan N has to be the same as another carrier’s Plan N. However, the Medigap plans might offer different perks, such as third-party discounts on dental, vision, or hearing. These third-party discounts are not considered insurance.

It’s also vital to remember that private insurance companies sell Medicare policies. You need to currently be covered by Medicare Parts A and B in order to acquire one.

 

Medicare Supplement Chart 2023

 

Choosing the Right Company for Medigap 

Rating of the Company

Medicare Supplement Companies are rated by 2 rating agencies which are A.M. Best and Standard & Poor’s (S&P) and are given letter grades A through F.  These letters describe the company as a whole including, claims loss ratio, customer service, and overall stability. We always recommend going with A+ rated companies when at all possible and would never go below an A- rating.

How Long A Company Has Been Selling Medicare Supplements?

Many people confuse the year in which a company was established with how long they’ve been selling Medicare supplements in a particular area. These are 2 completely different things. Many companies were established in the early-mid 1900s yet may have only been selling supplements in a particular area for 2 years (Or selling a particular plan for even less!). We never recommend going with a company that’s been in an area for under 5 years. We feel this is a comfortable amount of time for the company to get a good sample size and see how their claims loss ratio affects future premiums and allows those premiums to stabilize.

Many companies will come in with low premiums to undercut the competition. Going with these new companies puts you in a guinea pig situation. It might work out, but it might not. Why take the risk? We also find that newer companies have a policy fee associated with new enrollees. This should be an immediate red flag as the company is “buffering” its claims loss ratio and should be avoided.

Average Rate Increase History

Average rate increase history is perhaps the most important factor in your decision of which plan and company to go with and should hold a heavyweight. Again, we find newer companies in an area to have heavier rate increases than those that have been in the area for 20+ years. Companies could have rate increases as high as 20% per year! We often find that the higher the rating of the company, the more stable overall. Especially in issue age states where you’re locked in at the age in which you get your policy. This could have a drastic impact on the amount of premium you pay over the course of your lifetime. Seeing as Medicare supplements require you to be underwritten to switch plans or companies, and we can’t predict what our health situation will be, the stability of the company is key.

 

Questions to Ask your Insurance Company Before Locking the Deal

  • Do you have a license in my state?
  • Do you offer the Medigap policy I’m considering? (Name the plan using the letter it begins with.)
  • Does this Medigap plan involve medical underwriting?
  • If you are subject to underwriting, what is the waiting time period for a particular condition?
  • Is this insurance priced based on community, issue, or reached age-attained ratings? 
  • Has this Medigap policy’s premium gone up in the last three years? How much, if at all?
  • Are there any special offers or other advantages?

(This element influences how much your premium will cost today and whether it will increase as you get older.)  

Please read this article to learn more about these differences. https://medicarenationwide.com/issue-age-vs-attained-age-vs-community-age/

Choosing the Best Medicare Supplement Insurance Plan 

WHATs and HOWs to finding the best policy to complement Medicare. 

Pricing of the Plan

Cost should be the top consideration when shopping for supplement insurance plans. What is the cost of deductibles, premiums, and other expenses? It would help if you also thought about how much you spend on medical appointments and hospital stays. 

It’s crucial to remember that neither Original Medicare nor Medicare supplement have many out-of-pocket restrictions. 

Plans K and L are the two outliers.

However, the cost-sharing under other types of health coverage, like the ones mentioned below, is typically not covered by this sort of policy.

  • Medicare Advantage Plans
  • Stand-alone Medicare prescription drug plans Part D
  • Employee and union health benefits
  • Medicaid
  • Tricare
The Extent of Medicare Coverage

Medicare is widely accepted across a number of states, with some slight variation as per state regulations. Medicare Supplement Insurance assists some expenses not covered by Original Medicare Parts A and B. These plans assist in covering your Part A (hospital care) and Part B (medical care) copays, coinsurance, and deductibles, or any additional out-of-pocket expenses for things like hospitalization, doctor visits, home health care, lab fees, durable medical equipment, and other healthcare expenses.

Medicare will fund its portion of the approved sum for covered medical expenses. Your Medicare Supplement Insurance will then start covering its portion of the expenses as secondary insurance.

Separate Medicare drug coverage, hearing aids, custodial care, and visual or dental care are not included in Medicare Supplement insurance since Medicare does not cover them as well. The plans can, however, be purchased individually. 

Owning a Supplement policy has a lot of benefits. For those who require expensive or regular treatment, it may help them save money. Additionally, even if you have health issues, any standardized Supplemental Insurance plans coverage is assured to be renewed. 

If you keep paying the premium, it typically cannot be canceled. One of the most well-known benefits of Medigap is that, unless you have a Medicare SELECT plan, you can typically see any physician or healthcare facility that accepts Medicare. 

Your Choice of Doctor and  Hospital

You should take into account a few variables while selecting your doctors and hospitals:

Are your doctors Medicare-eligible? Medicare is widely accepted. Even if they are not accepting the Medicare-approved rate, you can still be reimbursed from Medicare and a Medigap plan for the Medicare-approved rate by filing a claim directly with Medicare. You can not file for reimbursement if you own a Medicare Advantage plan since you would have replaced Medicare as your primary insurance to join a managed care network offered by the Medicare Advantage insurance carrier. So make sure you have a Medigap plan and not a Medicare Advantage plan if you want to know you can be reimbursed by Medicare if your doctor only accepts cash.

Do you have to select a network of hospitals and healthcare providers? You do not have to stay with Medicare and a supplement plan. You would have to be concerned about a network if you enrolled in a Medicare Advantage plan.

Whether you require referrals is another concern you might have. A doctor’s referral is not necessary with a Medicare Supplement insurance plan in order to see a specialist. 

The Level and Quality of Healthcare

The standard of your care matters when it comes to your health. Whether it’s an urgent situation or a routine checkup, you’ll probably want to ensure you’re getting the best care available. Finally, ask yourself if you are happy with the standard of your care. You can decide on a policy using the Medicare Drug Coverage information and other relevant knowledge.

Do You Travel Frequently?

If so, it could be advantageous to consider buying a Med-Supp policy. You might be able to get insurance that covers travel. To understand what is covered by your policy, carefully read it.

 

Quick Questions to Ask Yourself before choosing a Medigap Plan

Choosing a Medicare plan entails giving some thought to what would work best for your needs and way of life. When contrasting Medicare plans, you might wish to ponder the following questions into account:

  • What medical needs do you have?
  • Do you visit your primary care doctor for an annual checkup once a year? 
  • Do you also require additional services from specialists?
  • Do you need outpatient surgery, or do you anticipate needing hospitalization for a surgical procedure?
  • Do you currently take any prescription drugs? Would you need a Medicare Drug plan separately?
  • If yes, do you take generic pharmaceuticals or prescription drugs, such as insulin or other injectables?
  • Do you have a chronic illness that makes you more likely to require additional care?
  • Do you require eye or dental care?
  • Do you want access to mental health professionals like therapists and counselors included as part of your coverage?
  • Do you want the freedom to choose any doctor, or are you content to see one in a network?
  • Do you want coverage wherever you go if you travel?

Knowing the answers to these and similar queries may help you make the best choice for your Medicare coverage needs.

 

What Advantages Can You Get from Purchasing a Medicare Supplement Plan?

Medicare Supplement plans cover expenses that Original Medicare does not cover. These include the cost of prescription drug coverage, hospital stays, hospice care, blood tests, and ER visits. 

If you are in the stage where you can expect frequent or constant medical attention, medicare supplement plans can significantly reduce any out-of-pocket costs you could incur.

 

What Is the Pricing Range of a Medicare Supplement Plan?

Insurance rates are determined by carrier actuarial risk assessments, geographical and demographic factors, such as zip code, age, and sometimes health, and smoking status (if underwriting is required.) Prices vary greatly and can be anywhere from $20-$500 a month depending on the Medigap plan, what it covers, and if you are enrolling during an Open Enrollment period (not subject to underwriting) or if you qualify for a higher rate because you enrolled outside of the Open Enrollment period. For more information on enrollment periods. Please see the chart below.

 

Is it Worth it?

Medicare supplements cover all the remaining costs for Part A and Part B for both inpatient and outpatient Medicare-approved medical claims. You can lower your monthly premium if you assume a bit more risk, such as enrolling in Plan N, where you are responsible for copayments. Copayments are fixed dollar amounts you pay for doctor and specialist visits before you are seen. On Plan N, it would be up to $20 for any doctor that accepts Medicare, whether a specialist or not. If you had Plan G or N, it would fully cover your ER visit up to $1,600 (Part A deductible). Among many other Part A and B costs covered, that alone is worth it.

Medicare.gov does not list prices for Medicare supplement plans, but it can be a Medicare.gov accessed resource for you to read general information. For information on Medicare supplement plans, you have to speak to an insurance agent that represents the insurance carrier. Working with an independent broker is free, and it is easier than speaking to a lot of agents. We are one of the most reputable independent brokers in the industry available to assist you and can provide you with prices and details about the plans.

 

How do businesses set their policy prices?

Although Medigap plans offered are standardized, prices for the same plan might differ significantly. 

To determine their costs, insurance companies have access to a wide range of options. Your cost may vary depending on your age, gender, place of residence, use of cigarettes, and general health.

Additionally, the cost of all Medigap policies will increase as you age, but some more so than others. You must consider businesses with a more substantial track record of price stability.

 

When should I purchase a Medigap policy?

Open Enrollment is the ideal opportunity to acquire Medigap coverage. This six-month term starts when you reach 65 and enroll in Medicare Part B. Irrespective of your health during this time, insurance providers cannot deny you coverage or charge you more for a policy. Your Open Enrollment period may be extended if you put off enrolling in Medicare Part B since you or your spouse still are employed and have creditable coverage. Creditable coverage is considered comprehensive insurance deemed qualified to delay Part B without being subject to a penalty for late enrollment. Most group health insurance plans are qualified, but you would want to make sure yours is creditable coverage. You can also avoid underwriting if you are outside of an Open Enrollment period and qualify for a Guaranteed Issued policy.

 

Common Guaranteed Issue Rights mean: 

  • You have a Medicare Advantage Policy, and your plan expires, or you relocate out of the service region are two examples of common guaranteed issue rights.
  • You have Original Medicare as well as a group health plan via your employer and you are involuntary dropped from your plan. In some cases, voluntarily left your plan.
  • You’ve been a member of a Medicare Advantage Policy for less than a year and wish to switch back after abandoning a Medigap plan.

For more examples: you can visit here: https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

From this article, we hope it’s clear that premium alone is not enough information to make an informed decision about which plan and company to choose. Often, you will stay with the company and plan you choose for life. So make it a good choice!

For more information on a particular plan and company in your area, please reach out to us at.

Prefer to chat by phone? Give us a call at 1-888-559-0103.

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