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Many Medicare recipients are unwittingly getting trapped in restrictive Medicare Advantage plans without knowing all the facts.  Here are a few solid pointers that will help you and your loved ones know what you're really getting into before you take the plunge.   Be sure to read all the way through to my recommendations on the bottom of this article. 

Brandon

Medicare Advantage Plans vs Medicare Supplement and Medigap Insurance

1) You should not make a decision to buy a Medicare Advantage Plan by comparing the premium of the plan to your Medicare Supplemental Plan

Many Agents will try to compare your Medicare Advantage plan premiums to that of your Medicare Supplemental policy, and they are normally lower.

However, a lower price is no more a reason to buy a Medicare Advantage plan and give up Medicare Parts A and B. than it is to buy a scooter rather than a Mercedes just because it costs less.

To compare prices and come up with a good decision, you must make sure that you are making an apples to apples comparison. This is impossible with Medicare Advantage Plans and Medicare Supplemental Plans as they vary in benefits and structure. Medicare Supplemental Plans along with Medicare Parts A and B normally offer many more benefits and freedoms than Medicare Advantage Plans. In the end, you get what you pay for.

2) To enroll in a Medicare Advantage Plan, you must give up coverage from Medicare Parts A and B

If you choose a Medicare Advantage HMO or PPO Fee For Service Plan, you will be dis-enrolled from Medicare Parts A and B.

Medicare will then pay a monthly premium to the Medicare Advantage plan to provide your health care. The plan may require you to pay an additional premium and may charge you a co-payment each time you go to the doctor or get a prescription.

To join a Medicare Advantage plan, you must have both Medicare Part A and B and not have end-stage renal disease. Also, not all plans are available in all areas of the state that you live in an area that has a plan.

3) You can have increased control over your choice of healthcare providers with Medicare Parts A and B alone rather than a Medicare Advantage Plan, even without a Medicare Supplemental (Medigap) Plan.

Medicare Parts A and B allow you to choose any physician or hospital in the United States. In critical times, this freedom to choose and access the best providers could make a huge difference in treatment, and even save your life.

Medicare Advantage Plans are not so flexible, possibly with severe consequences. Medicare HMOs require you, in most instances, to use only physicians and hospitals in the HMO's network. You can generally go to any doctor or provider you want with a private fee-for-service plan you must find a provider that will treat you and accept the plans terms and conditions.

4) Medicare parts A and B alone (without a Medicare Supplemental) can provide you comparable benefits to Medicare Advantage Plans without restricting your ability to choose your healthcare providers or putting administrative restrictions on your physician for claim payments and referrals

Medicare Advantage Plans must provide, by law, at least the same benefits (or actuarial equivalent) of Medicare. However, this can be deceptive. What this means is that they will offer you benefits based on dollar amounts only that will average what Medicare offers, though they may package the benefits differently. Packaging differences can best be explained by taking a dollar away from you in one place and giving it back in another, which maintains the "actuarial equivalent" requirement. However, though the average payments will be similar after care has been received, Medicare Advantage Plans may restrict or delay you from receiving treatment at that you would choose if your insurance coverage allowed you whatever you wanted.

5) Do not purchase a Medicare Advantage Plan solely to get Prescription Drug Coverage

If you are eligible for Medicare Advantage Plans, you are eligible for Medicare Part D plans that you can keep without giving up Medicare Parts A and B or your Medicare Supplemental (Medigap) Policy.

6) A Medicare Advantage Plan will restrict your right to choose your physicians and hospitals, even with Private Fee for Service Plans, possibly resulting in serious health consequences.

Medicare Advantage Plans only require that they offer you a certain type of healthcare. For instance, if you needed treatment for colon cancer, for instance, they would have to allow you to see physicians and hospitals who treat cancer. However, if you chose to take advantage of the increase in survival rates demonstrated by a hospital or treatment center that specializes in cancer treatments and a physician who specializes or has great experience in colon cancer, you may not be allowed to use them, or you might experience severe delays with your Medicare Advantage Plan. What's worse, if you decide to go to them and pay on your own, you will no longer have Medicare Parts A and B to fall back on. You will be responsible for 100% of all costs.

7) A Medicare Advantage Plan may choose not to renew their contract with Medicare each year in any area. If this happens, you will no longer be allowed to participate in the plan.

Medicare Supplemental Plans and Medicare, however, are guaranteed renewable for life. You can never lose coverage as long as you pay your premiums. What's Important About Making Healthcare Decisions with Health Insurance Remember, the reason that you have health insurance is not solely for the sake of having health insurance. Health insurance for the sake of merely having insurance is boring and expensive. Instead, you purchase insurance to ensure that, if and when health problems occur, that you will be able to recieve the best quality healthcare without regard to the costs involved. Many Seniors make the mistake of simply purchasing insurance based on the monthly cost, possibly exposing themselves to serious health risks caused by reduced access to healthcare.

My reccomendations:

  1. Ultimately it is best to stay enrolled in Medicare Parts A&B and have a comprehensive Medicare Supplemental (Medigap) policy to pay the gaps that Medicare doesn't cover.
  2. If you cannot afford your Medicare Supplemental Policy, first shop around to make sure that you are paying the lowest premium possible. Enter your information above to request a Free Medigap Insurance Quote from Medigap360.
  3. Even if you can afford your current Medicare Supplemental policy, it is best to shop around to make sure that you are not paying more than you have to.
  4. If you still cannot afford Medicare Supplemental Insurance, do not enroll in a Medicare Advantage Plan. Instead, stay with Medicare Parts A&B. This will provide you access to choose any physician or hospital without delay. For the gaps that are left by Medicare coverage, you should be able to work out payment plans with your provider or find charitable programs to assist you . We have never heard of anybody who was not able to get the treatment that they need when they have Medicare Part A and B alone.
  5. Do not take a Medicare Advantage Plan just for Prescription Drug Coverage. Talk with a qualified and licensed Medicare Supplemental Specialists about your prescription drug insurance options including Medicare Part D.

Call for your Free Medigap Insurance Quote

(888) 875-4463

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  • How do I find the best price for my Medicare Supplemental Insurance Coverage?
  • Which Medicare Supplemental Insurance Policy is the best?
  • What should I consider when choosing a Medicare Supplemental Insurance Company?
  • How can Medigap360 Help Me in choosing and applying for Medigap coverage?
  • How do I change my Medigap Plan in order to save money?
  • If I change my Medigap Coverage will I have a waiting period for pre-existing conditions?
  • When should I make my Medigap Policy effective?
  • What is the fastest way I can get covered and start saving money?



How do I Find the Best Price for My Medicare Supplemental Insurance Coverage?

We make it easy for you at Medigap360. All you have to do is request a multi-company Medicare Supplemental insurance rate analysis from our website.

Which Medicare Supplemental Insurance Policy is the Best?

From our experience we have found plan F and plan G to be the most popular. However, many people have found plan C, D, E and I very economical. It always depends on your particular situation and risk tolerance. If you are having trouble deciding, one of our licensed Medicare Supplemental insurance specialists will be happy to assist you in finding the best plan for you.

What Should I Consider When Choosing a Medicare Supplemental Insurance Company?

Though all companies offer similar standardized plans there can still be some differences. You want to make sure that you are purchasing from a licensed insurance company in your state with an approved Medicare Supplemental insurance policy. Other things you may want to consider is if the company puts a waiting period on pre-existing conditions and if that applies to you. Financial strength is also important. Do not be too concerned if you haven't heard of the company before, there are many insurance companies out there that are very dependable that don't spend tons of money on advertising to make their name known.

How Can Medigap360 Help Me in Choosing and Applying for Medigap Coverage?

We hope, first of all that you find the information on this site to be helpful. We feel that we have put together the most comprehensive website on Medicare Supplemental insurance information in the country. Furthermore, we have taken painstaking measures to present it in a way that is easy to understand and will help you to make the right money saving decisions about your Medicare Supplemental insurance coverage and be able to get back to your life. However, we know that all this information can be overwhelming when you don't do this for a living like we do. We will be happy to help you in any way we can. You can call our toll free number and talk to a licensed Medigap specialist and we will help to educate you in deciding what the very best policy is for you and your family and we can even help you to enroll. You'll find our specialists to be the most knowledgeable in the industry. Since 1984, all we have been doing is helping seniors save money on their Medicare Supplemental insurance while ensuring comprehensive coverage.

How do I Change My Medigap Plan in Order to Save Money?

If you already have a Medicare Supplemental insurance policy you most likely will be able to change to another policy if you find a lower premium. In most cases, you will be able to change without any waiting periods or loss of one day of coverage. However, this must be handled properly with the assistance of a licensed agent. To check your eligibility and save money on your Medigap premiums, simply fill out our rate analysis inquiry or call us toll free at (888) 875-4463. We will be able to determine if changing is right for you. We can guide you through every step of the process to make sure you save the most money if possible, without any gaps in your Medicare Supplemental insurance coverage.

If I Change My Medigap Coverage will I Have a Waiting Period for Pre-Existing Conditions?

In most cases you will not. Medicare Supplemental insurance providers have the option to put up to a 6 month waiting period on pre-existing conditions. If you are subject to this waiting period then previous conditions that you had before applying for coverage may not be covered. However, any new conditions that arise will be covered immediately.

Some companies exercise this option and some don't. However, if you have been covered by a previous Medigap policy or other creditable coverage for the length of the companies waiting period, that waiting period will be deemed as satisfied and you will have coverage from day one. Furthermore, no Medicare Supplemental insurance company is allowed to have any exclusions to their coverage for past medical conditions beyond the pre-existing conditions waiting period. That means, if a company issues you a policy, they cannot exclude certain medical conditions that you have. If they issue you a policy and you are not subject to a waiting period on pre-existing conditions, they will have to cover all conditions old and new.

When Should I Make My Medigap Policy Effective?

If you are just now becoming eligible for Medicare you should make the effective date as soon as possible but no earlier than the effective date of Medicare Parts A and B. If you are replacing coverage, you should apply in time with a future effective date long enough out to receive and review your policy before the effective date of coverage. This will give you time to make sure your transaction was handled properly and that the right policy was issued before cancelling your existing coverage.

What is the Fastest Way I Can Get Covered and Start Saving Money?

The fastest way is to call and speak with one of our licensed Medicare Supplemental insurance specialists at (888) 875-4463. They will be able to evaluate your situation, determine the best plan of action for you and help you get started.

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Medigap Eligibility

Insurance companies must sell you a Medigap (Medicare Supplement) plan during certain periods of time — one period is called "open enrollment period." The others are called "guaranteed issue periods."

At other times, insurance companies may refuse to sell you a policy. If you have or used to have health problems, you may not be able to buy the Medigap plan of your choice. Most companies will have a few simple health questions that your Medigap360 Medicare Supplement Specialist can ask you to determine your eligibility.

Eligibility: Open Enrollment & Guaranteed Issue Periods

Open Enrollment

Seniors: Medigap companies must sell you a policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. These six months are called your "open enrollment" period. During open enrollment, a company must allow you to buy any of the Medigap plans it offers. You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and still have the right to buy any other Medigap policy, so long as the sale takes place during the six months after you enroll in Medicare Part B.

Although a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before covering your pre-existing conditions. Pre-existing conditions are conditions for which you received treatment or medical advice from a physician within the previous six months.

Your right to open enrollment is absolute, even if you wait for several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.

People with disabilities: People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right is only applicable to Medigap Plan A. Companies selling Medicare supplement insurance in Texas may not deny you a Plan A policy because you have pre-existing conditions. Companies are not required to offer the other plans to Texans with disabilities, but they may do so if they wish. During the first six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 12 plans.

Guaranteed Issue

You may have the right to buy a Medigap policy outside of your open enrollment period if you lose certain types of health coverage. For people over age 65, the guaranteed issue right applies to Medigap plans A, B, C, F, K, and L. For people under age 65, this guaranteed issue right applies only to Medigap Plan A. In general, this right is for 63 days from the date coverage ends or from the date of notice that coverage will end. Companies may not place any restrictions, such as pre-existing condition waiting periods or exclusions, on these policies. This is called "guaranteed issue." You must provide proof of the loss of your health care coverage. Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights, but they are only eligible for Medigap coverage under Plan A. This guaranteed issue right is also extended to people on Medicare who lose Medicaid because of a change in their financial situation.

Guaranteed Issue and Medicare Advantage Plan Disenrollment

What often goes unnoticed about Medicare Advantage Plans is that they reserve the right to terminate their contract with Medicare from year to year in any service area that they wish. When this happens, you will no longer be able to continue with your plan and will be placed back on Original Medicare at the beginning of the following year.

If your Medicare Advantage plan terminates its contract in your service area, you have the right to purchase any Medigap plan A, B, C, F, K, or L offered in your state without regard to your medical history or condition. If your Medicare Advantage plan ends services in your area, it must explain to you in writing your options and timeframes to buy a Medigap policy.

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Medicare Insurance Basics

Medicare Insurance is a Health Insurance Program For:

  • People Age 65 or Older,
  • People under age 65 with certain disabilities, and
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant.)

Medicare Insurance Benefits Plan Basics:

Medicare Part A (hospital) pays for in-patient hospital services, skilled nursing facility care after a hospital stay, home health care, and hospice care. Medicare Part A also pays for all but the first three pints of blood in a calendar year.

Medicare Part B (medical) pays for medical expenses, clinical laboratory services, and outpatient hospital treatment. In most cases, Medicare Insurance pays 80 percent of the cost of covered services.

Covered medical expenses include physicians´ services and supplies. Some Medicare Part B services are paid as a fixed copayment under the outpatient prospective payment system.

Medicare Part B also pays for some preventive services. Ask your physician about screening tests, flu shots, and vaccines covered by Medicare.

Medicare prescription drug coverage (also called Medicare Part D) pays for prescription drugs, both generic and brand name. You must join a prescription drug plan to have this coverage.

Options for receiving Medicare Insurance benefits

Medicare enters into annual contracts with insurance companies and managed care plans to provide coverage through different types of health plans. The original Medicare plan is available to everyone. Original Medicare is also sometimes called Medicare fee-for-service or traditional Medicare. You can go to any doctor or hospital that accepts Medicare. Original Medicare coordinates with most group retirement plans, Medicaid, Medicare savings programs, and Medigap insurance.

You may have the option to join a Medicare Advantage plan (formerly called Medicare + Choice). Medicare Advantage plans include health maintenance organizations (HMOs), preferred provider plans (PPOs), private fee-for-service plans (PFFS), and medical special needs plans. You can only join a Medicare Advantage plan if a plan is available in your area and you have Medicare Parts A and Part B. Some plans may have additional eligibility requirements. The federal Centers for Medicare and Medicaid Services (CMS) administers Medicare Advantage plans. Plans provide their members with a handbook upon enrollment that outlines the complaints and appeals process for denial of services.

CMS publishes a handbook, called Medicare and You, that describes Medicare coverages and health plan options. The handbook is mailed to every Medicare beneficiary each year.

Services Not Covered by Medicare Insurance Benefits

  • Long-term care services (generally not covered) 
  • Private-duty nursing care
  • Most dental care and dentures.  
  • Healthcare received while traveling outside the United States, except under limited circumstances
  • Custodial care, such as help walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine (these are commonly referred to as activities of daily living)
  • More than 100 days of skilled nursing facility care during a benefit period following a hospital stay (the Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing facility for 60 consecutive days)
  • Homemaker services
  • Cosmetic surgery and routine foot care
  • Routine eye care, eyeglasses (except after cataract surgery), and hearing aids.

What You´ll Have to Pay with Medicare

Both Medicare Part A and Part B have costs that you must pay. These include monthly premiums, deductibles, copayments, and coinsurance. You also pay the full cost of services not covered by Medicare.

Premiums are amounts you pay regularly to keep your coverage. Most people do not have to pay a Part A premium, but everyone must pay the Part B premium. The premium amounts may change each year in January. A deductible is the amount you must pay for covered medical expenses before Medicare begins to pay. A copayment is a fixed charge for a medical service. Coinsurance is the percentage of the cost of a covered service that you pay after Medicare pays its portion of the cost.

Health care providers who "accept assignment" agree to limit their fee to the Medicare-approved amount for a service or supply, although you must pay any deductibles, coinsurance, or copayments due. Providers who do not accept assignment may charge as much as 15 percent above the Medicare-approved amount when treating Medicare patients. You must pay the excess amount. The amount you owe is shown on the Medicare Summary Notice that you receive from Medicare. If you were charged more than the 15 percent and paid it, your provider must refund the excess charges to you within 30 days. If you believe a provider has overcharged you, question the bill before you pay it and contact the Medicare carrier that processed your claim.

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Before you consider a Medicare Advantage Plan, I want to give you an insider’s perspective of how it may affect you and your family on the deepest level. I’m not talking about saving a few bucks here or there, I’m talking about your health, longevity and your life itself. Did you know that if you are considering a Medicare Advantage plan rather than traditional Medicare, you may not only be exposing yourself to administrative hassles and headaches, but you could possibly be dooming yourself unnecessarily to many years of suffering or even signing your own death warrant?
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