Strokes are fatal in 17% of cases and are the fifth leading cause of death in the United States. For the remaining 73%, stroke recovery is needed to reduce brain injury, but it can cost an average of $17,000 in the first year! It’s important to understand the role of Medicare and how a Medicare Supplement plan can help you save on costs.
Medicare Coverage for Stroke Victims
Stroke Recovery Appointment | Medicare Plan Finder
An inpatient rehabilitation facility requires you to participate in three hours of therapy every day. If you are unable to participate in three hours of care per day, you can move into a skilled nursing facility with a rehab program.
Choosing the right stroke rehabilitation facility is crucial for recovery. Once you are released from the hospital, your options include an inpatient rehabilitation facility, a skilled nursing facility, or a long-term care hospital. Depending on the severity of your stoke, you may be able to return home and utilize home healthcare or outpatient therapy.
Here are some questions to keep in mind when choosing a facility:
Are they accredited through the Commission on the Accreditation of Rehabilitation Facilities?
What medical services are available?
How intense is the recovery program?
How much does Medicare pay for stroke rehab?
Inpatient Rehabilitation:
Medicare will pay for an inpatient rehabilitation facility the same way it covers hospital stays. This means you are fully covered for 60 days. After 60 days, you will pay $341/day until you reach 90 days, and then $682/day until you reach 150 days. If your care extends past 150 days, you will have to pay the full amount, but your cycle resets after you spend 60 days at home.
Your hospital coverage includes a semi-private room, hospital meals, nursing services, intensive care, drugs and medical supplies used during your stay, lab tests and x-rays, operation and recovery services, some blood transfusions, rehabilitation, and symptom management.
It does NOT include non-medically necessary amenities like completely private hospital rooms, private nurses, and personal care items that hospitals may provide (shower supplies, TV, etc.). To learn more about Medicare Part A coverage, click here.
Home Health Care:
If you are discharged to your home, Medicare will cover up to 60 days for home health services. Medicare Part B will cover your outpatient therapy (physical, speech-language pathology, occupational) at 80%; you will be responsible for 20%.
How many days will Medicare pay for a rehab facility?
Medicare has a 100-day rule for skilled nursing coverage, meaning that Part A will cover 100 days in a skilled nursing facility. The first 20 days are covered completely, but the remaining days (21-100) require coinsurance of $170.50/day.
When you are hospitalized for a stroke, you have 30 days to enter the skilled nursing facility. Like hospital stays, benefit periods last for 60 days. If you leave the facility and are back home for at least 60 days, the next time you enter a facility your “day count” will reset to 0.
Stroke Rehabilitation
The goal of stroke rehabilitation is to recover your body’s functions as much as possible. The process includes exercises to improve actions like talking, walking, and using the restroom.
In some cases, full recovery may be difficult. In this case, your therapist will teach you compensatory strategies. For example, if you lose the ability to use your arm, your therapist will teach you other ways to use the restroom, get into bed, and cook your own meals.
How long does it take for a person to recover from a stroke?
The average stroke patient will see the most improvement in the first three months. However, recovery time will vary on a case-by-case basis depending on the stroke severity. If your brain stem was damaged during the stroke, your recovery time could be a year or longer.
What percentage of stroke patients make a full recovery?
The National Stroke Association estimates that roughly 10% of stroke patients make a complete recovery. This may sound like a small percentage, but don’t let that discourage you! 25% recover almost completely excluding minor impairments (like minimal vision or memory loss). Another 40% will recover but require special short-term care.
Can paralysis from a stroke be reversed?
When you have a stroke, the lack of oxygen and blood cells to your brain can cause damage to millions of brain cells, which can lead to paralysis. This damage is irreversible if the cells are killed, but damaged cells can resume function over time.
Plus, scientists at the Pacific Neuroscience Institute are researching ways to reverse the effects of a stroke by transplanting stem cells and using them as a source for brain cell regeneration. This research will continue, but for now, stroke rehabilitation is the best method to regain independence and recover several of your body’s functions.
How soon after a stroke can you start rehab?
Stroke recovery starts as soon as you are stable. This is typically 24 to 48 hours after a stroke. The first stage of recovery typically takes place in the hospital, but this is dependent on your unique circumstances. After you are discharged from the hospital, your doctors, nurses, and family can help you choose a suitable living arrangement based on your needs.
Benefits of Medicare Supplements
The costs for stroke recovery can add up quickly, and these costs should not disrupt your rehabilitation plan. A Medicare Supplement plan can help cover your copayments, coinsurance, and deductibles. There are 10 plan options (Plan A, B, C, D, F, G, K, L, M, and N). The costs will vary per plan and on which state and county you live in.
Plan F is the most popular Medicare Supplement plan. If you do not have Plan F but you would like to, you can lock yourself in by enrolling NOW. You must enroll before January 1, 2020, to receive Plan F coverage. If you miss this deadline, there’s good news!
Plan G is almost identical to Plan F! The only difference is that Plan G does not cover the Part B deductible (which is less than $200 for most people). In reality, by switching to Plan G you will not be losing much at all. However, keep in mind that you can still keep your Plan F after January 1, 2020, if you enroll in 2019.
If you are interested in exploring Medicare Supplements or have any questions regarding your current coverage, contact us! We have licensed agents across 38 states who are dedicated to making sure you are enrolled in the plan that best fits your needs and budget.
If you are looking for coverage beyond Original Medicare, our agents can help you select a Medicare Advantage (MA) plan instead. Many MA plans offer hearing, dental, and vision coverage, and some even offer group fitness classes like SilverSneakers®. Call us at 844-431-1832 or fill out this form to get in contact with an agent.
Contact Us | Medicare Plan Finder
This post was originally published on March 7, 2019, by Kelsey Davis and was updated on August 7, 2019, by Troy Frink.
As you age, it can become difficult to perform everyday tasks such as bathing or getting dressed, and you may need assistance to do those things.
Long term care may consist of skilled nursing services or physical therapy immediately following an illness or injury, or it may consist of someone coming to your house to help you with day-to-day tasks.
Does Medicare Cover Long Term Care?
Medicare Long Term Care Coverage | Medicare Plan Finder
Original Medicare does not cover long term care unless it follows a hospital stay or is for necessary medical treatment.
However, you can use certain Medicare Advantage (Part C) or Medigap (Medicare Supplement) insurance plans to help pay for non-medically necessary long term care. Here’s what Original Medicare will cover:
Medicare Skilled Nursing Coverage
Medicare Part A will cover short stays (100 days or less) in skilled nursing facilities if you meet these qualifications:
You’ve been admitted to the hospital for at least three days
A Medicare-certified skilled nursing facility admits you within 30 days of the initial hospital stay
Your treatment plan involves skilled care such as physical therapy or skilled nursing services.
Medicare will cover 100 percent of the costs for the first 20 days. In 2019, your copay for days 21-100 is $170.50.
For Medical Treatment
In order for Medicare to cover long term care for medical treatment, your doctor must first deem it medically necessary. Medicare Part B will cover the following services:
Intermittent and part-time skilled nursing care
Physical therapy
Occupational Therapy
Speech pathology
Your durable medical equipment (DME) can be covered if your doctor prescribes it and it will be used for at least three years. Medicare Part B also covers mental health services to help manage the psychological and cultural issues that come with having an illness.
There is no limit on how long you can receive the above services if your doctor reorders them every 60 days.
Chronic Special Needs Plans (C-SNP) will cover long term care services for people with chronic illnesses. The covered services for conditions such as Parkinson’s and ALS are to help prevent and slow the progression of the symptoms.
Original Medicare will NOT cover prescription drugs for chronic illnesses, however. Prescription coverage falls under Medicare Part D and certain Part C plans.
Part D Checklist | Medicare Plan Finder
Medicare Hospice Coverage
If you have a terminal illness with no chance of improvement, are expected to live less than six months, and are looking for peace instead of a cure, Medicare will cover hospice care.
In order for Medicare to cover drugs to control the symptoms and to relieve pain, you must be receiving care from a Medicare-approved hospice provider.
You can receive hospice care at your home, in a nursing home, or in a hospice care facility. When you enter hospice care, you will have an entire team of people focused on your overall comfort and well-being including your spiritual and emotional needs, not just your physical needs.
Long Term Care Coverage With Medicare Supplement Vs. Medicare Advantage
Private insurance companies offer plans that can go beyond what Medicare Parts A and B will cover. For non-medically necessary long term care, you won’t be able to use Original Medicare, and, for the most part, you won’t be able to use Medicare Supplements, either. If you want long term care coverage, a Medicare Advantage plan may be your best option.
Long Term Care Medicare Supplement
Medicare Supplements (Medigap) plans are designed to fill in the financial gaps Original Medicare creates. For example, you are financially responsible for that $170.50 copay. You can use a Medicare Supplement to help make those payments easier.
Medicare Advantage
Medicare Advantage (MA) plans are insurance plans that can cover medical services Original Medicare does not. While Medigap plans are strictly for help paying for out-of-pocket costs, MA plans are for additional medical coverage. Certain Part C plans can include coverage for DME and non-medical long term care, so it’s critical you know what your options are.
Note: You cannot have both a Medicare Supplement and a Medicare Advantage plan, so having someone help you sift through the thousands of plans out there and find the right one for you is extremely important to your overall health and well-being.
Medicare Advantage | Medicare Plan Finder
Why It’s Important to Have a Plan
Long term care can easily cost hundreds or thousands of dollars a month, and those costs will only increase. By 2050 the baby boomer population in the US will be 80 million, and that means more competition for home health care and therefore steeper prices. Having a health insurance plan to help with those costs might not only help you stay in good health, but also give you peace of mind.
Get Medicare Long Term Care Coverage Today
Are you looking for Medicare long term care coverage? One of our licensed agents can answer your questions and help you find the right plan for you. Fill out this form or call us at 844-431-1832 for a no-obligation appointment today.
Find Medicare Plans | Medicare Plan Finder
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Original Medicare vs. Medicare Advantage
The Annual Enrollment Period is quickly approaching and starting October 15, you will be able to switch Medicare Plans. Which do you favor in the battle of Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each, you will be better prepared to make that decision.
What is Medicare?
Medicare is operated under the federal government and covers a variety of health care expenses and provides benefits for seniors over 65 as well as those with Social Security benefits or certain health conditions. There are many parts, policies, and new standards associated with Medicare. We get it – it’s confusing! It’s important to understand the history of Medicare Part A B C D, because AEP is right around the corner!
Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage).
Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.
Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.
If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescription drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.
Time to get the coverage you need with Medicare!
History of Medicare
National health coverage wasn’t even discussed until President Roosevelt in 1912. He ran on a platform that included providing health coverage to anyone who needed it. Flash forward to 1945 when President Truman took office. Within seven months, he called for a national health fund that would be available to all Americans.
Truman fought hard, but it took another 25 years before anything went into effect. In 1965, Lyndon B Johnson signed legislation that provided benefits for seniors over 65. As of 2018, the Centers for Medicare and Medicaid Services (CMS) estimate that over 58.5 million people benefit from Medicare. As more policies and new standards go into effect and technology creates healthcare innovations in this industry, Medicare will continue to evolve.
Medicare Part A B C D
Medicare is broken into specific parts and each part is unique. Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy.
Most beneficiaries receive Part A for free and Part B is covered by a monthly Medicare premium. Beyond Original Medicare, there are Parts C and D. Part C is Medicare Advantage (MA).
MA plans combine Part A (hospital fees insurance) and Part B (medical insurance) and usually prescription drug coverage. Part D is a standalone plan that is purchased separately on top of Original Medicare. It can help cover the cost of prescription drugs.
What is Medigap?
If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan. What is Medigap? Medigap plans help pay some of the cost that Original Medicare does not cover. This can include copayments, coinsurance, and deductibles. Medigap plans generally don’t cover vision or dental care but may include prescription drug coverage. They are sold by private insurance companies. You cannot be enrolled in a Medicare Advantage plan and Medigap, so it’s important to compare and evaluate your budget and needs.
Pros and Cons of Medicare
Some people love Medicare, and others don’t care for it.
Why Medicare is Awesome
Premiums: If you worked for most of your life, you won’t have to pay any premium for Medicare Part A!
Healthcare Innovation: Medicare has increased healthcare innovations in the medical market tremendously. Thanks to Medicare, millions of Americans suddenly have access to health coverage they otherwise would be unable to afford. Millions of dollars have been invested in healthcare innovation and development!
Medicare “Rules:” CMS has steady Medicare rules that help prevent fraud, waste, and abuse. Without breaking the Medicare Rules, Medicare agents and plans can’t take advantage of you!
Why Some People Dislike Medicare
Hospital Fees: Even with the help of Medicare, hospital fees can still cost a pretty penny. Medicare beneficiaries typically pay 20% of the total fee. Additionally, Medicare typically does not have a cap. This means that if you have a series of health issues within a year, you may be spending more than you originally budgeted.
Prescription Drug Coverage: Medicare does not cover prescription drugs. If you are looking to purchase drug coverage, you will need to purchase separate prescription drug coverage through Medicare Advantage or Part D.
Limitations: Original Medicare provides the same health coverage for everyone. There is no personalization or choosing the exact benefits you want, unless you enroll in Medicare Advantage. If you are seeking more than basic health coverage, an MA plan could be perfect for you.
Enrolling in Medicare Advantage
What is Medicare Advantage?
The history of MA plans is relatively short compared to Original Medicare. Just like Medicare, MA plans have benefits for seniors over 65 and certain disabled persons. These plans are rising in popularity and may be the best option for you!
Medicare Advantage plans can allow you to have a monthly premium for all your additional benefits, like dental, vision, and prescription drugs. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors and other Medicare eligibles. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
The History of the Medicare Advantage Program
Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.
Medicare Advantage (Part C) Popularity
According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even fitness programs like SilverSneakers®. These plans have a set network of Medicare providers you must choose from, but don’t worry! There are many different networks and plans available.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.
HMOs:
An HMO, or Health Maintenance Organization, has a closed provider network. You’ll have to select one primary provider for most of your healthcare needs. HMOs may require you to get a referral for more severe injuries or illnesses.
PPOs:
PPOs, or Preferred Provider Organizations, allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.
Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
Pros and Cons of Medicare Advantage
Why Medicare Advantage Plans are Awesome
Premiums:KFF reported that half of Medicare Advantage beneficiaries in 2019 pay no premium at all, and most others pay between $20 and $100.
Out-of-pocket Max: Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have a limit for your out-of-pocket costs, saving you even more in the long run!
Prescription Drugs: Prescription drug coverage is often included in Medicare Advantage plans. This allows you to bundle your health coverage – saving you money and creating more convenience for you!
Unexpected Benefits: Some Medicare Advantage plans even include cool benefits like gym memberships!
Flexibility: There is a broad range of Medicare Advantage plans out there, so you may be able to choose between a few options to get the one that’s right for you.
Why Some People Don’t Like Medicare Advantage Plans
Limited Networks: There is usually no nationwide coverage with Medicare Advantage plans. This can be an issue if you frequently travel within the US. Additionally, your network may require that you only see specialists that your doctor refers you to.
Price Fluctuation: The specifics of your Medicare Advantage plan varies per provider. You may still be required to pay copays and coinsurance fees. Additionally, your Medicare premiums and copayments may change each year.
Medicare Doctor
Medicare Advantage vs. Medigap
When comparing Medicare Advantage vs Medigap, it’s easy to get confused. Medigap can only be purchased alongside Original Medicare. You cannot have a Medicare Advantage and Medigap plan at the same time. Medigap plans cost an additional monthly Medicare premium, but they help fill the cost gaps in coverage – this means less out of pocket costs for you.
Medicare Advantage vs Medigap prices can vary. If this is something you’re interested in, it’s important to compare policies.
medicareplanfindertool.com
Difference Between Medicare and Medicare Advantage
What is the difference between Medicare and Medicare Advantage? It is easy to confuse the two. The main difference is that while Original Medicare is the federal program, Medicare Advantage plans are privately owned. Medicare Advantage plans still have to follow all the rules determined by CMS (Centers for Medicare and Medicaid Services), but they are able to offer benefits that the federal program cannot. med
How to get Medicare Advantage
Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon!
From October 15 to December 7, anyone with Medicare can make changes to their plans. If you’re interested in purchasing a Medicare Advantage plan or hearing more about how to get covered, complete this form or call us at 844-431-1832 to arrange a free, no-obligation appointment with an agent and get covered today.
*This blog was originally published on September 20, 2018, and updated on July 28, 2019.
5 Medicare Enrollment Periods & What You Can Do During Each One
Did you know there are five different Medicare enrollment periods? You may qualify to enroll or make changes to your current coverage and have no idea! AEP is just a few months away, so we’d like to share with you what you can do during the various enrollment periods so you are properly prepared.
Initial Enrollment Period
Your Initial Enrollment Period (IEP) is typically your first opportunity to enroll in Medicare. Your IEP is three months before your 65th birthday and three months after. This gives you a seven-month window to enroll in your preferred coverage.
In most cases, if you do not enroll in Part A and Part B (Original Medicare) during your IEP, you will be charged a late enrollment penalty fee that will be added to your monthly Part B premium. If you do not have prescription drug coverage, you should also consider enrolling in a Part D plan to avoid other penalties down the road. You are not required to enroll in a Medicare Advantage or Medicare Supplement plan, but you should consider enrolling to optimize your coverage.
The General Enrollment Period (GEP) is for those who are enrolling in Medicare for the first time but missed their IEP. The GEP runs from January 1 to March 31 each year, and coverage will begin in July.
During the GEP, you can:
Enroll in Original Medicare if you missed your IEP
*If you enroll for the first time during the GEP, you can follow up by enrolling in a Medicare Advantage plan during a period from April 1 through June 30.
Annual Enrollment Period
The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, all Medicare beneficiaries can make changes to their plans. You may not need to do anything during AEP. However, major insurance carriers can change the benefits that they offer every year. It’s possible that a change in your plan benefits or your provider network will change how you feel about your plan. Ultimately, it’s always a good idea to speak with an agent. Any changes you make during AEP become effective on January 1 of the following year.
Most people can only make changes to their plans once a year (during AEP), but if you qualify for a Special Enrollment Period you can make those changes during different times of the year or even all year long. Lifelong SEPs allow you to change plans once every quarter for the first three quarters of the year. Circumstantial SEPS allow you to change plans once following a particular event.
Starting in 2019, there will be a new “Medicare Open Enrollment Period” that will run from January 1 through March 30. OEP was created for anyone who signs up for a Medicare Advantage plan during AEP to enroll in a different plan, without having to wait until the following fall. You do not have to do anything during OEP unless you are unhappy with the coverage you enrolled in during AEP.
Change from Medicare Advantage to Original Medicare only, with the option to add a prescription drug plan
Contact Medicare Plan Finder
Are you looking to enroll in Medicare Advantage, Medicare Supplements, or Part D? Are you still confused on which Medicare enrollment periods you qualify for?
Our agents at Medicare Plan Finder can answer any of your questions and simplify the enrollment process. They are contracted with most of the major carriers in your state so the agent should not show bias when enrolling. To speak with a licensed agent and to learn about plans in your area, click here or call 844-431-1832.
This blog was originally published on 10/23/18 and was updated on 7/15/19.
Everything You Need to Know About Medigap Plan M
More than one in four beneficiaries are enrolled in a Medicare Supplement (Medigap) plan. These plans work alongside Original Medicare and provide financial protection like help paying for your deductibles, coinsurance, and copays. There are ten different types of plans (A, B, C, D, F, G, K, L, M, and N) and each letter represents a different level of protection for a different price. You can have fewer benefits for a smaller monthly premium, or get more benefits for a slightly higher monthly premium. Is Medigap Plan M right for you?
What is Medigap Plan M?
Medigap Plan M is one of the cheaper options on the market because it doesn’t offer as many benefits. However, it still has more benefits than other plans (like plans K, L, and A). Specifically, Plan M covers:
100% of blood work copays (up to three pints)
100% of hospice coinsurance & copayments
100% of skilled nursing facility insurance
100% of your Part A coinsurance & hospital costs
100% of your Part B coinsurance & copayments
100% of your Part B excess charges
50% of your Part A deductible
80% of a foreign travel emergency
The only benefit that is not covered is the Part B deductible. The only plans that cover the Part B deductible are Plan F and Plan C, but they are both going away in 2020. This is because Congress found that paying the Part B deductible encouraged people to go to the doctor more often than needed. You will need to enroll before 2020 to be grandfathered-in. However, if you choose to enroll in another plan (like Plan M), you will be responsible for the Part B deductible, but it’s only $185 in 2019.
Medicare Plan M vs. Medicare Part M (Are They Different?)
Medicare can be overwhelming, and it’s easy to confuse all the different parts and plans. Medicare “parts” refer to parts A and B (Original Medicare), Part C (Medicare Advantage), and Part D (prescription drug coverage). “Medicare plans” are generally referring to Medigap plans, and as we mentioned there are ten different types. There is no “Medicare Part M.” The proper name for Medicare Plan M is “Medicare Supplement Plan M” or “Medigap Plan M.”
Medigap Plan M Eligibility
To be eligible for any Medigap plan, you must be enrolled in parts A and B first. Medigap plans are sold through private insurance companies. However, most states are not required to sell Medigap plans to beneficiaries under 65. This means if you qualified for Medicare through ESRD (end-stage renal disease), ALS (Lou Gehrig’s disease), or SSDI (Social Security Disability Income) and are not 65, you can be denied Medigap coverage. To find out if you’re eligible, click here or give us a call at 844-431-1832.
What is the Cost of Medigap Plan M?
Medigap plans (A, B, C, D, F, G, K, L, M, and N) are generally very similar no matter which carrier you buy from. For example, Plan M from Carrier one would offer mostly the same benefits as Plan M from Carrier two. However, pricing can differ based on carrier, zip code, age, gender, and tobacco use. Our licensed agents can show you all of the available plans in your area and help you enroll in the plan with the best price. Click here or call 844-431-1832 to contact a licensed agent.
Medicare Plan M Reviews
Top Medigap carriers for 2019 include:
AARP
Aetna
Blue Cross Blue Shield
Cigna
Conseco
Gerber
Mutual of Omaha
Liberty National
Oxford
Physicians Mutual
State Farm
TransAmerica
Medicare Plan M vs Plan N (and other popular plans)
Some people confuse Medigap Plan M with Plan N. Plan N is one of the most popular plans (along with Plan G). Plan G covers everything except the Part B deductible. More specifically, it covers:
Blood work copays up to three pints (100%)
Foreign emergency travel (80%)
Hospice coinsurance and copayments (100%)
Part A coinsurance and hospital costs (100%)
Part B coinsurance and copayments (100%)
Part A deductible (100%)
Part B excess charges (100%)
Skilled nursing facility coinsurance (100%)
The only benefit that is included in Plan G that Plan N does not cover is the Part B excess charges. However, excess charges are relatively rare. You will only be charged an excess charge if your provider does not accept Medicare. If you would prefer to pay a bit more towards your monthly premium in exchange for coverage on excess charges, Plan G may be perfect for you.
Other popular plans include Plan F and Plan C, but as we mentioned, they are going away in 2020. These plans are popular because they cover the Part B deductible. The only difference between Plan F and Plan C is that Plan F covers Part B excess charges. Click here to find out which Medigap plan is best for you.
How to Enroll in Medigap Plan M
Did you know you can enroll in Medigap Plan M (or any Medigap plan) any time of the year? But if you wait too long, carriers can charge you more or even deny you coverage based on any health conditions you may have. Your best bet is to enroll during your Initial Enrollment Period (IEP). During this time, you shouldn’t be denied or charged more based on any conditions. If you IEP has already passed, that’s okay! One of our licensed can still show you plans that are available in your area. Click here or call 844-431-1832h.
Medigap and Pre-Existing Conditions (& How it Impacts You)
A pre-existing condition is a medical condition that started before a person’s health benefits went into effect (like diabetes, COPD, cancer, sleep apnea, etc.) Some of the most common questions we get are, “Do pre-existing conditions impact your Original Medicare coverage? What is considered a pre-existing condition? How do Medigap and pre-existing conditions work?”
Original Medicare and Pre-Existing Conditions
Before we dive into Medigap and pre-existing conditions, let’s discuss the role of Original Medicare. A pre-existing condition cannot stop you from enrolling in parts A and B, and you will not be charged more due to your condition. This is great news for those who have been previously diagnosed with asthma, diabetes, cancer, or some other chronic health condition. However, your out-of-pocket costs can quickly add up if you’re only enrolled in Original Medicare. Fortunately, Medicare Supplements can help!
What are Medicare Supplements?
Medicare Advantage and Medicare Supplements are two very different types of plans. Medicare Advantage plans are stand-alone plans that offer the same benefits as Original Medicare. These plans often include extra health benefits like hearing, vision, dental, or group fitness classes (like SilverSneakers® and Silver & Fit®). Medicare Supplement (Medigap) plans offer financial protection but usually do not include additional health benefits.
You cannot be enrolled in a Medicare Advantage and Medicare Supplement plan at the same time. If you aren’t sure which type of plan is best for you, one of our licensed agents can help! To get started, click here or call 844-431-1832.
The average beneficiary enrolled in Original Medicare spends roughly $4,300 each year on premiums, deductibles, copayments, and other Medicare-related costs. Medicare Supplement (Medigap) plans can be purchased to work alongside Original Medicare to help cover these costs and provide financial protection through a range of benefits. These benefits include:
Blood work copays (up to three pints)
Foreign emergency travel
Hospice coinsurance and copayments
Part A coinsurance and hospital costs
Part A deductible
Part B coinsurance and copayments
Part B deductible
Part B excess charges
Skilled nursing facility coinsurance
There are ten different types of Medigap plans that you can choose from, and each plan offers a different combination of benefits. Generally, the more benefits a plan has, the higher the monthly premium will be. Medigap plans do not replace Original Medicare, and you must be enrolled in parts A and B first.
Popular Medigap Plans
The most popular Medigap plans are generally the ones that offer the most comprehensive coverage. They typically have higher monthly premiums, but they help you save money in the long-run. These plans include:
Plan F and Plan C are going away in 2020. They are the only two plans that cover your Part B deductible. Congress believed that covering the Part B deductible made the plan too inclusive, and people were encouraged to visit the doctor too often because it was practically free. If this specific benefit is important to you, you need to enroll before 2020. To get started, click here or call 844-431-1832.
Do Medicare Supplements Cover Pre Existing Conditions?
In general, if you enroll in Medigap when you are 65, you may not be penalized for preexisting conditions. However, if you are not yet 65 or if you wait too long, you may be charged more or denied based on your preexisting conditions.
However, if you can’t get a reasonably priced Medigap plan, there are hundreds of disabilities that are automatic qualifiers for Medicare Advantage Chronic Special Needs Plans. You do not have to be 65 to qualify for these plans as long as your disability is a qualifier.
Medigap Plans Eligibility
To be eligible for a Medigap plan, you must be enrolled in parts A and B first. Medicare Supplements are sold through private insurance companies. However, states are not required to sell Medigap plans to beneficiaries under 65. This means if you qualified for Medicare through ESRD (end-stage renal disease), ALS (Lou Gehrig’s disease), or SSDI (Social Security Disability Income) and are not yet 65, you can be denied a Medigap plan.
Medicare Supplements for Beneficiaries Under 65
When Can I Buy Medigap?
If you apply for a Medigap plan, you have certain rights guaranteed by federal law. These are called “guaranteed issue rights,” and they protect you from being denied healthcare. During your Initial Enrollment Period (IEP), you cannot be overcharged or denied access to Medigap based on pre-existing conditions.
You can purchase a Medigap plan year-around, but if you do not purchase a Medigap plan during your IEP, you can be denied coverage or required to pay a higher premium. This occurs through medical underwriting where the insurer can consider your age, gender, and pre-existing conditions you have been diagnosed with or treated for in the last six months. Plus, some insurers can refuse to cover your pre-existing condition for up to six months. This is called your waiting period. This can be avoided or shortened if you have had creditable health coverage. Insurers classify creditable health coverage to be any form of healthcare that has been active for at least 63 consecutive days.
Medigap Plan Finder
If a Medigap plan is something that sounds interesting to you, your best Medigap plan finder tool is a licensed agent! Our licensed agents are contracted with all of the major plans and carriers to eliminate any bias when showing you plan availability and costs. If you’re interested in speaking with a licensed agent or setting up an appointment, click here or call 844-431-1832.
This blog was originally published on 10/28/18, but was updated on 6/14/19.
What is Medigap Plan L?
Medicare Supplement plans (also known as Medigap plans) work alongside Original Medicare to provide financial benefits and protection. More than nine million beneficiaries are enrolled in a Medigap plan, and enrollment increases each year.
There are ten standardized plans broken down by letters (A, B, C, D, F, G, K, L, M, and N). Each letter represents a different range of coverage for a different price. You can have fewer benefits for a smaller monthly premium, or get more benefits for a slightly higher monthly premium.
Most plans are guaranteed renewable for life, meaning as long as you pay your premium on time, you should not be canceled from your plan due to a new health condition. Plans are also generally the same regardless of which carrier you enroll with. If you’re looking for financial benefits to supplement your Part A and B, Medigap Plan L may be perfect for you.
What Does Medigap Plan L Cover?
Medigap Plan L is one of the cheaper options on the market because it doesn’t cover as much as some of the other plan types. Specifically, Plan L covers:
100% of your Part A coinsurance & hospital costs
75% of blood work copays (up to three pints)
75% of hospice coinsurance & copayments
75% of skilled nursing facility insurance
75% of your Part A deductible
75% of your Part B coinsurance & copayments
Other benefits of Medigap plans include coverage for:
Part B deductible
Part B excess charges
Foreign travel emergency
Plan L Costs
Medigap plans (A, B, C, D, F, G, K, L, M, and N) are generally very similar no matter which carrier you buy from. This means that, for example, Plan L from Carrier 1 would offer mostly the same benefits as Plan L from Carrier 2. However, pricing can differ based on carrier, zip code, age, gender, and tobacco use. Our licensed agents can show you all of the available plans in your area and help you enroll in the plan with the best price. Click here or call 844-431-1832 to contact a licensed agent.
Medicare Supplement Eligibility
To be eligible for a Medicare Supplement plan, you need to be enrolled in Original Medicare (Part A and B). Medigap plans are sold through private insurance companies and are not required to sell a plan to beneficiaries under 65. This means if you qualified for Medicare by turning 65, having ESRD (end-stage renal disease) or ALS (Lou Gehrig’s Disease), or through Social Security Disability Income (SSDI), you may not be eligible for a Medigap plan. However, a licensed agent can help you find any available plans in your area that you may qualify for. Click here or call 844-431-1832 to contact a licensed agent.
Plan L Reviews
Some of the top Medigap carriers for 2019 include:
AARP
Aetna
Amerigroup
Cigna
Humana
Mutual of Omaha
WellCare
Popular Medicare Supplements
Some of the most popular Medigap plans are Plan G and Plan F because they offer the most coverage. Plan F is almost identical to G, the only difference is Plan F covers the Part B deductible. However, Plan F is going away, and you must be enrolled in Plan F no later than January 1, 2020, to maintain coverage. Plan G is cheaper than Plan F with almost identical benefits, so many beneficiaries prefer Plan G.
If you would prefer to pay a higher monthly premium, but have more financial protection, Plan G or F may be right for you. Contact a licensed agent to talk about plan specifics. Click here or call 844-431-1832.
Enroll in a Medigap Plan
You can enroll in Medigap Plan L (or any Medicare Supplement plan) any time of the year, but if you wait too long, carriers can charge you more or even deny you coverage based on your health conditions. You should consider enrolling in a Medigap plan during your Initial Enrollment Period (IEP). During your IEP, you should not be denied or charged more for any pre-existing conditions. If your IEP has already passed, that’s okay! A licensed agent can still show you plans in your area and help you enroll in a qualified plan. Click here or call 844-431-1832 to contact a licensed agent.
Guide to Medicare Supplement Plan N
Medicare Supplement plans, also known as Medigap plans, add financial benefits that work alongside Original Medicare. More than nine million beneficiaries are taking advantage of this additional financial protection, and enrollment continues to increase each year.
There are ten different types of Medigap plans, (A, B, C, D, F, G, K, L, M, and N), and each letter represents a different level of coverage. Plans are the same regardless of which carrier you enroll with. This means if you want to enroll in Plan N, the benefits are the same whether you enroll with Aetna, Cigna, etc.
Plus, most plans are guaranteed renewable life, which means you shouldn’t be dropped if a new health condition develops (as long as you pay your monthly premium on time). If you’re looking for financial benefits to supplement your Original Medicare, but don’t want a huge monthly premium, Medicare Supplement Plan N may be right for you.
What is Medicare Plan N?
Medicare Supplement Plan N was introduced in 2010 and has been a popular choice for beneficiaries ever since. Plan N covers:
Part A coinsurance and hospital costs
Part B coinsurance and copayments
Blood work copays up to three pints
Hospice coinsurance and copayments
Skilled nursing facility coinsurance
Part A deductible
Foreign travel emergency
Medicare Supplement Plan N Eligibility
To be eligible for any Medicare Supplement plan, you must be enrolled in Part A and B first. Medicare Supplements are sold through private insurance companies. However, most states are not required to sell Medigap plans to beneficiaries under 65. This means if you qualified for Medicare through ESRD (end-stage renal disease), ALS (Lou Gehrig’s disease), or SSDI (Social Security Disability Income) and are not 65, you can be denied a Medigap plan. To find out if you’re eligible, click here or give us a call at 844-431-1832.
What is the Cost of Medicare Supplement Plan N?
As we mentioned, plan benefits are usually the same from carrier to carrier. However, that doesn’t mean the pricing is the same. Plan N requires some cost sharing in certain situations. There is typically a copayment of up to $20 for doctor appointments and $50 for hospital admittance. Medicare Plan N does not cover the Part B deductible ($185 in 2019) or Part B excess charges. Part B excess charges are up to 15% of what Medicare paid for a product or service. You are only responsible for the excess charges if your doctor does not accept Medicare assignment rates.
The cost of your monthly plan premium will vary based on your zip code, age, gender, and tobacco use. There’s no need to overpay for a plan if there is a cheaper plan available in your area that offers identical benefits. Our licensed agents can show you plans specific to your zip code and can help prevent overpaying. Click here or give us a call at 844-431-1832.
Medicare Supplement Plan N Reviews
If plan benefits are the same across carriers, why are some plans reviewed higher than others? Well, price is a huge factor. Companies with higher customer ratings have plans with higher ratings. Lastly, customer service is an important factor. Here is a list of some of the top Medigap carriers for 2019:
AARP
Aetna
Amerigroup
Cigna
Humana
Mutual of Omaha
WellCare
Medicare Plan N vs Plan G
Medicare Supplement Plan G is another popular Medigap plan. The only benefit that is included in Plan G that Plan N does not cover is the Part B excess charges. However, the thing to remember about excess charges is they are relatively rare. You will only be charged an excess charge if your provider does not accept Medicare. If you would prefer to pay a bit more towards your monthly premium in exchange for coverage on excess charges, Plan G may be perfect for you. One of our licensed agents can help you enroll. Click here or give us a call at 844-431-1832.
Medicare Plan N vs Plan F
Plan F has been a top-selling Medicare Supplement for years. The only difference between Plan F and Plan N is that Plan F covers the Part B deductible and Part B excess charges. Plan F is going away in 2020 (along with Plan C). The Centers for Medicare and Medicaid Services believe that coverage for the Part B deductible results in beneficiaries visiting the doctor too often, costing Medicare millions of dollars. If this benefit is something that is appealing to you, you need to enroll before 2020 to be grandfathered in. Fortunately, one of our licensed agents can help. Click here or give us a call at 844-431-1832.
How do I get Medicare Plan N?
You can enroll in a Medicare Supplement plan any time of the year, but carriers can charge you more or deny coverage if you wait too long. The best time to enroll is during your Initial Enrollment Period. During this time, you can enroll in any plan that is in your area without being denied or charged more for pre-existing conditions. Click here or give us a call at 844-431-1832 to get in contact with a licensed agent.
What is Medigap Plan K?
Medicare Supplements are often referred to as Medigap plans. These plans provide financial benefits and help cover out-of-pocket expenses that Original Medicare does not, like copayments, coinsurance, and deductibles. More than 22% of Medicare beneficiaries are enrolled in a Medigap plan and enrollment has increased each year since 2010.
Medigap plans are broken down into ten standardized plans (A, B, C, D, F, G, K, L, M, and N). Each letter offers a different range of coverage at a different price point. You can evaluate which benefits are the most important to you and if you would rather pay a higher monthly premium for more benefits or pay less and receive less coverage.
Medicare Supplements are also popular because most are guaranteed renewable life, which means as long as you pay your premium on time, you will not be canceled from your plan due to new health conditions. Plus, Medicare Supplements are generally the same regardless of which carrier you enroll with. If you’re looking to supplement your Original Medicare, Medigap Plan K may be a good option.
What does Medigap Plan K Cover?
The fewer benefits a plan provides, the lower the monthly premium is. This means Plan K is cheaper than other plans on the market like Plan F or Plan G. Plan K covers:
Part A coinsurance and hospital costs
50% of Part B coinsurance and copayments
50% of bloodwork co-payments (up to 3 pints)
50% of hospice coinsurance and copayments
50% of skilled nursing facility coinsurance
50% of your Part A deductible
Other benefits of Medicare Supplements include:
You’re able to keep your current doctor (as long as they accept Medicare)
You can see a specialist without needing a referral
Coverage travels with you throughout the U.S.
Plan K Costs
Medigap plans are generally the same regardless of which carrier you enroll with. This means if you want to enroll in Medicare Supplement Plan K, you will have the same coverage whether you enroll with Blue Cross Blue Shield, Cigna, or another carrier. However, while the coverage may be the same, the costs are not. The cost of your plan will vary based on your zip code, age, gender, and tobacco use. Our licensed agents can show you available plans in your area and help you enroll in a plan that fits your needs and budget. Fill out this form or give us a call at 844-431-1832.
Medicare Supplement Eligibility
Medicare Supplement plans are designed to work alongside Original Medicare. To be eligible, you must be enrolled in Part A and B first. Medicare Supplements are sold through private insurance companies. However, most states are not required to sell Medigap plans to beneficiaries under 65. This means if you qualified for Medicare through ESRD (end-stage renal disease), ALS (Lou Gehrig’s disease), or SSDI (Social Security Disability Income), you could be denied Medigap coverage. Your best bet is to speak with one of our licensed agents. They can help you look for any plans that are available to you and discuss plan specifics. Fill out this form or give us a call at 844-431-1832.
Plan K Reviews
Some of the top Medigap carriers for 2019 include:
AARP
Aetna
Amerigroup
Cigna
Humana
Mutual of Omaha
WellCare
AARP Medicare Supplement Plan K
AARP is a very popular choice when purchasing Medigap Plan K. AARP offers competitive rates that have only been increased an average of 2.9% over the last 5 years. They also provide fast service through the claims process. Most claims are processed within ten days or less. Lastly, AARP has a 98% customer satisfaction service rating. If you’re interested in enrolling in Medigap Plan K with AARP, fill out this form or give us a call at 844-431-1832.
Enroll in Medigap Plan K
You can enroll in a Medicare Supplement plan any time of the year, but if you wait too long, carriers can charge you more or deny you for your health conditions. The best time to enroll is during your initial enrollment period. During this time, you can enroll in any plan that is in your area and not be denied or charged more for pre-existing conditions. A licensed agent can show you available plans in your area and help you save money in the long-run. When you meet with one of our agents, there is never a cost to you and absolutely no obligation to enroll. Fill out this form or give us a call at 844-431-1832.
What is Medicare Supplement Plan A?
Medicare Supplement Plan A is often referred to as Medigap Plan A or Medicare Plan A. Like other Medicare Supplements, Plan A helps cover the gaps that Original Medicare does not, including coinsurance, copayments, and deductibles. There are ten types of Medicare Supplement plans (A, B, C, D, F, G, K, L, M, N).
About Medicare Supplements
Most plans are guaranteed renewable life, meaning as long as you pay your premium on time, you won’t be canceled from your plan due to a new health condition. Plus, unlike Medicare Advantage plans, Medigap plans are generally the same no matter which carrier you enroll with. If you’re looking for coverage assistance, a Medigap plan may be the way to go – but which one? Here’s everything you need to know about Plan A.
What does Medicare Supplement Plan A cover?
Plan A offers the least amount of benefits among all Medicare Supplements, but that doesn’t mean you shouldn’t consider it! The less benefits a plan provides, the lower the monthly premium is. Since Plan A offers the least coverage, it is typically one of the cheapest plans on the market. Plan A covers:
Part A coinsurance and hospital costs
Part B coinsurance and co-payments
Bloodwork co-payments (up to 3 pints)
Hospice coinsurance and co-payments
Plan A Costs
All Medigap plans provide the same basic benefits regardless of which carrier you choose. This means if you want to purchase Plan A, you will have the same coverage whether you enroll with Aetna, Blue Cross Blue Shield, or Cigna, etc. However, here’s the catch… the costs will vary based on carrier, zip code, age, gender, and tobacco use. Some plans are as low as $70/month while some are as high as $140/month. Certain plans can add extra benefits, like SilverSneakers®, but this is rare.
If you choose to enroll in a Plan A Medicare Supplement plan, you will be responsible for your Medicare Part A and B deductibles. You will also be responsible for any skilled nursing facility care coinsurance, Part B excess charges, and emergency health costs while traveling. This is great if you rarely see unexpected health costs and would rather have lower monthly costs than high premiums for benefits you don’t use.
You know your health better than anyone, and if you generally have high costs in the areas that Plan A does not cover, it may not be the best plan for you. Instead, you should consider the popular, more comprehensive, Plan G.
Plan A Reviews
If the benefits are going to be mostly the same no matter which carrier you choose to go with, why do the prices differ? There is no reason to overpay when the benefits are the same. There are so many top rated companies that sell Medigap. Companies with higher ratings have plans with higher ratings. Customer service is also an important factor. Here is a list of the top Medigap carriers for 2019:
AARP
Aetna
Amerigroup
Cigna
Humana
Mutual of Omaha
WellCare
Plan A for Disabled People
If you are under 65 and qualify for Medicare through a disability, you may be able to enroll in a Medicare Supplement plan. The availability of these plans will vary depending on where you live. Federal law doesn’t require companies to sell you a plan if you are under 65 unless you live in California, Massachusetts, or Vermont. These states are required to offer at least one Medigap policy. Other states may offer Medigap plans, but they are not required to by law. Policies for those under 65 often cost more, so you may want to consider a Medicare Advantage plan instead.
Medicare Part A vs. Plan A
Medicare can be confusing, and it’s easy to confuse all the different parts and plans. We don’t want you to confuse Medicare Supplement (Medigap) Plan A with Medicare Part A. Part A is part of Original Medicare and covers hospital care, skilled nursing facility care, hospice, and home health services. Plan A is one of the ten Medicare Supplement Plans. You may hear Plan A referred to as Part A, but Plan A is the correct term. Here’s an easy way to remember it: Medicare only has four parts (A, B, C, and D), while all Medicare Supplements are referred to as plans.
Enroll in Medicare Supplement Plan A
The best time to enroll in a Medicare Supplement plan is during your initial enrollment period (three months before and after your 65th birthday). During this time, you can enroll in any plan that’s available in your area regardless of any health issues you may have. Outside of your IEP, you can enroll year around, but carriers can deny you or charge you more for existing conditions. Your best bet is to speak with a licensed agent. There is never a cost for meeting with one of our agents, and you are never obligated to enroll. Fill out this form or give us at a call at 844-431-1832.
