In Arizona, medical beneficiaries who are in need of help for paying Medicare expenses must consider enrolling in a Medicare Supplement Plan known as Medigap Plan. It must be noted that Medigap plans are available through private insurance companies, not only in Arizona but in every state across U.S.
Medigap plans generally help with the expenses which are incurred under original Medicare plans which are Plan A and Plan B. Medigap plans are now almost same across all of the United States in terms of both policies and cost. For those of you who are not sure about the number of Medigap plans, just know that there are 10 standardized Medigap plans available in all of the states. The plans are labelled from A to N where Plan A and Plan B are the most basic plans which every state offers under the rule of federal administration.
If you are already enrolled original Medicare Plan A and B, then you are eligible to sign up for Medigap Plans. Not many people know but the best time to buy a Medicare Supplement plan is during the Medigap Open Enrollment Period. This period starts as soon as you reach the age of 65 and is also enrolled in Medicare Plan B. Individuals can sign up for any Medigap plans during this time according to the plans available in their state. The important thing to keep in mind is that there are no additional enrollment periods besides each of theirs Medigap Open Enrollment Period.
In Arizona and across all of the United States, Medigap plans doesn’t include prescription drug coverage, so you have to enroll in a Part D plan for prescription for separate Medicare to cover the cost of medicines or drugs. Prescription drug plans for Medicare Part D in Arizona are available through private insurance companies.
It has been observed through the survey that Arizona is the most famous destination to retire. Surprisingly, above a million residents of Arizona are dependent on the Medicare for their main source of health insurance.While no revolutionary changes in Medicare supplement insurance is scheduled for 2016, there are some things to keep in mind which may affect the safety and availability of certain plans.
Here is the possible increase in premiums and Part B deductible. For example, Plan C, Plan F, and high deductible Plan F covers Part B deductible, so if the increased rates for these popular supplements may also increase. In Arizona, all the Medicare Supplement Plans must conform to the standards set by the Medicare Organization. Supplement standards include names from A to N. Each supplement offers basic benefits like coinsurance and blood donations. The only thing to remember is that every supplement is identical from one or another insurance company. In order to determine rates, you must compare different insurers providing Medigap plans however there should not be a big difference because of the Arizona Medigap Policy. It is important that you familiarize yourself before with the Medigap plan as well as each and every plan before you make any purchase.
Supplement Plan F is the most comprehensive among the 10 other plans, covering almost 100 % of Medicare related costs. But even for Medicare Supplement Plan F recipients in Arizona can still incur some out – of -pocket expenses such as Medicare Part B premium.
As soon as you reach the age of 65, you need only a phone call to buy Medigap policy and get excellent coverage without question. And if you buy a policy in the first six months of enrolling in Medicare, you do not have to answer questions about your health. Do not worry if your doctors are not in the network, because you will be covered if you see any doctor who accepts Medicare.
Many people don’t realize the fact that how much they will be spending if they will be selecting the plan which covers the entire Medigap plans. There are total of 10 Medigap plans and each one has its own benefit. The four most comprehensive plans are C, D, F and G which account for more than 60% of all the Medigap sales according to Kaiser Family Foundation research. Plan F, the most expensive among all of them and covers every Medicare gap represents 40% of all policies sold. If your health is good than you must consider a plan which is not much comprehensive for e.g. Plan N and L are good choices because they will save you around $200 to $400 a year.
Medicare and Medigap benefits are identical in all 50 states, however policies and pricing rules may differ (Massachusetts, Minnesota and Wisconsin have their own standardized plans). If you know the rules in your state, this may save you money. You can choose when to upgrade an existing plan to switch to another insurer or drop your current Medicare plan during the annual open enrollment to change Medigap policies.
Most of the people become eligible for Medicare when they turn 65, although some beneficiaries can get Medicare even before if they have some kind of disability. You will automatically get Medicare as soon as you turn 65 if you are already receiving Social Security benefits. Otherwise, you will have to enroll in Medicare during the enrollment period.
There are also many private Medicare options available if you are a Medicare beneficiary in Arizona. Medicare coverage like drug prescription and supplemental coverage are only available through private insurance companies. Your private Medicare options will depend on where you live and the plans available in your area. We hope you found this article helpful as we shed light on Arizona’s Medigap policies. If you are an Arizona resident, feel free to contact www.azmedicare.info for further details.
- July 27, 2016
- Arizona Medicare Advantage plans, centers for medicare and medicaid services, MA PLANS, medicare, Medicare Advantage, Medicare Advantage Plans, medicare az, Medicare beneficiaries, medicare supplements in phoenix az, Medigap plans, Part D plans, prescription drug plans
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Health insurance as you age:
Health is an exquisite blessing which we accept wholeheartedly, but we also need to accept ill health in the autumn of our lives. The declining years bring copious physical and mental vicissitudes. The US health insurance system comprehends it and offers a variety of coverage plans. Most of the US citizens who belong to the age group of 65 and above, bank on Medicare to cover the cost of health care to a certain degree. The Medicare does not offer a comprehensive coverage plan, so the Medicare beneficiaries opt for the supplemental Medigap plans to widen the scope of the coverage. These plans are not only for the elderly people, but the people with certain disabilities are also eligible for these plans.
What is Medicare?
As mentioned above, Medicare is a national health insurance program that addresses the needs of people who are above 65 or have certain qualifying disabilities. The Medicare coverage is not much comprehensive. It can only be availed in a couple of ways. The first one is original Medicare consisting of Part A and Part B or Part C. Part A is the hospital insurance while Part B is medical insurance. Part C is a standalone plan which is used as a substitute for original Medicare, Part C is also known as Medicare advantage. It is administered by Medicare-approved private insurance companies like AzMedcare that operates in Phoenix, Arizona. In some cases, the users of original Medicare and Medicare advantage can get prescription drug coverage after purchasing Part D. Besides buying part D, they can also go for the Medicare supplemental insurance or Medigap. The users have to choose among Part D and Medigap as these are mutually exclusive.
What is Medigap?
Medigap coverage plans exist at the portfolio level and support the original Medicare coverage. Medigaps are the private health insurance policies just to supplement the original Medicare plans. Both Medicare original and Medigap plans pay their share and cover the medical costs individually. The Medigap plans cover the costs that are left out by original Medicare. The cost which is not covered in the Medicare plan is known as the coverage gap and as the name depicts, Medigap fills this gap. Similarly, Medicare does not cover the amount exceeding Medicare-Approved amount and the purchase cost for the Medigap policy.
AZMEDICARE; Arizona Medigap policy provider, makes Standardized Medigap policies available for the people of Phoenix. These standardized Medigap policies are aligned with the Arizona Medgap polices. These policies are labeled by letters A, B. C. D. F, G, K, L, M and N. These are called as standardized policies because all the services providers offer the same coverage plans that meet a certain set standard. It should also be noted that all these plans have same benefits but their cost varies from one company to another. Well, the selection of the Medigap plan is entirely based on your needs. You can chose the plan which best suits your requirements. The Medigap policies are renewable and the insurance provider cannot cancel your policy unless you are not willing to pay the premium amount.
Benefits of Medigap policy:
First and the most valuable benefit of Medigap policy is hospitalization. Along with the Part A coinsurance, it gives additional 365 days coverage for hospitalization. Secondly, it bears the medical expenses that are not borne by the Medicare Part B coinsurance. It also covers the copayments for outpatient services. Medigap policies also cover three pints of blood yearly, if the patents needs blood transfusion. Palliation of chronically ill, terminally ill or seriously ill patient’s pain is quite costly, so the Medigap care provides Hospice care coverage as well.
When to buy Medigap policy in Arizona?
It is better to buy the Medigap policy in the open enrolment period. This period automatically starts when you enters the first day of the month when you turn 65. This period is comprised of six months. You must be previously enrolled in Medicare Part B. if you enroll outside the OEP period, the premium rates would be affected. You may also be required to take a physical review of your health information. The price and conditions out of OEP period differ from OEP.
How to choose the best level of Medigap policy?
Living in Arizona, you have the option of choosing among 10 standardized Medigap offers. You have also the option to choose the best insurance provider among 50 companies. These providers don’t sell all the Medigap plans, but their offer must include plan A. In addition to plan A, Plan C or Plan F can be added. Plan F, a highly deductible plan as you have to pay the deductible amount of $2,180 before the policy starts paying you. On the other hand for the Plans K and L Medigap plan pays 100% of the covered services for the rest of the year.Plan N pays 100% of the Part B coinsurance (except up to $20 copay for some doctor visits and up to $50 copay for ER treatments that don’t require inpatient admission).
This might seem a bit complex but you need to thoroughly read ins and outs of each and every plan. You can also check the discounts offered by the company as AZMEDICARE offers discounts for women, non-smokers, or married people, yearly payment discounts, multiple policy discounts etc. Your medical policy should be tightly aligned with medical needs along with your financial abilities. AZMEDICARE provides medicare supplement insurance plans in Arizona and stresses that you should choose a plan, considering the currents needs and the related concerns in the future. For you ease, AZMEDICARE provides 6 types of medicare advantage plans. Health maintenance organization plans, preferred provider organization plans, private fee for services plans, special needs plans, point of services plans and medical savings account are these types. You can choose what suits you the best. ADMEDICARE will also suggest the best option if you seek assistance in any of the stages of Medicare advantage plans.
In the sphere of health insurance, US citizens have various coverage options at their disposal. Medicare is the national health insurance program, administered by the US federal government through private insurance companies. The Medicare supplements in Phoenix AZ, also known as Medigaps, are the coverage choice of most Medicare policyholders who don’t get additional insurance through their employers or Medicare Part C (Medicare Advantage).
What are Medigap and Medicare supplements in Phoenix AZ?
Medigap is a type of supplemental insurance designed to help with the gaps in the Original Medicare. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance).
The Medigap policies are standardized by the Centers for Medicare & Medicaid Services (CMS), operating within the Department of Health and Human Services (HHS).
They are regulated on a state level (by state insurance departments). However, the CMS prescribes the minimum coverage that various Medigap plans must provide across the country.
Medigap only supplements Original Medicare and cannot be used as a standalone plan. To purchase a Medigap policy, you must have Original Medicare (Parts A and B).
Note: Medicare beneficiaries can’t be covered by Medicare Advantage and Medigap at the same time.
Medigaps are sold by private companies. When you join a Medigap plan, you will pay your provider a monthly premium in addition to your monthly Part B premium.
Medigap policies up-close
To protect seniors, all Medigap policies are standardized. This means that under the law, all Medigap policies must provide the same basic set of benefits. This basic coverage includes Part A and Part B coinsurance amounts, as well as additional hospital benefits not covered by Original Medicare, as given below:
|Part A Hospital Coinsurance:
||Days 61-90 of a hospital stay (in each Medicare benefit period).
||Days 91-150 of a hospital stay. (Medicare covers these 60 days only once in a person’s lifetime).
|Additional Part A Hospital Benefits:
||Covers additional 365 days of hospital care once Original Medicare hospital benefits are used up.
||100% covered by all Medigaps
|Pays for the Part B coinsurance after the annual deductible is reached.
||100% covered by Plans A, B, C, D, F, G, M, and N (plan N requires up to $20 copayment for some office visits and up to $50 copayment for outpatient ER visits.)
|Part A and B Blood Coverage:
||Pays for the first 3 pints of blood/year.
||100% covered by Plans A, B, C, D, F, G, M and N.
|Part A Hospice Coinsurance:
||Covers coinsurance for outpatient prescription drugs and inpatient respite care.
||100% covered by Plans A, B, C, D, F, G, M and N.
Medigap plans available in Arizona
As of 2013, Arizona residents can choose from a total of 11 standardized policies (A, B, C, D F, High Deductible F, G, K, L, M and N). F and High Deductible F are considered separate plans.
Note: As of June 1, 2010, plans D and G have different benefits than those sold before.
Plans E, H, I and J are no longer available, but people that already have them can generally keep them.
All same-letter Medigap plans offer the same benefits, regardless of the provider. In contrast, the costs of same-letter plans vary greatly between providers (based on location, plan level, health and age). Costs can even vary between providers in the same city.
Make sure to get as much information as you can about the plans, their benefits and costs before making your final decision.
All insurance companies selling Medigaps are obligated to offer Plan A. If their offer includes any other Medigap plan, they must offer either Medigap Plan C or Plan F.
Medigaps can also be purchased as Medicare SELECT plans. In this case, in order to receive full insurance benefits, you’ll have to use hospitals and, occasionally, doctors within your plan’s network (except in cases of emergency).
These policies are generally cheaper than other Medigap policies, provided you go to a Medicare SELECT point of care.
If you receive care outside the Medicare SELECT network, you’ll be responsible partially or fully for the costs not covered by Medicare. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
What Medicare Supplemental Insurance can do for you
Due to the coverage gaps in the Original Medicare, most people choose to buy additional insurance. Medigap policies serve as protection against excessive expenses created by these gaps and unforeseen medical circumstances. This includes longer hospital stays, copayments, deductibles, and health care outside the U.S.
People usually choose supplemental insurance based on their current or potential medical needs, their budget and the insurance company ratings.
As a result, some people opt for a plan which provides more comprehensive, so-called “first dollar coverage”. First dollar coverage means that the Medigap policy pays the deductibles and copayments, with zero out-of-pocket costs for the beneficiary.
Others choose cheaper plans which cover only the most costly services if a medical situation arises.
Healthcare providers may charge more than the Medicare-approved amount for their services and some Medigaps cover these excess costs as well. This gives policyholders more latitude when choosing their hospitals and doctors.
Note: Plans A and B provide basic coverage, and their premiums are the lowest.
The most popular Medigap plans in Arizona and the U.S. are Plan F (40% beneficiaries nationwide) and Plan C (13% beneficiaries nationwide). They are also more comprehensive than other plans.
Medigap plans don’t include prescription drug coverage. For this purpose, you can enroll in a standalone Medicare Prescription Drug Plan (Part D) offered by Medicare-approved private companies.
When to purchase a Medigap policy
The best time to buy a Medigap policy is during the 6-month Medigap Open Enrollment Period. This period starts the month you turn 65 and enroll in Medicare Part B. For the duration of this period:
– You have a guaranteed right to purchase any policy available in your area.
– The insurance provider can’t refuse to sell you a policy or charge you more if you have pre-existing medical conditions.
However, in some cases, the provider can refuse to cover your costs for certain conditions for up to 6 months (pre-existing condition waiting period).
There are also eligibility windows outside the Open Enrollment Period. For instance, certain qualifying life events can make you eligible for a special enrollment period. These events include moving to a new state, certain income changes, as well as changes in family size (marriage, divorce and childbirth).
If you’re using Medicare or planning to join the program, you’re probably wondering if you should get some form of supplemental insurance. Life is unpredictable and an accident or a debilitating illness can result in thousands of dollars spent in treatment costs. If you want additional insurance against life’s unexpected surprises and costs, checking out the different Arizona Medigap plans is a good place to start.
Arizona Medigap plans in the USA
The US healthcare system is multi-leveled and complex. More than half of all coverage is delivered through programs such as Medicare, Medicaid, the Children’s Health Insurance Program and the Veterans Health Administration.
The majority of US citizens under 65 are insured through their employers. Some have private insurance, while the rest are uninsured. Public sector employees are ensured through the government.
Before you decide if Medigap is the right choice for you, familiarize yourself with all your health insurance options. It’s the only way to make an informed decision about your healthcare future.
You can do research on the topic online or consult insurance providers. You can also talk to people already using the choices you are considering.
What is Medicare?
Medicare is the federal health insurance program serving seniors over 65, regardless of their current health, medical history and income.
Individuals under 65 may be eligible for Medicare if diagnosed with end-stage renal disease (ESRD) or a qualifying long-term disability.
Medicare eligibility is linked to a person’s social security benefits. The program is available to people over 65 that have worked for at least 10 years, with social security and Medicare withholding tax deducted from their pay during that time.
Medicare is structured as follows:
Medicare Part A covers inpatient hospital care, limited skilled nursing care and hospice care. It’s premium free for people who have paid into social security for at least 10 years.
Medicare Part B covers non-hospital expenses, like doctor visits, blood tests, X-rays, diabetic screenings and outpatient care. Part B is available for a monthly premium.
Medicare Part C i.e. Medicare Advantage is offered by private companies as an alternative to Original Medicare. It often bundles all the coverage aspects of Medicare into one plan.
Medicare Part D covers the costs of prescription drugs. It’s available as a stand-alone plan through private companies. You can also get your Part D through Medicare Advantage.
Medicare enrollment is mandatory. As long as you have Medicare Part A, you can consider yourself covered. However, if you only have Part B, you may be subjected to a tax penalty for not having essential coverage.
What is Medigap designed to do
Medicare does provide a lot of coverage, but its scope is nonetheless limited. The purpose of Medigap is to help cover some of the costs left out by Original Medicare, like copayments, coinsurance, and deductibles.
This extra coverage allows beneficiaries to better control and predict their annual medical expenses.
Original Medicare and Medigap work together to provide better coverage. First, Medicare pays its share of the Medicare-approved amount for your healthcare services, after which Medigap covers its share.
A few points to remember:
Medigap plans are available as stand-alone policies from private insurance companies, for a monthly premium.
There are 10 standardized Medigap plans available in Arizona, identified by letters (A – D, F – G and K – N). The word standardized means that same-letter plans must offer the same benefits regardless of the insurance provider.
Premiums for same-letter plans vary greatly between providers, so you’ll have to do some research before choosing a plan.
Plan rates can vary depending on your age, place or residence, provider and plan type.
The most comprehensive and popular plan in Arizona is Plan F. This plan covers pretty much all out-of-pocket costs for Parts A and B. The other plans cost less, but allow more gaps to remain open.
Medigap policies are renewable. As long as you pay the monthly fee, your provider cannot terminate your insurance even if you have health problems.
The best time to buy a Medigap policy is when your Medicare coverage begins. If you join Medigap within the first six months of enrolling in Medicare Part B, insurance companies are obligated to sell you a policy regardless of your health status.
After this deadline, you can be denied coverage based on health issues, at the provider’s discretion.
Medigap policies don’t include prescription drug coverage. For this purpose, you will need a Medicare Prescription Drug Plan (Part D).
Reasons to buy a Medigap plan
When contemplating additional insurance, make sure to ask your doctor if Medicare will cover the services and supplies you need. Overall, Original Medicare doesn’t cover many services and items required by many seniors.
According to experts, you should get a Medigap policy if you can afford one, even if you’re currently in good health and don’t need additional insurance.
You won’t need a Medigap plan if you qualify for Medicaid, have an employment-based medical retiree option, if you’re already using a Medicare Advantage plan, and of course, if you are extremely wealthy.
Depending on the plan, Medigap will either pay all or some of the costs not covered by Medicare.
Your Medigap policy is designed to protect you against excessive out-of-pocket costs, especially if you are ill or severely injured, require prolonged hospitalization or require more care as you age.
For instance, if you are hospitalized and you only have Original Medicare, you’ll be required to pay a hospital deductible of $1,216 for each benefit period. For inpatient stays exceeding 60 days, you’ll be responsible for a portion of the daily costs from the 61st day onwards (coinsurance).
These costs will go up the longer you remain hospitalized. Once your lifetime limits are exhausted, you will have to pay the inpatient costs in full.
The same applies to doctor appointments and medical procedures. Your deductible is $147, after which you’ll have to pay 20% of the Medicare approved amount for doctor services and medical equipment. Depending on the bill, this can be a substantial amount.
Also, keep in mind that:
- Even if you finish this year without needing your Medigap policy, the situation may change next year.
- You should do your homework and check the provider’s reputation, including the claims-paying ability, service and customer care quality.
- If you move to another state after you retire, you may need to change your Medigap plan.
- One Medigap policy covers only one person.
Diseases don’t only take their toll on your physical and mental wellbeing – they can also deplete your life savings. Most US citizens over the age of 65 rely on Medicare to cover their healthcare expenses, at least to a certain degree, as its coverage is not comprehensive. As a way to avoid excessive medical costs, Medicare beneficiaries can extend the scope of their health insurance coverage by purchasing one of the supplemental Medigap plans. Read on to find out what really matters when you are considering a Medigap policy for your healthcare needs.
Basic facts about Medicare
Medicare is the national health insurance program, addressing the needs of people aged 65 or above and other people with certain qualifying conditions.
There are 2 ways to get your Medicare coverage: Original Medicare, consisting of Part A (hospital insurance) and Part B (medical insurance) or Medicare Advantage (Part C), which is a standalone plan designed as a substitute for Original Medicare, administered through Medicare-approved private insurance companies.
If needed, users of Original Medicare and Medicare Advantage can add prescription drug coverage by purchasing Medicare Part D. Original Medicare beneficiaries in Arizona can also buy supplemental coverage known as Medicare Supplement Insurance (Medigap), which can only be used in combination with Original Medicare. Medigap and Medicare Advantage are mutually exclusive and you cannot have both.
Medigap – concept and important facts
Medigaps are private health insurance policies designed to supplement Original Medicare and cover some of the costs left out by Original Medicare. These are referred to as coverage gaps, hence the name Medigap. Coverage may include out-of-pocket costs such as deductibles, coinsurance, copayments, as well as hospice or additional hospital coverage.
When you receive healthcare as a Medigap beneficiary, Medicare pays its share of the Medicare-approved amount, after which the Medigap policy pays its share, thus supplementing the costs of your Original Medicare benefits. Medicare doesn’t cover any of the purchase costs for your Medigap policy. One Medigap policy only covers one person.
In Arizona, insurance companies can only sell you “standardized” Medigap policies, labeled by letters (A, B, C, D, F, G, K, L, M, and N). Standardized means that all providers selling a particular Medigap plan must offer the same coverage and benefits.
However, unlike the benefits, the costs of same-lettered plans do differ across providers. This is why, when purchasing a healthcare plan, it is best to choose the plan that fits your needs first and foremost, and then shop for the best price.
Arizona companies are not required to offer Medigap plans to disabled Medicare beneficiaries. Medigap policies are renewable (with the exception of policies purchased before 1992), meaning that your insurance provider cannot cancel your policy, unless you stop paying premiums or the company goes out of business.
Medigap plans offer the following basic benefits:
- Hospitalization – Part A coinsurance plus additional 365-day coverage after Medicare benefits end
- Medical Expenses – Part B coinsurance (usually 20% of Medicare-approved expenses) or copayments for outpatient services
- Three pints of blood each year, if you need transfusion
- Hospice care – Part A coinsurance
Medigap plans – coverage scope and costs
As a rule, Medigap policies sold in Arizona do not include long-term care, vision or dental care, hearing aids, eyeglasses, or private‑duty nursing, but some of them do offer coverage while traveling abroad.
As of 2006, Medicare Supplement plans in Arizona do not include prescription drug coverage. Your Medigap plan comes with a monthly premium, in addition to the monthly Medicare Part B premium. Monthly premiums for Medicare Supplement plans in Arizona range from around $40 to $300, depending on the beneficiary’s age and provider.
How insurance companies set their premiums
The ways in which insurance providers price their Medigap policies are important, as they will affect your present and future expenses. Premium rates can be set as follows:
- community-rated i.e. no-age-rated: premiums are the same, regardless of the beneficiary’s age;
- issue-age i.e. entry-age rated: premiums are based on your age when you first buy the policy. The sooner you enroll, the less you will pay;
- attained-age rated: premiums are based on your current age, and they increase as you grow older.
When to purchase a Medigap policy in Arizona
It is recommended that you join a Medigap plan during the open enrollment period (OEP), when you have a guaranteed issue right to buy a Medigap policy, regardless of your health status (i.e. when the provider is required by law to sell you a Medigap policy).
The 6-month Medigap OEP automatically starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. However, you may have to wait up to six months for coverage of a pre-existing condition.
If you enroll in a Medicare Supplement Plan outside of your OEP, you may be subject to medical underwriting, which can affect the premium rates and whether the provider will sell you a policy or not. This basically means the company can ask you to take a physical, review your health information and then decide whether to offer you coverage, at which price and under which conditions.
Choosing a Medigap policy in Arizona
Arizona residents can choose from 10 standardized Medigaps, offered by around 50 insurance providers. More than half of the beneficiaries statewide use Medigap Plan F, followed by Plan C as the distant second.
Medigap providers don’t have to sell all Medigap plans, but their Medigap offer must include Plan A. If they offer any plan in addition to Plan A, they must offer Plan C or Plan F.
Plan F is also offered as a high-deductible plan. This means that you have to pay for Medicare-covered costs (coinsurance, copays, deductibles) up to the deductible amount of $2,180 before your policy pays anything.
For Plans K and L, after you meet your annual out-of-pocket limit and Part B deductibles ($147 in 2015), the Medigap plan pays 100% of the covered services for the rest of the year.
Plan N pays 100% of the Part B coinsurance (except up to $20 copay for some doctor visits and up to $50 copay for ER treatments that don’t require inpatient admission).
When choosing a Medigap policy, check if the company offers discounts, such as discounts for women, non-smokers, or married people, yearly payment discounts, multiple policy discounts etc.
Generally, your choice of health insurance policy should match your medical needs but also your financial abilities. When choosing a plan, always consider your current needs and try to foresee future concerns.
As you get older, health insurance becomes an undeniable necessity, regardless of current health status. Medicare, the national health coverage system managed by the US federal government primarily addresses the insurance needs of senior citizens and the disabled. Its coverage however is limited, hence many Medicare beneficiaries opt for some form of additional health insurance. If you are looking for a plan that addresses your health insurance needs more comprehensively, consider the different Medicare supplements in Phoenix AZ.
What is Medicare?
Medicare is a nationwide health coverage program available to US citizens 65 and older, people receiving disability insurance and people suffering from specific conditions (end-stage kidney disease and Lou Gehrig’s disease).
Medicare is a four-part program. Parts A and B are referred to as Original Medicare. Part A covers costs of inpatient care in hospitals, skilled nursing or rehab facilities, whereas Part B covers outpatient and preventive care, doctor visits, ambulance services etc.
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare. To join, you must have Medicare A and B. Medicare Part D is available as a standalone plan and covers prescription drug costs. Parts C and D are optional and are offered by private companies.
What is not covered by Original Medicare?
Original Medicare doesn’t cover cosmetic surgery, health care outside the US, hearing aids, long-term care, most types of eye and dental care, non-emergency transportation and prescription drugs (with the exception of immunosuppressants and oral anticancer drugs). Also, policyholders need to pay the deductibles, copays and coinsurance required by Medicare.
To cover medical expenses not included in Medicare, a majority of Medicare users have some kind of supplemental health insurance, including employer or military-based coverage, Medicaid (government insurance for low-income families) or some of the different private options – Supplemental Insurance for Original Medicare (known as Medigap) and Medicare Advantage.
Choosing Medicare supplements in Phoenix AZ
When it comes to supplemental health coverage, people tend to confuse Medigap and Medicare Advantage, despite their significant differences. Medicare Advantage (Medicare Part C) replaces your Original Medicare. It is supplied by private insurance companies, which provide the full range of Part A and B benefits, under contract with Medicare.
To join Medicare Advantage, you must have Medicare Part A and be eligible for Medicare Part B. Medicare Advantage comprises several plans with different benefits. Most of them cover prescription drug expenses.
How does Medigap work?
Unlike Medicare Advantage, Medigap complements Original Medicare. As the name suggests, Medigap is designed to fill in the coverage gaps in Original Medicare. This includes copays, coinsurance, deductibles, health care abroad and hospice expenses (palliative care for the seriously ill).
To buy Medigap, you must have Medicare Parts A and B. You can’t buy Medigap if you already have Medicare Advantage, but you can drop the latter and apply for a Medigap plan before your Medicare Advantage coverage expires. Medigap plans don’t cover long-term care, eye or dental care, hearing aids, eyeglasses, or private nursing care.
When to buy a plan
The best time to buy a plan is during the open enrollment period. This term describes a six-month period that starts the first day of the month you turn 65, during which insurance companies are obligated to sell you any of the 10 Medigap plans, irrespective of your current health status or past medical history.
If you miss this opportunity, you may still buy a Medigap plan, but the insurance company has the discretion to reject you on health grounds through a so-called medical underwriting process. This is a process where the insurance company uses your health information to decide whether or not to sell you a policy.
You can cancel your Medigap by asking your provider to terminate your plan and send you a confirmation. However, your provider cannot cancel your policy as long as you pay your premiums on time, regardless of changes to your health. This is known as guaranteed insurability.
As of January 1, 2006, Medigap policies do not offer prescription drug coverage. For this purpose, you can buy Medicare Part D (Prescription Drug Plan) available through private insurers.
Medigap plans at a glance
Medigap comprises 10 standardized plans, offering different levels of coverage. Standardized means that regardless of the insurance provider or the location, the benefits offered by the 10 plans will be the same. In accordance with federal law, all Medigap plans have to be labeled “Medicare Supplement Insurance”. Each of the 10 standardized plans is designated by a letter (A, B, C, D, F, G, K, L, M, and N).
However, although the plans offered by different providers are standardized, the costs are not. This means that different insurance companies charge different premiums for the same policy, so make sure you do some research before making a decision. In Arizona, people can choose from all 10 Medigap plans. More than half of policyholders opt for Plan F, followed (albeit not closely) by Plans C, B and D.
Despite coming at the highest cost, Medicare Supplement Plan F is the most popular choice, due to its comprehensive coverage. Plan F covers 15% in excess of the Medicare-approved costs, leaving the policyholder with zero additional costs after Medicare has paid its share.
Plan C is the second most comprehensive plan. This plan doesn’t cover Medicare Part B excess costs. Both F and C don’t cover post-discharge expenses i.e. home recovery costs (drugs, rehab, medical supplies etc.).
No matter which option you choose, supplemental health coverage will significantly lower your medical expenses not covered by the traditional Medicare policy. Just keep in mind that after you choose your plan, you will also need to carefully choose the insurance company, since providers differ in the packages, premiums and coverage they offer.
Also, remember that the least expensive policy is not necessarily the best choice. Your health can change considerably in the future, actually making your currently affordable policy the most expensive one tomorrow. In any case, both Medigap and Medicare Advantage have annual memberships, which gives you the opportunity to change your mind and your plan once a year.
If you have Medicare, you know that there are a lot of things it does not cover. Beneficiaries who want to get additional coverage to their Part A and Part B insurance plans, can do so through the various Medicare supplements in Phoenix AZ. All of these are part of what’s known as “Medigap”.
In essence, there are “gaps” in your original Medicare coverage. This is where Medigap comes in, as the different Medigap plans cover health costs that are not covered by original Medicare. Medigap “fills in the gaps”. Medigap insurance plans are only available for participants who have both Medicare Part A and Medicare Part B coverage.
Choosing a Medigap policy is crucial for every health insurance beneficiary. Since your original Medicare coverage might not include certain expenses, you may have to face numerous out-of-pocket costs. These costs include coinsurance, copayments and so on.
Medicare supplements in Phoenix AZ include twelve standardized service plans. These Medigap plans are labeled with letters, from A through L. They all offer an extensive set of covered services for the beneficiaries who already have a Medigap A or B policy. The Medigap A policy is the basic coverage policy. The Medigap B policy covers everything that Medigap A policy offers, plus additional benefits.
When choosing a Medigap policy, you need to compare the various Medicare supplements. Comparing these supplements may be challenging for most Arizona residents. So, instead of making a choice on your own, you are welcome to rely on our expertise and knowledge. We can help you compare these supplement plans and choose the one that fits your needs.
Medicare Advantage vs. Medigap plan
When speaking of Medicare Advantage plans and Medigap plans, many people confuse the two. Some people believe they are similar, but there are major differences between these two options. What you need to know is that Medigap policies are only available to people who have Medicare Part A and Medicare Part B. Beneficiaries who have a Medicare Advantage plan cannot get Medigap.
Medigap can only be used by beneficiaries of traditional Medicare. This is private insurance that you can buy in order to cover some out-of-pocket expenses which are not covered by your traditional Medicare plan. These may include some Part B costs, Part A deductibles, medical emergency costs made abroad and so on. The coverage depends on which kind of policy you have.
The costs of your Medigap policy
The costs of Medigap plans are influenced by various factors. They depend on the type of Medigap plan, your age, health, and location. Once you choose your Medigap plan, you are obliged to pay a monthly premium. Most Medigap plans can help you pay for your Medicare co-payments, as well as the co-insurance for a hospital stay.
The benefits offered by a Medigap plan depend on the type of plan you choose. Less expensive plans offer less benefits and come with higher out-of-pocket costs. Meanwhile, more expensive plans include more benefits. These extra benefits may include coverage of routine checkups, at-home recovery costs, some Medicare deductibles, and so on.
It is crucial to decide which benefits are right for you, in order to discover what type of plan best fits your needs. That way, the cost of your Medigap policy will make sense and you can lower your out-of-pocket costs related to your health.
How to choose the right Medigap plan?
Choosing a health plan can be complicated. There are many factors to consider before you decide which plan is right for you and your family. Medicare supplements in Phoenix AZ offer you a variety of benefits to choose from.
If you’re wondering how to make the right choice, here are some essential questions to consider:
- Will your health plan cover all the services and medications you need?
- Will your health plan cover your regular visits to a doctor?
Compare all the options available and remember that your monthly premium isn’t the only factor to consider. Make sure you check all of the available cost-sharing elements such as copayments, coinsurance, and deductibles, which may be included in your plan.
If you need help with understanding all of these, it is wise to contact our professionals before you make a decision. In addition, here is what you need to know when choosing from the available Medicare supplements in Phoenix AZ.
1. What types of plans can I choose from?
We offer several supplement health plans and they are all different. Aetna Medicare Supplement Plans are health plans that we recommend in addition to Medicare Part A and Part B. These plans help you pay for additional healthcare costs, such as copayments and deductibles.
These Medicare supplement plans include benefits such as three pints of blood per year, and 365-day hospitalization coverage after the Medicare coverage ends. These plans also cover twenty percent of Medicare-approved expenses or copayments for outpatient services, among other things.
We also have experience with the Blue Cross Blue Shield Arizona (BCBSAZ) plan which covers expenses that are not covered by Medicare and Medicare Advantage. Moreover, we work with Mutual of Omaha Medigap insurance plans. These health plans help you reduce co-pays, premiums and deductibles for services covered by Medicare Part A and Medicare Part B insurance plans.
Another popular option we work with are the United Healthcare Supplement Plans. These plans may help you cover some expenses that are not included in Medicare Parts A and B such as deductibles, coinsurance, and copayments. United Healthcare supplements help you cover your annual out-of-pocket expenses and they don’t require a referral in case you need to see a specialist.
2. What does each health plan cover?
Are your current doctors in the plan’s structure? If the answer is no, it is wise to consider what fees your plan should cover. Additionally, you should check which hospitals your doctors are affiliated with, and if these hospitals are part of your plan’s structure.
One of the crucial elements that you should consider is whether your plan covers your spouse and children. Are any preventive services covered, such as checkups and blood pressure screenings?
3. What additional costs will I have to cover?
When choosing a Medigap policy, aside from the premium and deductible payments, you may also have to pay certain additional costs. These additional costs include copayments, coinsurance, your share of allowed charges, out-of-pocket maximum limits, and then limits on services and non-covered services, etc.
Choosing the right Medigap is a big decision. Before you decide, make sure you are well aware of what’s covered and what’s not. The health plan you choose will determine how you and your insurance will share the costs of your health care. Our experts can help you choose the best Medigap policy for you and your family.