Medicare is a federal government program that covers more than 6o million seniors and disabled individuals throughout the country. However, some people still don’t understand how the program is run and whether they qualify for coverage or not.
We reached out to industry experts with some of the frequently asked questions about Medicare and gathered helpful answers for you. Read through and if you still have unanswered questions, please feel free to contact us for further assistance.
What is the difference between a Medicare Supplement and Medicare Advantage?
Medicare Supplement is indemnity coverage that pays for the 20% not covered by original Medicare. You typically pay a monthly premium to offset those costs and rarely pay any office copays or coinsurance.
There are many different plan types that cover various services and events, including/excluding your part B deductible. You can see any doctor that accepts Medicare. Medicare Advantage is a managed care plan with networks, copays and coinsurance out of pocket (OOP), but with typically lower premiums and at least some coverage for dental, vision, transportation, fitness and other supplemental benefits.
Your drug plan is also wrapped into your Medicare Advantage Prescription Drug (MAPD) in most cases. There are some MA-only plans for those with existing drug coverage like Tricare for military retirees. You can enroll in a plan with a max out of pocket of $3400 or $6700.
How do I pick the best drug plan for me?
It’s all about total-out-of-pocket-costs and if/when I reach the donut hole. Your drug needs assessment will dictate the key and most costly drugs, your deductible and copays that drive your OOP expense. Medicare also counts your “true” OOP expense or TrOOP that gives you credit for your deductible and other items.
Do I have to buy a drug plan from the same company as my Medicare Supplement?
Do I need to update my drug plan every year?
The plans are updated yearly, but it is up to you to decide if a plan change is appropriate.
Do I have to wait for AEP to switch from one Medicare Supplement to another?
No. You can switch MS policies at any time, but you are subject to underwriting and that impact on premiums after you have used your initial enrollment or guaranteed issue right. A lot of business is written on replacements for aging individuals.
If I’m under the age of 64 and receive SSDI, can I get a Medicare Supplement?
After 24 months of continuous SSDI, you automatically become eligible for Medicare. You can enroll in a Medicare Supplement or MAPD or stay on Original Medicare.
What does “Guaranteed Issue” mean, and when does it apply?
It's the first eight months after your initial coverage need for Medicare or the termination of your Medicare Advantage plan contract that was covering you. You may be turning 65 or just got off a commercial plan at age 72, but GI is for those new to Medicare coverage and seeking a Medicare Supplement.
Does a Medicare Supplement cover vision and dental? If no, how do I find vision and dental if this is important to me?
Medicare Supplement does not cover this, and you have to find independent insurers for those needs. We have a dental/vision/hearing combo plan, for example.
Can I buy a Medicare Supplement if I’m on Medicare and Medicaid?
You technically can, but it is not always a great idea due to the premium amount. If you have a DSNP available, the coordination between a Medicare Advantage plan and state Medicaid services usually leaves you paying $0 or very, very little for any health or drug coverage. That is what most do – find a DSNP.
Why would someone pick a Medicare Advantage Plan over a Medicare Supplement?
Lower premiums, drugs included in premium, docs already in network, dental and vision coverage at some level
Does Medicare Cover Long-Term Care? Medicare Supplements? Medicare Advantage?
No. Long-term care is a separate type of coverage and must be purchased separately. There are limits on what Medicare pays through all of these that can get you through a month or two but not the long-haul.
How Does finding a doctor in my area work if I have Medicare Supplement vs Medicare advantage?
You have to look for the doctor and see/call to determine if they accept Medicare. All MAPD plans are required to keep an updated network database for in-network physicians.
What areas are leading Medicare brands looking at to expand their customer acquisition efforts?
Our footprint will be growing, but we are winning on Star-ratings and plan quality. It's getting that message home to the right people.