Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome to today's Medicare three sixty show. I'm Jennifer Lee,
your Medicare three sixty hosts, and let us speak in
Today we are going to go over Medicare Supplement Insurance MEDICAA.
How does medica GAP work? Hard health care services and supplies.
(01:06):
Medicare Supplement insurance METAGAP policies sold by private insurance companies
can help pay some of the remaining health care costs
for covered services and supplies like co payments, co insurance
and deductibles. So we are on section five, page seventy
five of the Medicare New Handbook twenty twenty five. Some
(01:27):
medicap policies also cover services that original Medicare doesn't cover,
like medical care when you travel outside the US. Generally,
metagap doesn't cover long term care like care in a
nursing home, vision or dental services, hearing aids, eyeglasses, or
private duty nursing. MEDICAP policies are standardized. Metagaps must follow
(01:53):
federal and state laws designed to protect you, and they
must be clearly identified as Medicare supplement. Insurance insurance companies
can sell you only standardized plans, which are named in
most states by letter A to d FG KA N
so many letters. All plans of the same letter offer
(02:17):
the same basic benefits, no matter where you live or
which insurance company you buy the policy from. Some offer
additional benefits. Compare the benefits of each letter plan to
find one that meets your needs. In Massachusetts, Minnesota, and Wisconsin,
medigap policies are standardized in a different way. Get information
(02:39):
and finding MEDIGAP policies in your area by going on
Medicare dot gov slash, medigap Dash, Supplement Dash Insurance Dash plans.
You could also visit Medicare dot gov slash publications to
review the booklet Choosing a MEDIGAP policy, A guide to
health insurance for people with Medicare. Important to medigap plans
(03:03):
sold to people who are new to Medicare on or
after January first, twenty twenty aren't allowed to cover the
part be deductible. Because of this, Plan CNF are no
longer available to people new to Medicare on or after
January first, twenty twenty. However, if you are eligible for
Medicare before January first, twenty twenty, but haven't yet enrolled,
(03:28):
you may be able to.
Speaker 3 (03:29):
Buy Plan C or Plan F.
Speaker 2 (03:31):
While people new to Medicare on or after January first,
twenty twenty can't buy Plan CNF, they have the right
to buy Plans DNG instead of Plants CNF, which provide
the same benefits with exception of coverage.
Speaker 3 (03:47):
For the part be deductible.
Speaker 2 (03:49):
So the Plan F is the Cadillac of all plans.
That's what they call it. So just keep in mind
that is no longer available for people after January first,
twenty twenty. That or sixty five. That we're sixty five,
So you do have to pay the deductible for Plan G,
(04:15):
but sometimes Plan F is way more expensive, and some
Plan F members do move to Plan G to save,
so many just knowing that they do have to pay
that deductible. Okay, so how do I compare metigap plans?
The Sharp Blow Show's basic information about the different benefits
(04:37):
covered by Medicare Supplement Insurance METAGAP, and twenty twenty five
A percentage appears. The MEDIGAP plan covers that percentage of
benefit and you're responsible for the rest. So, like I mentioned,
there's A B, C, D, F, G, K, L, M N.
(04:57):
That's a lot of letters. So all of those MEDAGAP
plans do cover one hundred percent of Medicare Part A
co insurance and hospital costs up to an additional three
hundred and sixty five days after Medicare benefits are used.
So just keep in mind that deductible when you go
(05:21):
to the hospital, and then the sixty to ninety day
and the ninety two plus days, you're not paying that
because mid the MEDA gap is covering that at one
hundred percent on.
Speaker 3 (05:35):
All of the plans.
Speaker 2 (05:36):
Okay, So Medicare Part B co insurance or the co payment,
So all of these ABCDFG M and then pay one
hundred one hundred percent of that part be co insurance
(05:56):
or co payment, So that's like the twenty percent co
insurance that Original Medicare has. So classic example, you go
get surgery and new your hip replacement cost one hundred
thousand that twenty percent that you're on the hug for.
If you do have a metagap plan, the plan ABCD FG,
(06:21):
M and N play for that. K pays fifty percent
of that and L pays seventy five percent. So the
ones that are most popular, I will go over which
is going to be your G.
Speaker 3 (06:38):
Okay or your KAY or your N.
Speaker 2 (06:41):
So let's see blood benefit first three pints, so it's
one hundred percent covered on abcd FG, also M, but
K is fifty percent LS seventy five percent, and N
is one hundred percent okay part A hospice care co
(07:03):
insurance or co payment, So A B C D F
G plus M N N cover one hundred percent of that.
The only one is the K is fifty percent in
the LS seventy five percent, So skilled nursing facility care
co insurance C D F G, N, M pay N
(07:28):
N pay one hundred percent, K is fifty percent in
LS seventy five percent Part A deductible. K that is, B,
C D, F, G, N pays one hundred percent of
your Part A deductible, and the K pays fifty percent.
(07:49):
In the L pay seventy five percent and the M
pays fifty percent Part B deductible. The only ones that
cover the Part B deductible is C, N, F, F,
and like I mentioned earlier, this is no longer available
for those that turn sixty five or over in twenty twenty. Okay,
(08:10):
so Part B excess charge, so sometimes a doctor could
charge more than the medicare fees one and a half
percent or so. This says that these companies will also
pay that. So the only up letters that cover that
are F and G okay, foreign travel emergency up to
(08:34):
plan limits, so C, D, F, G, M, and N
cover eighty percent of that. That's one of the things
I don't like about metagap plans is because typically it's
like a lifetime of fifty thousand and then you still
have a co insurassurance and sometimes are deductible on that.
Speaker 3 (08:59):
Okay, So home.
Speaker 2 (09:01):
For meta gap plans K and L, there is an
out of pocket limit, so the K is seven twenty.
Speaker 3 (09:09):
And the LS thirty six ten.
Speaker 2 (09:12):
SO Plans F and G also offer high deductible plans.
In some states, you may pay Medicare covered costs, co insurance,
co payments and deductibles up to the deductible amount of
twenty eight hundred and seventy in twenty twenty five before
your policy pays anything. You can't buy plants CNF if
you're new to Medicare or after January first, twenty twenty,
(09:37):
go to page seventy five. So. There are some high
deductible plans that are in lower in price if you
do wish to to just pay a high deductible, so
for plans K and L after you meet your out
of pocket yearly limit and your yearly part be deductible
two hundred and fifty seven dollars in twenty five. The
(10:01):
medigap plan pays one hundred percent of covered services for
the rest of the calendar year plan and pays one
hundred percent of the part B co insurance. You must
pay a co payment of up to twenty dollars for
some office visits, up to fifty dollars for emergency visits
that don't result in an inpatient admission, so.
Speaker 3 (10:25):
The money there.
Speaker 2 (10:27):
Okay, what else should I know about medigap? Before you
could buy Medicare supplement insurance medic gap, you must generally
have Part A and B. With medigap, you pay a
monthly premium to a private insurance company in addition to
the monthly Part B premium you paid a Medicare. If
you're thinking about metagap, be sure to compare plans. The
(10:50):
cost may vary between plans offered by different companies for
exactly the same coverage, and you may go up as
and it may go up as you get old. Some
states limit medicap premium costs. A medigap policy only covers
one person spouse's.
Speaker 3 (11:06):
In separate coverage, so.
Speaker 2 (11:08):
That is the biggest thing. People always say, Oh, is
this a joint thing? No, Medicare is an individual plan policy.
So typically if you do see a spouse with another
spouse's medicap, typically they do it for household purposes and
it's on one billing statement. So I've seen that happen.
(11:30):
Also seen people in their eighties and nineties that the
prices have definitely increase year after year and sometimes if
you don't keep an eye out on it and review
it every couple of years, then you could definitely save
money in your eighties or nineties if you could actually
(11:50):
pass through underwriting or on one of those dates that
have the birthday rule, which I'll probably talk in a
later time, that you could switch your plans without any underwriting.
So in some states you may be able to buy
another type of METAGAP policy called Medicare Select. It requires
you to use hospitals and in some cases doctors within
(12:12):
its network to be eligible for full insurance benefits except
in an emergency. If you buy Medicare Select, you have
rights to change your mind within twelve months and switch
to standard metagap. Can I buy metagap and a separate
drug plan from the same company, Yes, but you need
to make two separate premium payments contact the company to
find out how to pay your premiums. So that's kind
(12:34):
of one of the overbearing things that my clients don't
like in regards to Medicare supplement, because you do have
to pay for your Part B premium, then you have
to pay for your Medigap premium, then you have to
pay for your prescription drug plan premium right, and then
if you have extra dental vision, hearing benefits and ancillary products,
(12:58):
then that is going to be a separate charge. So
of course you know you're paying a premium for this
to get that total freedom. Can I have a drug
garbage in both medigap and my Medicare drug plan? No,
metagap doesn't have a drug plan. Go to page eighty
(13:18):
nine for more information. And yes, while you could have
the same insurance company from medigap and your drug plan,
sometimes that's not advisable, meaning the drug plans really change
in regards to their premiums and their formulary every year,
so that you should review every single year to make
(13:42):
sure that you're on the right plan and getting proper
coverage and saving money there. When does a medigap policy start? Generally,
your medigap policy will begin the first of the month
after you apply it, but you can decide on when
it will start. Typically, you mean it should start when
your effective date for Medicare is. You do have technically
(14:04):
six months for that, which I will answer in the
next question. When's the best time to buy a medicap policy?
The best time to buy a MEDIGAP policy is during
your meta gap open enrollment period. This six month period
begins the first month you have Medicare Part B medical
insurance and you're sixty five or older. So let's just
(14:24):
say your Medicare Part B effective is June first. You
technically have six months to apply for medigap policy without
any underwriting. Some states have additional open enrollment periods. After
this enrollment period, you may not be able to buy
a medigap policy may or it may cost more. In
(14:46):
certain situations, you may have rights to buy a medical
policy guaranteed if she writes outside of your MEDICAP open
enrollment period. If you delay signing up for Part B
because you have group health coverage because of you or
your spouse's current employments, your meta gap open and ROMAN
policy won't start until you get Part B. Federal law
(15:07):
generally doesn't require insurance companies to sell metagap to people
under sixty five.
Speaker 3 (15:12):
If you're under sixty.
Speaker 2 (15:13):
Five, you may not be able to buy the policy
you want, or any policy until you turn sixty five. However,
some states require metagap insurance companies to sell MEDIGAP policies
to people under sixty five. If you're able to buy
when it may cost more. I have seen this. It
definitely does cost more when it's under sixty five. But
we definitely will review all the plans in the area,
(15:35):
and sometimes there's a good deal or you know, like
the rates went significantly down for that particular area at
that particular month, so that's great. Hey, call your state
Health Insurance Assant program SHIP. Go to pages one fourteen
to one seventeen for the number of your local SHIP
or your state insurance department to learn about your rights
(15:55):
to buy METAGAP policy. Trusted agent or broker may also
be able to help. I highly recommend a trusted agent
just like myself to help you with that choice and decision.
Can I have a metagap and Medicare advantage plan? If
you're in a Medicare advantaged plan, it's illegal for anyone
(16:16):
to sell you a MEDIGAP policy unless you're switching back
to original Medicare. Okay, if you aren't planning to drop
your Medicare advantage plan and someone tries to sell you
MEDIGAP policy, reported to your state insurance department. If you
have metagap and join a Medicare advantage plan, you may
(16:36):
want to drop medagap. You could use metagap to pay
for your Medicare advantage plan co payment seductibles and premiums,
so you cannot have both at the same time. And
you want to make sure that if you cancel your
metagap to go to a Medicare advantage plan, that it
(16:58):
is canceled. And I've had a specific situation one of
our clients, for some reason, she did not pay for
her part b Medicare premiums, so Medicare did drop her,
but her Medicare supplement plan was still billing her right,
so kind of defeats the purpose to just make sure
(17:21):
that if you cancel or you don't want to be
on a metagap, you need to call and cancel it.
If you're going to go on a Medicare advantage or
just original Medicare, so important if you want to cancel
your MEDIGAP policy, contact your insurance company.
Speaker 3 (17:40):
I guess we just think the same.
Speaker 2 (17:41):
In most cases, if you drop your MEDIGAP policy to
join a Medicare advantage plan, you may not be able
to get the same policy back, or in some cases,
any MEDIGAP policy unless you leave your Medicare advantage plan
during your trial right period. If you drop a medigap
policy to join an Medicare advantage plan for the first time,
you'll have a single twelve month period your trial period
(18:05):
to get your medigap policy back if this same insurance
company still sells it once you return to original Medicare.
If it isn't available, you could buy a medigap policy
you qualify for that's sold by another insurance company in
your state. Except for plans M or N, you may
also have an opportunity to join a Medicare drug plan
at this time. If you joined a Medicare advantage plan
(18:28):
when you were first ULTO for Medicare partner at sixty five,
you can choose from any medigap policy that's sold by
an insurance company in your state. If you switch to
original Medicare within the first year of joining the Medicare
advantage you may also have an opportunity to join a
Medicare plan at this time. Okay, some states provide additional
(18:56):
special rights to buy a medigap policy, and that's really
more of like your birthday rule. Okay, where can I
get more information? Call your state insurance department. Call one
hundred Medicare to get the phone numbers. Visit Medicare dot
(19:16):
gov slash metagap slash slash, supplement dash and insurance plans
to find policies and pricing in your area. Visit Medicare
dot gov slash publications to review the booklet Choose a
Medigap policy, A guide to health insurance for people with Medicare.
Call your state health insurance program ship. Go to pages
one fourteen to one seventeen for the phone number your
local SHIP, A trusted agent or broken your area may
(19:39):
be able to help. Go to pages ten to fourteen
for an overview of your Medicare options. Okay, last week's episode,
I did go over some changes to Medicare original Medicare.
Just want to touch on it again. Just keep in
(19:59):
mind the Medicare supplements is really the total freedom of
choice to go to any doctor or any specialists or
hospital that takes Medicare without any authorizations or approvals necessary. However,
starting in twenty twenty six, there is a pilot program
in six states that basically has about seventeen services that
(20:22):
will need require pre authorization approvals.
Speaker 3 (20:25):
That pilot will.
Speaker 2 (20:29):
Then have AI generated these approvals. But of course it's
going to be the last person's decision is going to
be a human being, right, So this is definitely unprecedented
because as of right now, there shouldn't be any approvals
(20:51):
or authorizations necessary just as long as this is a
Medicare covered service and the doctor or specialists or hospital,
I'll take original Medicare. So this is going to obviously
change depending on how these pilots go. Of course, if
the pilots go really well, right, I mean, what's to say,
(21:13):
they will initiate it to more states and implement it
and increase the services that they need the authorizations. So
these services are services that have more claims and maybe
more fraudulent claims, so that's why they're doing it. So
(21:37):
I could see that point where they're trying to save
on fraud, waste, and abuse, which is a great thing.
But the other point is this is original Medicare. There's
supposed to be no authorizations or approval. Why pay for
the premiums if you have to get approvals? Right? So
(21:57):
more a follow on that, more update to that as well,
And a lot of people when they are turning sixty five,
they always ask, you know, what's better Medicare? Advantage Medicare supplement.
What's the best plan. First of all, it's going to
(22:22):
depend on your specific area, your zip code, your county,
because every county has different plans, right, depend on your state.
Some states just have better plans than others, right, And
it depends on your preference, so meaning do you want
(22:43):
total freedom and control which may change in the future.
Do you want value meaning you want to pay the
lowest costs, have a packaged deal, don't pay now, pay later.
So it really depends because there are some counties to
have exceptionally great Medicare advantage plans, and it's very hard
(23:07):
to decipher which plan because of the meta gap. You
have to pay a premium to on top of your
Medicare Part B, you have to pay additional drugs plan
and sometimes.
Speaker 3 (23:19):
Your drugs even cost more.
Speaker 2 (23:21):
I've seen it cost you know, four or five times
more than a Medicare advantage.
Speaker 3 (23:27):
But it is a personal preference.
Speaker 2 (23:29):
It is good to talk to a trusted, independent agent
just like me, to go over your choices, one that's
not biased and that has the contracts and the knowledge
to go over both of your options, right, because that's
the thing. You ultimately are the decision maker in your healthcare.
(23:53):
So it is best to get sound advice that's not
bias and it's factual, and then you can make a
decision with your healthcare needs, preferences, affordability, location on what
plan would be best for you. So we do go
(24:15):
over the pros and cons, the underwriting factors if there
are any, and just everything that we can. Sometimes I
meet with someone that particularly knows what they want and
some don't and we go back and forth. Then just
go over the facts on each and see which makes
(24:37):
sense to the individual. So today we went over meta gap.
I enjoyed our time here. I will see you next week.
Once again, this is Jennifer Ley, Medicare three sixty show
host signing up.
Speaker 3 (24:52):
You have a wonderful day.
Speaker 1 (24:55):
Thank you for joining the program Medicare at three sixty.
Hope you found to today's episode insightful and empowering. Remember,
understanding your Medicare options is key to making the right
choices for your health and financial well being. If you
have questions or topics you would like covered in future
episodes of Medicare three sixty, don't hesitate to reach out
(25:18):
and speak with our licensed insurance agent. Until next time,
Stay informed and take charge of your healthcare journey. This
has been Medicare three sixty, your trusted source for all
things Medicare take care,
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with host licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare, whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome to today's Medicare three sixty show. I'm Jennifer Lee,
your Medicare three sixty hosts, and let us speak in
Today we are going to go over Medicare Supplement Insurance MEDICAA.
How does medica GAP work? Hard health care services and supplies.
(01:06):
Medicare Supplement insurance METAGAP policies sold by private insurance companies
can help pay some of the remaining health care costs
for covered services and supplies like co payments, co insurance
and deductibles. So we are on section five, page seventy
five of the Medicare New Handbook twenty twenty five. Some
(01:27):
medicap policies also cover services that original Medicare doesn't cover,
like medical care when you travel outside the US. Generally,
metagap doesn't cover long term care like care in a
nursing home, vision or dental services, hearing aids, eyeglasses, or
private duty nursing. MEDICAP policies are standardized. Metagaps must follow
(01:53):
federal and state laws designed to protect you, and they
must be clearly identified as Medicare supplement. Insurance insurance companies
can sell you only standardized plans, which are named in
most states by letter A to d FG KA N
so many letters. All plans of the same letter offer
(02:17):
the same basic benefits, no matter where you live or
which insurance company you buy the policy from. Some offer
additional benefits. Compare the benefits of each letter plan to
find one that meets your needs. In Massachusetts, Minnesota, and Wisconsin,
medigap policies are standardized in a different way. Get information
(02:39):
and finding MEDIGAP policies in your area by going on
Medicare dot gov slash, medigap Dash, Supplement Dash Insurance Dash plans.
You could also visit Medicare dot gov slash publications to
review the booklet Choosing a MEDIGAP policy, A guide to
health insurance for people with Medicare. Important to medigap plans
(03:03):
sold to people who are new to Medicare on or
after January first, twenty twenty aren't allowed to cover the
part be deductible. Because of this, Plan CNF are no
longer available to people new to Medicare on or after
January first, twenty twenty. However, if you are eligible for
Medicare before January first, twenty twenty, but haven't yet enrolled,
(03:28):
you may be able to.
Speaker 3 (03:29):
Buy Plan C or Plan F.
Speaker 2 (03:31):
While people new to Medicare on or after January first,
twenty twenty can't buy Plan CNF, they have the right
to buy Plans DNG instead of Plants CNF, which provide
the same benefits with exception of coverage.
Speaker 3 (03:47):
For the part be deductible.
Speaker 2 (03:49):
So the Plan F is the Cadillac of all plans.
That's what they call it. So just keep in mind
that is no longer available for people after January first,
twenty twenty. That or sixty five. That we're sixty five,
So you do have to pay the deductible for Plan G,
(04:15):
but sometimes Plan F is way more expensive, and some
Plan F members do move to Plan G to save,
so many just knowing that they do have to pay
that deductible. Okay, so how do I compare metigap plans?
The Sharp Blow Show's basic information about the different benefits
(04:37):
covered by Medicare Supplement Insurance METAGAP, and twenty twenty five
A percentage appears. The MEDIGAP plan covers that percentage of
benefit and you're responsible for the rest. So, like I mentioned,
there's A B, C, D, F, G, K, L, M N.
(04:57):
That's a lot of letters. So all of those MEDAGAP
plans do cover one hundred percent of Medicare Part A
co insurance and hospital costs up to an additional three
hundred and sixty five days after Medicare benefits are used.
So just keep in mind that deductible when you go
(05:21):
to the hospital, and then the sixty to ninety day
and the ninety two plus days, you're not paying that
because mid the MEDA gap is covering that at one
hundred percent on.
Speaker 3 (05:35):
All of the plans.
Speaker 2 (05:36):
Okay, So Medicare Part B co insurance or the co payment,
So all of these ABCDFG M and then pay one
hundred one hundred percent of that part be co insurance
(05:56):
or co payment, So that's like the twenty percent co
insurance that Original Medicare has. So classic example, you go
get surgery and new your hip replacement cost one hundred
thousand that twenty percent that you're on the hug for.
If you do have a metagap plan, the plan ABCD FG,
(06:21):
M and N play for that. K pays fifty percent
of that and L pays seventy five percent. So the
ones that are most popular, I will go over which
is going to be your G.
Speaker 3 (06:38):
Okay or your KAY or your N.
Speaker 2 (06:41):
So let's see blood benefit first three pints, so it's
one hundred percent covered on abcd FG, also M, but
K is fifty percent LS seventy five percent, and N
is one hundred percent okay part A hospice care co
(07:03):
insurance or co payment, So A B C D F
G plus M N N cover one hundred percent of that.
The only one is the K is fifty percent in
the LS seventy five percent, So skilled nursing facility care
co insurance C D F G, N, M pay N
(07:28):
N pay one hundred percent, K is fifty percent in
LS seventy five percent Part A deductible. K that is, B,
C D, F, G, N pays one hundred percent of
your Part A deductible, and the K pays fifty percent.
(07:49):
In the L pay seventy five percent and the M
pays fifty percent Part B deductible. The only ones that
cover the Part B deductible is C, N, F, F,
and like I mentioned earlier, this is no longer available
for those that turn sixty five or over in twenty twenty. Okay,
(08:10):
so Part B excess charge, so sometimes a doctor could
charge more than the medicare fees one and a half
percent or so. This says that these companies will also
pay that. So the only up letters that cover that
are F and G okay, foreign travel emergency up to
(08:34):
plan limits, so C, D, F, G, M, and N
cover eighty percent of that. That's one of the things
I don't like about metagap plans is because typically it's
like a lifetime of fifty thousand and then you still
have a co insurassurance and sometimes are deductible on that.
Speaker 3 (08:59):
Okay, So home.
Speaker 2 (09:01):
For meta gap plans K and L, there is an
out of pocket limit, so the K is seven twenty.
Speaker 3 (09:09):
And the LS thirty six ten.
Speaker 2 (09:12):
SO Plans F and G also offer high deductible plans.
In some states, you may pay Medicare covered costs, co insurance,
co payments and deductibles up to the deductible amount of
twenty eight hundred and seventy in twenty twenty five before
your policy pays anything. You can't buy plants CNF if
you're new to Medicare or after January first, twenty twenty,
(09:37):
go to page seventy five. So. There are some high
deductible plans that are in lower in price if you
do wish to to just pay a high deductible, so
for plans K and L after you meet your out
of pocket yearly limit and your yearly part be deductible
two hundred and fifty seven dollars in twenty five. The
(10:01):
medigap plan pays one hundred percent of covered services for
the rest of the calendar year plan and pays one
hundred percent of the part B co insurance. You must
pay a co payment of up to twenty dollars for
some office visits, up to fifty dollars for emergency visits
that don't result in an inpatient admission, so.
Speaker 3 (10:25):
The money there.
Speaker 2 (10:27):
Okay, what else should I know about medigap? Before you
could buy Medicare supplement insurance medic gap, you must generally
have Part A and B. With medigap, you pay a
monthly premium to a private insurance company in addition to
the monthly Part B premium you paid a Medicare. If
you're thinking about metagap, be sure to compare plans. The
(10:50):
cost may vary between plans offered by different companies for
exactly the same coverage, and you may go up as
and it may go up as you get old. Some
states limit medicap premium costs. A medigap policy only covers
one person spouse's.
Speaker 3 (11:06):
In separate coverage, so.
Speaker 2 (11:08):
That is the biggest thing. People always say, Oh, is
this a joint thing? No, Medicare is an individual plan policy.
So typically if you do see a spouse with another
spouse's medicap, typically they do it for household purposes and
it's on one billing statement. So I've seen that happen.
(11:30):
Also seen people in their eighties and nineties that the
prices have definitely increase year after year and sometimes if
you don't keep an eye out on it and review
it every couple of years, then you could definitely save
money in your eighties or nineties if you could actually
(11:50):
pass through underwriting or on one of those dates that
have the birthday rule, which I'll probably talk in a
later time, that you could switch your plans without any underwriting.
So in some states you may be able to buy
another type of METAGAP policy called Medicare Select. It requires
you to use hospitals and in some cases doctors within
(12:12):
its network to be eligible for full insurance benefits except
in an emergency. If you buy Medicare Select, you have
rights to change your mind within twelve months and switch
to standard metagap. Can I buy metagap and a separate
drug plan from the same company, Yes, but you need
to make two separate premium payments contact the company to
find out how to pay your premiums. So that's kind
(12:34):
of one of the overbearing things that my clients don't
like in regards to Medicare supplement, because you do have
to pay for your Part B premium, then you have
to pay for your Medigap premium, then you have to
pay for your prescription drug plan premium right, and then
if you have extra dental vision, hearing benefits and ancillary products,
(12:58):
then that is going to be a separate charge. So
of course you know you're paying a premium for this
to get that total freedom. Can I have a drug
garbage in both medigap and my Medicare drug plan? No,
metagap doesn't have a drug plan. Go to page eighty
(13:18):
nine for more information. And yes, while you could have
the same insurance company from medigap and your drug plan,
sometimes that's not advisable, meaning the drug plans really change
in regards to their premiums and their formulary every year,
so that you should review every single year to make
(13:42):
sure that you're on the right plan and getting proper
coverage and saving money there. When does a medigap policy start? Generally,
your medigap policy will begin the first of the month
after you apply it, but you can decide on when
it will start. Typically, you mean it should start when
your effective date for Medicare is. You do have technically
(14:04):
six months for that, which I will answer in the
next question. When's the best time to buy a medicap policy?
The best time to buy a MEDIGAP policy is during
your meta gap open enrollment period. This six month period
begins the first month you have Medicare Part B medical
insurance and you're sixty five or older. So let's just
(14:24):
say your Medicare Part B effective is June first. You
technically have six months to apply for medigap policy without
any underwriting. Some states have additional open enrollment periods. After
this enrollment period, you may not be able to buy
a medigap policy may or it may cost more. In
(14:46):
certain situations, you may have rights to buy a medical
policy guaranteed if she writes outside of your MEDICAP open
enrollment period. If you delay signing up for Part B
because you have group health coverage because of you or
your spouse's current employments, your meta gap open and ROMAN
policy won't start until you get Part B. Federal law
(15:07):
generally doesn't require insurance companies to sell metagap to people
under sixty five.
Speaker 3 (15:12):
If you're under sixty.
Speaker 2 (15:13):
Five, you may not be able to buy the policy
you want, or any policy until you turn sixty five. However,
some states require metagap insurance companies to sell MEDIGAP policies
to people under sixty five. If you're able to buy
when it may cost more. I have seen this. It
definitely does cost more when it's under sixty five. But
we definitely will review all the plans in the area,
(15:35):
and sometimes there's a good deal or you know, like
the rates went significantly down for that particular area at
that particular month, so that's great. Hey, call your state
Health Insurance Assant program SHIP. Go to pages one fourteen
to one seventeen for the number of your local SHIP
or your state insurance department to learn about your rights
(15:55):
to buy METAGAP policy. Trusted agent or broker may also
be able to help. I highly recommend a trusted agent
just like myself to help you with that choice and decision.
Can I have a metagap and Medicare advantage plan? If
you're in a Medicare advantaged plan, it's illegal for anyone
(16:16):
to sell you a MEDIGAP policy unless you're switching back
to original Medicare. Okay, if you aren't planning to drop
your Medicare advantage plan and someone tries to sell you
MEDIGAP policy, reported to your state insurance department. If you
have metagap and join a Medicare advantage plan, you may
(16:36):
want to drop medagap. You could use metagap to pay
for your Medicare advantage plan co payment seductibles and premiums,
so you cannot have both at the same time. And
you want to make sure that if you cancel your
metagap to go to a Medicare advantage plan, that it
(16:58):
is canceled. And I've had a specific situation one of
our clients, for some reason, she did not pay for
her part b Medicare premiums, so Medicare did drop her,
but her Medicare supplement plan was still billing her right,
so kind of defeats the purpose to just make sure
(17:21):
that if you cancel or you don't want to be
on a metagap, you need to call and cancel it.
If you're going to go on a Medicare advantage or
just original Medicare, so important if you want to cancel
your MEDIGAP policy, contact your insurance company.
Speaker 3 (17:40):
I guess we just think the same.
Speaker 2 (17:41):
In most cases, if you drop your MEDIGAP policy to
join a Medicare advantage plan, you may not be able
to get the same policy back, or in some cases,
any MEDIGAP policy unless you leave your Medicare advantage plan
during your trial right period. If you drop a medigap
policy to join an Medicare advantage plan for the first time,
you'll have a single twelve month period your trial period
(18:05):
to get your medigap policy back if this same insurance
company still sells it once you return to original Medicare.
If it isn't available, you could buy a medigap policy
you qualify for that's sold by another insurance company in
your state. Except for plans M or N, you may
also have an opportunity to join a Medicare drug plan
at this time. If you joined a Medicare advantage plan
(18:28):
when you were first ULTO for Medicare partner at sixty five,
you can choose from any medigap policy that's sold by
an insurance company in your state. If you switch to
original Medicare within the first year of joining the Medicare
advantage you may also have an opportunity to join a
Medicare plan at this time. Okay, some states provide additional
(18:56):
special rights to buy a medigap policy, and that's really
more of like your birthday rule. Okay, where can I
get more information? Call your state insurance department. Call one
hundred Medicare to get the phone numbers. Visit Medicare dot
(19:16):
gov slash metagap slash slash, supplement dash and insurance plans
to find policies and pricing in your area. Visit Medicare
dot gov slash publications to review the booklet Choose a
Medigap policy, A guide to health insurance for people with Medicare.
Call your state health insurance program ship. Go to pages
one fourteen to one seventeen for the phone number your
local SHIP, A trusted agent or broken your area may
(19:39):
be able to help. Go to pages ten to fourteen
for an overview of your Medicare options. Okay, last week's episode,
I did go over some changes to Medicare original Medicare.
Just want to touch on it again. Just keep in
(19:59):
mind the Medicare supplements is really the total freedom of
choice to go to any doctor or any specialists or
hospital that takes Medicare without any authorizations or approvals necessary. However,
starting in twenty twenty six, there is a pilot program
in six states that basically has about seventeen services that
(20:22):
will need require pre authorization approvals.
Speaker 3 (20:25):
That pilot will.
Speaker 2 (20:29):
Then have AI generated these approvals. But of course it's
going to be the last person's decision is going to
be a human being, right, So this is definitely unprecedented
because as of right now, there shouldn't be any approvals
(20:51):
or authorizations necessary just as long as this is a
Medicare covered service and the doctor or specialists or hospital,
I'll take original Medicare. So this is going to obviously
change depending on how these pilots go. Of course, if
the pilots go really well, right, I mean, what's to say,
(21:13):
they will initiate it to more states and implement it
and increase the services that they need the authorizations. So
these services are services that have more claims and maybe
more fraudulent claims, so that's why they're doing it. So
(21:37):
I could see that point where they're trying to save
on fraud, waste, and abuse, which is a great thing.
But the other point is this is original Medicare. There's
supposed to be no authorizations or approval. Why pay for
the premiums if you have to get approvals? Right? So
(21:57):
more a follow on that, more update to that as well,
And a lot of people when they are turning sixty five,
they always ask, you know, what's better Medicare? Advantage Medicare supplement.
What's the best plan. First of all, it's going to
(22:22):
depend on your specific area, your zip code, your county,
because every county has different plans, right, depend on your state.
Some states just have better plans than others, right, And
it depends on your preference, so meaning do you want
(22:43):
total freedom and control which may change in the future.
Do you want value meaning you want to pay the
lowest costs, have a packaged deal, don't pay now, pay later.
So it really depends because there are some counties to
have exceptionally great Medicare advantage plans, and it's very hard
(23:07):
to decipher which plan because of the meta gap. You
have to pay a premium to on top of your
Medicare Part B, you have to pay additional drugs plan
and sometimes.
Speaker 3 (23:19):
Your drugs even cost more.
Speaker 2 (23:21):
I've seen it cost you know, four or five times
more than a Medicare advantage.
Speaker 3 (23:27):
But it is a personal preference.
Speaker 2 (23:29):
It is good to talk to a trusted, independent agent
just like me, to go over your choices, one that's
not biased and that has the contracts and the knowledge
to go over both of your options, right, because that's
the thing. You ultimately are the decision maker in your healthcare.
(23:53):
So it is best to get sound advice that's not
bias and it's factual, and then you can make a
decision with your healthcare needs, preferences, affordability, location on what
plan would be best for you. So we do go
(24:15):
over the pros and cons, the underwriting factors if there
are any, and just everything that we can. Sometimes I
meet with someone that particularly knows what they want and
some don't and we go back and forth. Then just
go over the facts on each and see which makes
(24:37):
sense to the individual. So today we went over meta gap.
I enjoyed our time here. I will see you next week.
Once again, this is Jennifer Ley, Medicare three sixty show
host signing up.
Speaker 3 (24:52):
You have a wonderful day.
Speaker 1 (24:55):
Thank you for joining the program Medicare at three sixty.
Hope you found to today's episode insightful and empowering. Remember,
understanding your Medicare options is key to making the right
choices for your health and financial well being. If you
have questions or topics you would like covered in future
episodes of Medicare three sixty, don't hesitate to reach out
(25:18):
and speak with our licensed insurance agent. Until next time,
Stay informed and take charge of your healthcare journey. This
has been Medicare three sixty, your trusted source for all
things Medicare take care,
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