Medicare Supplement Plans
in Capistrano Beach, California
Capistrano Beach, California residents nearing the age of 65 are often concerned about whether or not they have the adequate health insurance coverage they need as they begin to get older. In the US, as soon as you turn 65, Medicare will become your primary form of insurance coverage. This holds true regardless of whether or not you qualify for retiree health insurance through a current or former employer.
While Medicare covers a variety of healthcare needs, you may find that it does not always cover everything. If you find yourself with gaps in insurance coverage, it may be time to consider looking into a Medicare supplement plan (sometimes called a Medigap plan). Medicare-supplement-plans.net makes it easy to find a Medicare supplement plan that not only suits your unique healthcare needs but will fit your budget as well.
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Capistrano Beach, California
MEDICARE SUPPLEMENT PLANS
Many people in Capistrano Beach, California believe that once they transition onto Medicare, all of their health care expenses will be covered under either Medicare Part A or Part B. However, the reality of the coverage you receive under Medicare may be very different. There are limitations to the coverage that Medicare Part A and B provides. Recognizing this gap in coverage, private insurance companies offer Medicare supplement plans, also known as Medigap plans, to help cover what Medicare does not.
There are a few prerequisites that must be met before a person can qualify for a Capistrano Beach, California Medigap plan. Keep in mind before you begin looking into plans that any person interested in a Medigap plan must already be covered under Medicare Part A and Part B, and will be required to pay a Medigap premium to the private insurance company and still pay their Medicare Part B premiums.
There are several other important aspects of Medicare supplement plans to be aware of as you research your plan options.
This page will help you understand everything you and your spouse should know while you are evaluating your choices. You can also call anytime to be connected with a Medicare supplement insurance agent who can help you understand your options and find the perfect plan for your needs.
WHEN TO ENROLL IN A Capistrano Beach, California
MEDICARE SUPPLEMENT PLAN
If you are interested in enrolling in a Medicare supplement plan in Capistrano Beach, California and you would like to take advantage of more affordable rates, it is important to enroll during your open enrollment period. This enrollment period begins during the first six months that you are 65 years old and are also enrolled in Medicare Part B. Keep in mind that enrollment does not begin on your actual birthday, rather, it begins in the month of your 65th birthday.
During this period, insurance companies are mandated to provide you with the best possible coverage rates regardless of pre-existing conditions or health issues.
You can also take advantage of the best Medicare supplement rates if you qualify for a guaranteed issue right. People who qualify for a guaranteed issue right have lost their coverage either because their previous insurance carrier committed fraud or if you find that you can no longer be covered under a group health plan.
Of course, if you find that you are outside of the open enrollment period and you do not qualify for a guaranteed issue right, you can still sign up for a Medicare supplement plan but you may not receive the same great rates that you would have been eligible for during open enrollment. Also, keep in mind, if you enroll in a Medicare supplement plan outside of open enrollment, an insurance company can deny you based on pre-existing conditions or opt to charge you a higher monthly premium.
If you have questions about enrollment periods, local Capistrano Beach, California agents are standing by to answer all your questions and make sure you understand all of your options.
While it is true that insurance is important at every stage of life, it becomes more and more essential as we get older. There is a higher likelihood that someone over the age of 65 may need to see a doctor on a regular basis.
The idea of developing a Medicare plan for Americans over the age of 65 was conceived of as early as 1912 by President Theodore Roosevelt. However, the idea of Medicare as we know it today did not gain momentum until President Harry S. Truman came into office in 1945. It would still be another 20 years before the idea of Medicare became a reality for Americans all over the country.
In 1965, President Lyndon B. Johnson signed into law the legislation that would allow any American over the age of 65 to receive Medicare benefits. In a show of solidarity with the plan, Lyndon B. Johnson and his wife became America's first Medicare beneficiaries.
When it comes to Medicare coverage, one of the decisions [city] residents will need to make is which parts to enroll in. You have the option to enroll in just Medicare Part A or to add Part B. You have seven months to make that decision. Medicare provides you with the opportunity to finalize your enrollment as early as three months before you turn 65 and up to three months after turn 65.
Enrolling in Medicare is relatively simple. You can use the online Medicare application which is available on the Social Security Administration's website. You are highly encouraged to take advantage of this platform because you can use it not only to enroll in Medicare benefits but also to put off receiving benefits or social security if you intend to work past the age of 65. Additionally, using this method of applying for benefits removes the annoyance and frustration of going to your local social security office to begin the process. If there are any questions or concerns, a social security representative will reach out to you to settle the matter.
WHAT'S NOT COVERED
When it comes to Medicare Supplement plans, deciding on the right option can be a bit more complicated. That's why we help connect you with a friendly and experienced insurance agent in Capistrano Beach, California. They can help explain all the Medicare supplement plans available to you and find one that fits your budget and your needs. Before you explore the details associated with any Medicare supplement plan, it's important that you first understand what is covered under your basic Medicare coverage. Medicare is divided into Parts A and B. The majority of people that receive Part A Medicare benefit do not have to pay a monthly premium for the coverage. In most cases, if you have worked for at least 30 quarters or ten years, and you have paid Medicare taxes during that time, you will not have to pay Medicare premiums once you qualify for coverage.
If you have not worked for the required time period to qualify for Medicare, you can still opt to purchase standard Medicare coverage. Remember, coverage by both Medicare Part A and Part B is a requirement to enroll in any Medigap plan. In 2020, the premium for Medicare coverage if you have worked less than 30 quarters is $458. If you worked anywhere between 30 and 39 quarters, you will be required to pay $252.
Medicare Part A covers major medical expenses. For example, if you need to be hospitalized or if you need to receive care from a skilled nursing facility, these services will all be covered, at least for a period of time, under Medicare Part A. It's important to note, however, that this part of Medicare only offers these services for a certain amount of days throughout the year. A recipient of Medicare Part A cannot expect for their stay at a skilled nursing facility to be covered through this insurance indefinitely.
You will need to pay a premium for Medicare Part B coverage, however, this usually is automatically deducted from your Social Security benefit, civil service benefit, or railroad retirement board benefit. Medicare Part B will cover your “every day” medical expenses. If you need to go to see a doctor, if you require mental health services, or if you need lab tests, these will all be covered through Medicare Part B.
OUT OF POCKET EXPENSES
WITH ORIGINAL MEDICARE
The current premium rate for Medicare Part B is $144.60 per month. However, if your income is higher there is a possibility that your premium rates may be higher. The out-of-pocket cost associated with Medicare Part B is roughly 20% of the overall cost of the service. So, if your doctor charges you $100 for an office visit, you will need to pay $20 per visit and Medicare Part B would make up the rest of the cost. The percentage associated with your out-of-pocket cost might be higher depending on the type of doctor you need to see.
Whether you are seeing your Capistrano Beach, California doctor for a routine visit or you need to go to the hospital for a serious procedure, it's essential that you bring your Medicare ID card with you. When you first enroll in Medicare you will receive a unique identification card that lists your name as well as your Medicare ID number.
Medicare will not always cover the full expense of the health care coverage that you need. This is what makes Medigap plans so popular. Medicare has set pre-approved rates for services. If your cost of care goes over that rate and you do not have a Medicare supplement plan, you could be faced with having to pay the excess cost out-of-pocket which can be significant.
WHAT DOES MEDIGAP COVER
In many ways, Medigap (also known as a Medicare Supplement plan) is an extension of your Medicare Part A and Part B coverage. Although Medicare will typically cover the lion share of services that are covered by these two plans, it's always possible that there may be some lingering health care costs when everything is all said and done. Examples of remaining costs could include copayments, coinsurance, and deductibles.
When you have a Capistrano Beach, California Medigap plan, Medicare will continue to cover its share of costs at the Medicare-approved rate. The Medigap policy will pay whatever amount is outstanding which can save you hundreds, if not thousands, of dollars in out-of-pocket costs every year.
WHAT'S NOT COVERED
BY MEDIGAP PLANS
Although Medigap plans are incredibly helpful to bridge the gap between what Medicare will pay and what the ultimate cost of healthcare is, there are still some things that even a Medigap plan will not cover. Some services that Medigap will not cover include long-term care, vision (including eyeglasses), dental, hearing aids, and private-duty nursing.
It's essential to note that if you find yourself in a situation where you have been hospitalized and you are referred to a rehab facility, Medicare will generally cover your stay but only for a set number of days. Unfortunately, there is no private insurance that will cover the full cost of a long-term care crisis or if you require private-duty nursing. Deciding on the right plan can be confusing. When you call our toll-free number, you will have the opportunity to ask all your questions of a local Capistrano Beach, California insurance agent who specializes in Medicare supplement plans.
Sometimes people confuse Medicare with Medicaid. Medicaid can become important for example in instances when you do not have the funds to pay privately for your stay in a long-term care facility, Medicaid may be able to help. There are generally two versions of Medicaid, however, Capistrano Beach, California residents over the age of 65 would want to focus on a version of Medicaid that covers long-term care expenses. There are specific clinical and monetary limits associated with Medicaid however. For example, you must exhibit the need for assistance with certain activities of daily living and you must meet specific income limits.
MEDICARE SUPPLEMENT PLANS VS.
MEDICARE ADVANTAGE PLANS
Capistrano Beach, California Medicare Supplement plans (aka Medigap) and Medicare Advantage plans are two different things and it is important to understand the distinctions between them. A Medicare Supplement plan is specifically available to people who are already enrolled in Medicare Parts A and B. These plans are used as an extension of your current Medicare coverage and are designed to fill some of the most common gaps in Medicare coverage.
A Medicare Advantage Plan, also known as Medicare Part C, is an alternative way to receive your Medicare benefits. One downside to this type of plan is that it is more restrictive than a traditional Medigap plan in numerous ways. If you need to go to the doctor or the hospital, you may be restricted to certain Capistrano Beach, California doctors and hospitals covered by a Medicare Advantage Plan. With a Medigap plan, as long as your [city] doctor of choice accepts Medicare, you can see any doctor that you want.
One of the reasons why a Medicare Advantage Plan may be appealing to some Medicare recipients is the cost. Many plans come with a $0 monthly premium in conjunction with the premium for your Part B coverage. A Medigap plan will have a monthly premium. Keep in mind, however, that under a Medicare Advantage Plan you are still responsible for all out-of-pocket costs including your co-pays, co-insurance, and deductibles while under a Medigap plan your total out-of-pocket costs are greatly limited. It's important to understand the details of these different options. If you still have questions, call to speak to a helpful Capistrano Beach, California insurance agent.
Another reason why some Medicare beneficiaries opt for a Medicare Advantage Plan is the fact that prescription medication is covered under the type of plan. Additionally, a Medicare Advantage Plan offers various times throughout the year that you can either enroll in a plan or opt to switch to another that is more suitable for your needs.
DOES MEDIGAP COVER
ME AND MY SPOUSE?
A major difference between a Medigap plan and traditional private insurance is the fact that you cannot purchase a plan that covers more than one person. Similar to your traditional Medicare coverage, a Medigap plan will only cover you and not your spouse or any other member of your family.
If your spouse wants to sign up for a Medigap plan, they would need to do so according to their individual timeframe. For example, if you turn 65 in May but your spouse does not turn 65 until the following year, your spouse would need to wait until next year to enroll in any type of plan.
Because you and your spouse need to maintain separate coverage, you will have two separate premiums. Additionally, there is no guarantee that your premium rates will be the same. For instance, if you enroll in a Medigap program during open enrollment but your spouse is unable to for some reason, you will likely notice that his or her premium rate is higher than yours.
IS MY Capistrano Beach, California
MEDIGAP POLICY RENEWABLE?
Your Medigap policy is renewable every year. It's important to note that if you drop your Medigap plan or if you allow your policy to lapse, there is no guarantee that you will be able to get on the same plan again.
If the company does allow you to re-enroll, they are not mandated to provide you with the same rates. If you need to renew your plan or enroll in a new one, call to be connected with a local agent in Capistrano Beach, California today.
PRESCRIPTION DRUG COVERAGE
FOR Capistrano Beach, California RESIDENTS
People in Capistrano Beach, California over the age of 65 are commonly required to take certain prescription drugs on a daily basis. Many people do not realize that prescription medication is not covered under Medicare Part A or Part B. Additionally, medications are not covered by any Medigap plan.
Because prescription drugs can be expensive, it is nearly impossible to expect that the average retiree would be able to afford their medications at the out-of-pocket rate. This is why many retirees in Capistrano Beach, California enroll in Part D Medicare which specifically includes a prescription drug plan.
Before you enroll in a Part D plan, review which plan covers the medication that you need. Our Capistrano Beach, California agents can help you understand your options. Medicare Part D plans are split up into four tiers. For example, you may be attracted to the Tier 1 plan because it has the lowest copayment, however, this plan only offers generic prescription medication. If there are specialty prescriptions that you cannot live without, you should consider the Specialty tier plan. Although this plan does have the highest copayment, you will never need to worry about getting the medication that you need.
Overall, there are several things to take into consideration when thinking about purchasing a Medigap plan. If you have questions at any time, we encourage you to reach out so we can connect you with a Medicare Supplement expert who can help you understand your options.