Medicare Supplement Plans
in Durham, California
Durham, 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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MEDICARE SUPPLEMENT PLANS
FOR RESIDENTS OF Durham, California
Original Medicare Part A (hospital cover) and Part B (general medical cover) offer financial support to help pay for many of the costs involved with quality medical care. However, many people quickly discover that when they are eligible for Original Medicare, the plan doesn't cover everything they need. Medicare Supplement Plans, also known as Medigap plans, help to bridge the gaps in coverage that Original Medicare misses.
But just what plan do you need? The range of lettered Medicare Supplement Insurance plans can be confusing and choosing the right one during your Medicare Open Enrollment Period can place added stress on you. Don't worry - with a basic understanding of the differences between the standardized Medigap plans and the ins and outs of getting Medigap cover, you can pick a plan perfectly suited to your needs.
To make it even easier, call to be connected with a local Durham, California insurance agent specializing in Medicare Supplement Insurance who can answer all your questions and help you choose the right plan to suit your needs and budget.
WHAT ARE MEDIGAP PLANS?
Medigap, another name for Medicare Supplement Insurance, is a form of insurance that can be combined with Original Medicare. A Medigap policy can only be purchased if you have what is known as Original Medicare, which includes Part A and Part B of the Medicare Insurance Plans. In order to obtain Original Medicare, you must be 65 or older. If you are under the age of 65, you can still qualify for Medicare if you have certain disabilities or suffer from End-Stage Renal Disease.
A Medigap plan is basically a form of extra insurance that aims to make your Durham, California health insurance coverage more conclusive, reducing your overall medical costs and providing you with benefits that go beyond Original Medicare. The main areas of your Original Medicare plan that a Medigap plan is able to help you with include coinsurance, deductibles, and copayments.
Medicare Supplement Insurance plans in Durham, California generally pay after your Original Medicare has paid its share of your medical costs. However, your Medigap policy will often only pay for your coinsurance payments after you've reached your deductible amount.
Medicare Supplement Plans adhere to [state] state and federal laws. These laws are in place to help protect you as a patient. They also help to make choosing a plan easier because all of the plans with the same letter (the way they are categorized) offer the same basic benefits. What this means is that when comparing two different insurance providers' Plan A, for example, the only major difference will be the monthly premium cost.
IN Durham, California
There are a range of plan options available to residents of Durham, California. During your Medigap Open Enrollment Period, which is discussed in the section below, you are able to choose any of the plans that best suits your needs.
When comparing Durham, California plans, you must not only consider the monthly premium costs and range of coverage, but you must also carefully consider your future needs. Once you have chosen a plan, if you want to change it at a later date, then you may have to pay more than you initially would, unless you are still within your 6-month Medigap Open Enrollment Period. You may also lose various benefits that can protect you from being turned down for pre-existing conditions, meaning that you may not be covered for the condition or may have higher premiums.
All of the Medicare Supplement Plans are categorized by letters. Since laws and regulations require that each lettered plan meets certain minimum requirements, it's easier to choose a private insurance provider. Basically, one lettered plan will offer you the same basic coverage as another, with only the cost of your monthly premiums differentiating the competing plans. Navigating these differences can be confusing. If you have questions, call to be connected with an insurance agent in Durham , California who can help you decide on the right plan for you.
From January 1, 2020, both Plan C and Plan F are no longer available to new applicants that have only become eligible for Medigap after January 1, 2020. If you have Plan C or Plan F already, then you are not required to change your plan and you may continue to take advantage of the plan's coverage. For our breakdown of the lettered plans, Plan C and Plan F will be discussed so that you may compare them with other available plans if you are considering changing your policy.
It's important to note that your Medigap plan will generally only pay for coinsurance after you have reached your deductible amount.
MEDICARE SUPPLEMENT PLANS
Below is a breakdown of what percentage of cost the various Durham, California Medicare Supplement Insurance plans will cover. Let's take a look at each of the Original Medicare benefits and which plans cover them and which plans don't. Plans cover the full amount unless otherwise stated with a percentage. The percentage indicates what amount of the medical bill will be covered after your Original Medicare plan's coverage.
Full cover for coinsurance and hospital costs under Part A: Plan A, B, C, D, F, G, K, L, M, and N.
The first 3 pints of blood required: Plan A, B, C, D, F, G, K (50%), L (75%), M, and N. Part B copayment or coinsurance: Plan A, B, C, D, F, G, K (50%), L (75%), M, and N (Plan N will need to you pay a small fee when visiting a doctor's office or the emergency room if you don't become an impatient).
Hospice care copayment or coinsurance in Part A: Plan A, B, C, D, F, G, K (50%), L (75%), M, and N.
Part A deductible: Plan B, C, D, F, G, K (50%), L (75%), M (50%), and N. Part B deductible (unavailable with updated Medigap plans): Plan C and Plan F.
Skilled nursing facility care coinsurance amount: Plan C, D, F, G, K (50%), L (75%), M, and N. Part B excess charges (if the healthcare costs exceed the Medicare-approved amount): Plan F and Plan G.
80% cover for foreign travel emergency care (plan limits may apply): Plan C, D, F, G, M, and N.
You may notice that Plan K and Plan L only cover a percentage of most Original Medicare benefits; however, there are limits placed on the amount you'll have to pay for medical care each year. Once you have reached your out-of-pocket limit for the year - $5,880 for Plan K and $2,940 for Plan L in 2020 - as well as your Part B deductible - $198 in 2020 - then the plans will pay for all of your covered services in full until the end of the year.
Examine your current and expected medical needs, weigh the options available, and the costs involved before making your decision. If you have questions, call to be connected with a local Durham, California Medicare supplement specialist today.
When is the best time to apply for a Medigap plan? The short answer is during the Medigap Open Enrollment Period. This period is from the start of the first month in which you turned 65 or older and have Medicare Part B. It lasts for 6 months.
There are several regulations and standards that Medigap policies are required to have under federal and [state] state law. These regulations help to protect you. During the Medigap Open Enrollment Period, you have protection against being turned down for one of the above-mentioned lettered plans due to your medical history or pre-existing conditions.
During open enrollment, your current state of health cannot be factored in by the insurance company when calculating your monthly premiums, which essentially means that you will be charged the same premium as a healthy person even if you suffer from a pre-existing medical condition that would normally increase your premiums.
Your coverage also will not be delayed if you apply during your Medigap Open Enrollment Period, except in certain circumstances where pre-existing condition coverage may be delayed for a maximum period of 6 months, known as the "pre-existing condition waiting period". There are other situations where pre-existing condition coverage may not be a part of your plan if the condition was treated or diagnosed within 6 months before your Medigap plan coverage. This is referred to as the "look-back period".
Basically, during your Medigap Enrollment Period, you will be able to receive better prices and usually better coverage if you have pre-existing conditions. If, however, you want to purchase a Medicare Supplement Plan outside of the 6-month period after you become eligible, then all of the protection that the period offers you may be lost.
Outside of the Medicare Open Enrollment Period, you may be subject to medical underwriting requirements for the various lettered plans available. This can increase your monthly premiums and you may not receive cover for pre-existing conditions. Through medical underwriting, the insurance company will decide how much they will charge you, potential waiting periods for pre-existing condition cover, or if you'll even be able to choose the letter plan that you want. It is therefore of the utmost importance that you choose the plan that you want during the time that you have protection.
There are exceptions to purchasing a Medigap policy outside of the Open Enrollment Period while still benefiting from the protections it usually offers if you qualify for what is known as "guaranteed issues rights". These are sometimes referred to as Medigap protections.
WHAT IS COVERED?
With Part A and Part B of Medicare, you are covered for a substantial amount of the costs involved with hospital and general medical care. Part A of your Medicare policy helps you to pay for medical care such as home health care, inpatient care in a hospital, hospice care, skilled nursing care in a facility.
Part B of your Medicare policy helps to pay for medical services such as durable medical equipment (hospital beds, wheelchairs, walkers, and more), outpatient care, medical care from healthcare providers, preventative services (regular screenings, vaccines or shots, and more), and home health care.
However, Original Medicare falls short with its coverage for many other important healthcare areas and situations. The areas of your Original Medicare plan that are considered gaps in your coverage include hearing care, vision care, dental care, health insurance coverage during travel abroad, and excess charges which occur when Medicare-approved amounts are lower than the actual medical bill.
The overall costs for receiving medical care in Durham, California can also be substantial in certain situations if you just have an Original Medicare policy. The areas where you may end up paying a considerable amount include your coinsurance payments, copayments, and deductibles.
For these reasons and more, many people opt for a Medigap plan to help them with the medical costs involved with receiving treatment at the cost of a monthly premium and minimal additional costs. If you would like to learn more about Medicare Supplement insurance plans, call today to be connected with an insurance agent specializing in Medicare supplement plans in your area.
WHAT DOES A MEDICARE
SUPPLEMENT PLAN COVER?
In the above section which compares Medigap policies available in Durham, California, each of the lettered plans is explored in detail. A Medicare Supplement Plan can be purchased if you have both Part A and Part B of the Medicare policies, or Original Medicare. It basically helps you to cover costs that you would normally have to pay yourself when getting healthcare through Original Medicare.
The expenses associated with your Original Medicare plan, apart from your monthly premiums, that a Medicare Supplement Plan is able to help you cover include coinsurance, copayments, and deductibles.
A Medicare Supplement Insurance plan can essentially put a limit on how much you'll have to pay for significant medical bills. It can provide you with assurance that no matter what your medical needs may be in the future, you will be financially supported with your medical expenses, as long as it is covered by the Original Medicare plan.
Depending on the letter plan you choose, you may also be covered for medical needs such as receiving medical treatment in another country or excess charges that come with Part B coverage.
WHAT'S NOT COVERED
BY A MEDICARE SUPPLEMENT PLAN?
A Medicare Supplement Plan does not cover all of your medical needs. In most cases, the cost involved with long-term medical services is not covered.
A standardized Medigap policy generally doesn't cover private-duty nursing, vision care and eyeglasses, hearing care and hearing aids, non-skilled care such as at a nursing home, and dental care.
As of January 1, 2006, Medigap policies also don't provide coverage for prescription medication; however, if you have a Medigap policy that covers prescription medication, then you may keep it unless there are grounds for termination.
THE DIFFERENCE BETWEEN MEDICARE SUPPLEMENT PLANS
AND MEDICARE ADVANTAGE PLANS
You may have heard about a Medicare Advantage Plan. It may seem similar to a Medicare Supplement Plan, but they are different forms of insurance. A Medicare Advantage Plan can only be purchased legally if you do not currently have a Medigap plan; one must be dropped in favor of the other.
A Medicare Advantage Plan combines Part A, Part B, and usually Part D. Basically, you will be paying lower out-of-pocket costs compared to an Original Medicare plan, which is mostly covered by a Medigap plan, but may be restricted in your choice of Durham, California healthcare providers. A Medicare Advantage Policy is generally part of a healthcare network and the insurance provider negotiates deals with the providers in order to provide you with lower costs for health care. However, you may be required to choose a primary doctor and may need referrals if you need medical services from a specialist.
In contrast, Original Medicare supported by Medigap isn't as limiting in your choice of healthcare providers because more doctors and healthcare providers accept both Original Medicare and Medigap policies. This may be important if you live in an area with limited healthcare provider options or your preferred Durham , California doctor isn't part of the list of providers in the network. Going out-of-network may have limited or no coverage.
Medicare Advantage may also offer additional benefits that Medigap policies don't usually offer. These may include preventative services, transportation to medical providers, vision care, dental care, hearing care, and over-the-counter medications.
Cost is another differentiating factor between Medicare Advantage and Medicare Supplement Insurance. In general, Medicare Supplement Plans will have higher premiums than Medicare Advantage Plans; however, with lower premiums comes greater out-of-pocket costs when you actually need healthcare.
Another potential important difference between the two options is coverage during travel to another country. Some Medigap insurance plans, such as Plan D, cover 80% of your foreign travel emergency care costs while Medicare Advantage may provide little or no coverage for such a situation.
CAN MEDICARE SUPPLEMENT
PLANS BE RENEWED?
Yes. With a Medicare Supplement Insurance policy, you can renew the plan you have because lettered Medigap policies are required to be "guaranteed renewable". This status allows you to renew the plan you have for as long you like, even in the case of a new medical condition.
As with prescription drug coverage on certain Medigap plans prior to January 1, 2006, the guaranteed renewable status also means that you will be able to keep your chosen policy even if the policy is no longer sold to newly eligible Medicare applicants.
However, there are scenarios where your Medicare Supplement Plan may be terminated by your insurance provider. If you do not pay your monthly premiums, provide false statements or information to your insurance provider, or commit an act of fraud, your provider may terminate your plan.
Lastly, in the unlikely event that your insurance provider becomes insolvent, then you may lose your Medigap policy.
WILL A Durham, California MEDICARE SUPPLEMENT PLAN
COVER ME AND MY SPOUSE?
Medicare Supplement Plans can cover both you and your spouse, but not under the same policy. You are currently not able to purchase a single Medigap policy for both you and your spouse. You may only purchase a Medicare Supplement Plan for yourself once you become eligible, which is generally when you turn 65 and have applied for Original Medicare.
Since the Medigap Open Enrollment Period only becomes an option once you are covered by an Original Medicare plan, the chances are that you will be eligible at a different time than your spouse, too.
To have Medigap cover for both you and your spouse, you will need to purchase and pay for two separate Medigap policies.
DO Durham, California MEDIGAP PLANS COVER
If you have a Medigap plan from before January 1, 2006, then you may have cover for prescription drugs if the medication is listed in the plan's formulary (a list of prescription drugs that are covered by the plan).
No Medigap plan purchased after January 1, 2006, has cover for prescription drugs. If you would like to have cover for prescription drugs or want to be covered for potential prescription drugs you might need in the future, then you will need to do one of the following. You can add a Medicare Prescription Drug Plan (Part D) to your Original Medicare, which still allows you to take advantage of Medigap policies. You can choose to add Part D to your plan between October 15 to December 7 each year. Or you may choose to switch to a Medicare Advantage Plan with coverage for prescription medication.
In both cases, you must ensure that the prescription medication that you are being prescribed is listed on the plan's formulary. If you are unsure if your medications are covered, a local Durham, California Medicare supplement insurance agent can help answer all your questions and make sure you choose a plan that covers the prescriptions you need.
Original Medicare can provide you with health insurance coverage for most major medical situations and general care. While the coverage you get with Original Medicare may cover most major scenarios, it doesn't cover everything, and you may be left with substantial medical expenses. Combined with a Medigap Insurance Plan, your medical expenditures can be limited, and you can receive coverage for things that aren't covered in your Original Medicare policy. Call today if you would like to speak with a local insurance agent to learn more about your options and find your ideal policy.