Medicare Supplement Plans
in Durham, North Carolina
Durham, North Carolina 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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Durham, North Carolina
MEDICARE SUPPLEMENT PLANS
If you are 65 or older, have certain disabilities while under 65, or have End-Stage Renal Disease, Medicare can help you to cover much of the costs involved with hospital and medical care. However, not everything is covered with a Medicare plan that includes Part A (hospital cover) and Part B (medical cover), also known as Original Medicare. If you want better coverage for more of your medical needs, then Medicare Supplement Plans, or Medigap plans, can be your ideal solution.
Navigating through the many possible Durham, North Carolina Medigap plans can feel intimidating, but we are here to help you cut through all the various policies to assist you in making an informed decision. With the right Medicare Supplement Plan, your healthcare can become more affordable because your current and future medical needs are better covered.
If you would like more assistance, call today. A local Durham, North Carolina insurance agent specializing in Medicare supplement insurance can help match you with the perfect plan that will provide coverage for your medical needs that Original Medicare doesn't cover.
WHAT IS MEDICARE
So, what exactly is Medicare Supplement Insurance? It is a type of insurance plan that is sold by private insurance providers in Durham, North Carolina and can only be bought if you have an Original Medicare plan. Original Medicare includes Part A and Part B. Part A of the Medicare plan covers areas such as skilled nursing care, home health care, inpatient hospital care, and hospice care - essentially, it covers emergency and inpatient care. Part B of the Medicare plan covers care received by doctors and healthcare providers, preventative services, durable medical equipment such as wheelchairs, home health care, and outpatient services.
A Medigap plan's purpose is to help fill the gaps in coverage that Original Medicare lacks. The coverage gaps left by Original Medicare include the costs of copayments, deductibles, and coinsurance.
Essentially, if you receive care, your Medicare policy will pay for the costs of care that are covered by your plan. Your Medicare Supplement Insurance plan will then pay its share of the costs involved with your healthcare. You will then be left to pay whatever is left over.
All Medigap policies follow [state] state and federal laws that are designed to protect the interests of the patient. Medicare Supplement Plans are standardized and therefore offer the same basic benefits depending on the type of Medigap policy it is (10 different lettered plans). The only real difference from one plan to another in the same letter category is the cost; even though two same-letter plans offered by different insurance companies have the same benefits, the premiums you pay may be different.
Due to the fact that costs are the only real difference between same-letter Medigap plans, it's important that you carefully compare prices from different insurance providers. This can save you a great deal of money over the course of several years. If you are unsure which plan is right for you, call today. A local Durham , North Carolina medigap specialist can help you understand your options and find the perfect plan.
HOW TO CHOOSE THE RIGHT PLAN
Choosing the right Durham, North Carolina Medigap plan to help you pay for the healthcare that falls outside your Original Medicare plan is about choosing one that will suit your current and future needs. While laws help to protect you by creating a standardized list of benefits that each Medigap plan must have based on its letter, some providers may offer additional benefits that can affect your decision.
It's important that you consider what your health might be like in several years' time; just because you don't need particular coverage at the moment, doesn't mean that you won't need it in the future. This is important because once you choose your plan, you may not be able to change it without having to pay higher premiums.
Medicare Supplement Plans are differentiated by letters. A Medigap policy will only cover your coinsurance payments once you've paid the deductible - which is the amount you need to pay for care before your Durham, North Carolina Medicare plan starts to pay - unless otherwise stated.
As of January 1, 2020, Plan C and Plan F are no longer sold to people who have become eligible for Medicare after January 1, 2020. However, if you already have either plan, then you may keep it. For the purposes of the letter category breakdown, we will include Plan C and Plan F for those seeking to compare and possibly change their current Medicare Supplement Insurance plan.
MEDICARE SUPPLEMENT PLANS A-N
Every lettered plan covers Part A hospital costs and coinsurance for 365 days after your Medicare benefits have been depleted. The differences and what Original Medicare benefits the lettered plans can help cover for residents of Durham, North Carolina are as follows.
Medicare supplement plans are organized by the letters A, B, C, D, F, G, K, L, M, and N. Below is a breakdown of each plan and what it does and does not cover.
With Part A, you'll have 100% cover for Part B coinsurance or copayment costs, the first 3 pints of blood, and copayment or coinsurance for Part A hospice care. You will have no cover for your part A deductible, part B deductible, coinsurance for skilled nursing facility care, excess charges on Part B (an excess charge is when the amount that a healthcare provider charges is higher than the amount that Medicare approves), and foreign travel emergency healthcare.
Under Plan B, your copayment and coinsurance in Medicare Part B, first 3 pints of blood, copayment and coinsurance in Part A for hospice care, and part A deductible are covered in full. Plan B does not cover foreign travel emergency care, your part B deductible, excess charges in Part B, or coinsurance for skilled nursing care in a facility.
Plan C is no longer available as of January 1, 2020. However, people who purchased this plan prior to 2020 are allowed to keep it. This plan covers your part A copayment and coinsurance for hospice care, part A deductible, part B copayment and coinsurance, part B deductible, first 3 pints of blood, and coinsurance for skilled nursing care facilities in full. Plan C also covers 80% of foreign travel emergency care. Only Part B deductibles are not covered in plan C.
Plan D covers medicare Part B coinsurance or copayments, the first 3 pints of blood, copayment or coinsurance for Part A hospice care, part A deductible, and care received from a skilled nursing facility in full. As with Plan C, 80% of your foreign travel emergency costs will be covered. Plan D does not cover part B deductible or part B excess charges.
Plan F no longer available as of January 1, 2020. But people who purchased it before 2020 are allowed to keep it. Plan F covers all of the above-mentioned Medicare benefits in full except for foreign travel emergency costs, which has 80% cover. It covers the most out all of the lettered plans.
Plan G covers medicare Part B copayments or coinsurance, part B excess charges, first 3 pints of blood, part A hospice care copayment and coinsurance, part B deductible, and coinsurance for skilled nursing care in a facility in full. 80% of foreign travel emergencies are covered. Plan G does not cover the Part B deductible.
Plan K will only cover Medicare Part A hospital costs and coinsurance in full. It provides 50% cover for part B copayment or coinsurance, part A hospice care's coinsurance or copayment, first 3 pints of blood, part A deductible, and coinsurance for skilled nursing facility care. Plan K will not cover your part B deductible, excess charges related to Medicare Part B, or emergency care during foreign travel. Furthermore, after you've reached your yearly out-of-pocket expense limit ($5,880 in 2020) and Part B deductible, the plan will cover all of the covered services for the remainder of the year.
Plan L is essentially a step up from Plan K. It covers all of the same Original Medicare benefits as Plan K, but instead of 50% cover, you will get 75% cover. Plan L has the same exclusions as Plan K. Once you reach your yearly out-of-pocket limit ($2,940 in 2020), the plan will pay for all of the covered services.
With Plan M, you can expect skilled nursing facility care coinsurance, first 3 pints of blood, coinsurance or copayment on Part A hospice care, coinsurance or copayment on Part B to be fully covered. 50% of your Part A deductible will be covered under Plan M as well as 80% of your foreign travel emergency costs. Plan M does not cover your part B excess charges or part B deductible.
Finally, Plan N, covers copayment or coinsurance on Part A hospice care, medicare Part B copayment or coinsurance (except for up to $50 for ER visits that don't end with inpatient care and $20 for healthcare provider office visits), skilled nursing facility care coinsurance, and your medicare Part A deductible in full. Plan N will not cover your Part B deductible or your Part B excess charges.
Durham, North Carolina MEDICARE SUPPLEMENT
Now that we've explored the differences in the various Medigap plans available in Durham, North Carolina, it's important to know when the best time is for you to choose a Medicare Supplement Plan. The best time to choose a Medigap plan is during what is known as the "Medigap Open Enrollment Period". The Medigap Open Enrollment Period starts the first day of the month when you have enrolled in Medicare Part B and turned 65 or older. You may have to pay penalties if you purchase your plan at a later date.
The Medigap Open Enrollment Period is a time where you can't be refused a certain Medigap policy based on your health problems. You also can't be charged more on your premiums, meaning that even if you have pre-existing conditions, you will pay the same monthly premiums as a healthy person.
The insurance provider may not delay your coverage except in some cases where your coverage for pre-existing may be delayed for up to 6 months. This is what is known as a "pre-existing condition waiting period. Pre-existing condition coverage may be excluded if the condition was diagnosed or treated within 6 months prior to your Medigap coverage - known as a "look-back period". While it may be excluded from your Medigap plan, it will still be covered under the limits of your Medicare plan.
During the Medigap Open Enrollment Period you can usually get much better prices. When outside of this period, insurance providers may use medical underwriting as a basis for how much to charge you or if they will accept your application. Medical underwriting is how an insurer decides, based on your medical history, how much to charge you, waiting periods for pre-existing condition coverage, and whether they will cover you or not through a specific lettered plan.
After your Medigap Open Enrollment Period, you are not guaranteed to be able to buy the policy you want, and may not meet the medical underwriting requirements. There are exceptions if you meet the requirements for guaranteed issues rights or Medigap protections.
WHAT IS COVERED BY
Part A and Part B, also known as Original Medicare, covers a great deal of your medical needs. But as many people discover, there are considerable gaps in the coverage that Original Medicare provides.
In Original Medicare Part A, you are helped with medical bills including hospice care, home health care, inpatient hospital care, and skilled nursing care in a facility.
In Part B of Original Medicare, the policy helps to pay for durable medical equipment such as walkers, hospital beds, and wheelchairs, outpatient care, health care you receive from providers and doctors, home health care, preventative services such as vaccines and medical screenings.
The gaps in Original Medicare coverage include areas such as health insurance coverage for foreign travel, nursing home care, routine care for hearing, foot care, dental services, and vision care.
With only an Original Medicare plan, you will have no coverage for prescription drugs as of January 1, 2006. Only by adding Part D can you receive prescription drug coverage. Other costs that must be considered with Original Medicare that Medigap can help to pay include coinsurance, deductibles, and copayments.
WHAT IS COVERED BY MEDIGAP
FOR RESIDENTS OF Durham, North Carolina
As discussed in the above section, there are many benefits that you have through your Original Medicare plan that can be better covered with the addition of a Medigap plan. It helps you to pay the costs involved that usually fall on your shoulders such as your deductibles, copayments, and coinsurance.
A Medigap policy can also help you to pay for things that aren't covered at all by your Original Medicare plan, such as emergency healthcare during travel to another country. For more detail on what standardized basic Medigap plans cover, refer to the above section on how to choose a plan.
WHAT ISN'T COVERED
While a Durham, North Carolina Medicare Supplement Insurance policy can help you to pay for gaps in your Original Medicare plan, it doesn't cover everything you'll need.
Generally speaking, a standardized Medigap policy won't help you to cover costs involved with long-term care, such as hearing aids, vision care, dental care, eyeglasses, non-skilled care such as care received in a nursing home, private-duty nursing.
MEDICARE SUPPLEMENT PLANS VS.
MEDICARE ADVANTAGE PLANS
Medicare Supplement Insurance plans cannot be used in conjunction with Medicare Advantage Plans. If you want a Medigap plan, then you cannot be covered by a Medicare Advantage plan, and vice versa. You can, however, apply for a Medigap plan if you are switching back to Original Medicare (Part A and Part B).
Medicare Advantage Plans, or Medicare Part C, is a Medicare plan that basically combines Part A, Part B, and Part D. Medicare Part D helps you to pay for costs involved with prescription drugs. Many Medicare Advantage Plans offer benefits that go beyond Part A and Part B, such as vision, dental, and hearing care. They may also offer extra benefits such as over-the-counter drugs, transportation to Durham, North Carolina healthcare providers, and preventative services.
However, Medicare Advantage Plans often require that you use in-network healthcare providers in order to be covered. Medicare Supplement Insurance plans can be offered as an HMO, PPO, and other types of networks that may ultimately limit the care providers available to in-network. With these networks, you often need to choose a Primary Care Physician (PCP) from a list, meaning that if you have a preferred doctor, they will need to be part of the plan's network.
With a Medigap plan, you will have covered access to more healthcare providers because generally, if a healthcare provider accepts Original Medicare, they will also accept Medigap plans. Another main difference between the two options is the cost. While Medigap plans tend to have higher premiums, there are less out-of-pocket expenses than with Medicare Advantage Plans. Foreign travel is also a factor. Generally, you will have greater medical coverage if you need it while traveling overseas with a Medigap plan than with a Medicare Advantage Plan.
Carefully consider your lifestyle and the types of benefits that you want before making your decision. If you would like further assistance in deciding which type of plan best suits you, call to be connected with a local agent in your area.
ARE MEDICARE SUPPLEMENT
All of the standardized Medigap policies available in Durham, North Carolina are guaranteed renewable. This means that even if you have new health problems since you first got your Medicare Supplement Plan, you are able to renew it for as long as you'd like to have the plan. It also means that if a plan you choose is no longer sold in the future, you will likely be able to renew your plan indefinitely.
There are exceptions. If you do not pay your premiums, commit fraud, or provide the insurance company with false information or statements, then the insurance provider has the right to terminate your plan.
CAN I GET Durham, North Carolina COVERAGE FOR
MYSELF AND MY SPOUSE?
Unlike usual Marketplace plans, you can only buy a Medigap plan for yourself. This means that if you want to get Medicare Supplement Insurance for yourself and your spouse, then both you and your spouse will need to apply separately.
Chances are that your Medigap Open Enrollment Period will also be different from your spouse's, so in order to benefit from the protection that it offers you, you will need to apply separately in any event.
Prescription drugs can be costly. If you need certain prescription drugs then having them covered is important to help offset the costs involved. Durham , North Carolina Medigap plans do not provide cover for prescription drugs as of January 1, 2006. In order to have insurance coverage for prescription drugs, you must include Medicare Part D.
Medicare Part D can be added to your Original Medicare plan while still being able to make use of the benefits of a Medigap policy. Part D plans provide standardized levels of coverage for prescription drugs, but each type of plan may vary when it comes to the exact prescription drugs that they cover, also known as a "formulary".
Before adding a particular Part D plan to your Original Medicare, you should ensure that the prescription drugs that you require are included in the formulary.
Choosing the right Medicare Supplement Insurance plan can make a significant difference in your life. Take your time and explore all of your options carefully so that you can be covered for all of your lifestyle and medical needs.
If you are finding your decision difficult to make, call to be connected with a local Durham, North Carolina insurance agent specializing in Medicare supplement insurance plans today.