Once you reach the age of 65, the odds are good that your medical needs will begin to increase. You may need to visit the doctor more often, receive more outpatient care, and you may even require an occasional hospital visit. However, for most people on a fixed or retired income, meeting these medical needs can be financially stressful. For this reason, the federal Medicare program exists. The base of the program, Parts A and B, cover the increasing need for doctor’s visits and hospital stays for elderly individuals who enroll in the program.
The program is designed to keep costs down while covering most of what retirement age individuals require to maintain good health. Part B, which covers things like doctor office visits and outpatient treatment, has a fixed monthly premium, as well as a yearly deductible for all enrollees. Part A might be free if you have a 10-year employment history (a total of 40 quarters in all). However, if your cumulative work history amounts to less than that, you may have to pay additional fees for Medicare Part A and its associated hospital visit coverage.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
There are 448,215 Kansas citizens 65 or older currently taking advantage of the Medicare Program. A modest 13% of those (or 58,267 individuals) have effectively replaced their Original Medicare (Parts A and B) with a Medicare Advantage policy. And additional 44% (or 196,048 beneficiaries) have chosen to supplement their Medicare with a Medigap policy (we’ll talk more about those later). Finally, the remaining 43% (192,732 people) have either decided to hold off on supplementing their Medicare coverage, or have some other form of supplement policy, perhaps through an employer.
Are you enrolled in Medicare yet? You can’t start looking for a Medicare supplement until you are. For more information, click the link above.
Well, the issue goes beyond just Kansas. Anyone age 65 or older who has successfully enrolled in Medicare Parts A and B should seriously consider supplementing their Medicare coverage. As comprehensive as the plan tries to be, it doesn’t quite cover everything. And the things it doesn’t cover can cause you some serious financial trouble if you aren’t prepared to pay for:
|Medicare Part A Costs||Medicare Part B Costs|
IF you are relatively new to the Medicare program and are already in fairly good health, you may not think that a supplement policy is necessary. That may be true for now, but you can’t predict what sort of health problems may develop later on down the road. Most prefer to put such worries at ease with either a Medicare Advantage plan, or a Medigap policy. We’ll go into the pros and cons of each plan now.
“Medigap” policies are the ten government-approved Medicare supplement insurance policies designed to protect you from the costly “gaps” in your Medicare benefits (hence Medi-“gap”). Plans A, B, C, D, F, G K, L, M and N are available in all 50 states, including Kansas, and each plan provides the exact same benefits as outlined in the table below. The only thing that varies are cost, and provider. Otherwise, each plan is exactly the same, regardless of your location.
[chart category=”supplement” name=”planTypes” state=”KS” zipcode=”66102″]
Medicare Part C, which is more commonly referred to as Medicare Advantage, is another form of protection against the expensive gaps in Traditional Medicare coverage. By law, each Medicare Advantage (MA) policy has to give you the exact same benefits as Traditional Medicare. Some plans offer even more, such as vision, dental, or prescription drug coverage, in order to bring in more clients. But once you sign up for your MA plan, you transfer power from the federal government over to a private health insurance company with respect to your medical needs and benefits.
Those who sing the praises of MA admire the simplicity of only having to deal with one single company, as opposed to both a Medicare supplement insurance agency and the federal government. However, make sure that your current doctor (or doctors) are also a part of any MA network you might want to sign up for before purchasing a policy. Many HMO and PPO Medicare Advantage networks are restricted, and you might end up switching doctors if you don’t do your homework first.
Not sure whether you need a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO)? The Medicare Advantage plan you choose will be a significant determining factor, among other things.
[chart category=”advantage” name=”topHMOPlans” zipcode=”66102″ state=”KS”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”66102″ state=”KS”]
It’s hard to say which form of coverage is the superior policy. What works well for some might be too complicated or expensive for another. Below, the informative table will highlight exactly how Medigap and Medicare Advantage are different from one another:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
We’ve included a directory of Medicare supplement resources and contact information below relevant to all Kansas residents. Managing your health care needs is a highly complicated and personal issue. This article alone can give you helpful and informative knowledge, but it cannot answer all of your questions. Contacting the offices and agencies below, however, can also help:
[chart category=”general” name=”usefulContacts”]
Mon-Fri, 8am-8pm EST