Medicare Plans Maryland

Coverage and Benefits

If you are approaching the age of 65, you should take advantage of the federal Medicare program and start the enrollment process as early as possible. The Medicare program is designed to help retired US citizens take care of their health care needs during their retirement years. The base program, which is sometimes referred to as Original Medicare, is made up of Medicare Part A, and Medicare Part B. These two parts cover most of an elderly person’s medical needs, including hospital and outpatient services. However, it’s important to understand that Original Medicare can’t cover everything. We’ll discuss these coverage gaps here in this article, and also help you find ways to offset these potential expenses.

Medicare Parts A and B have certain basic fees as costs associated with each. For those with a lengthy employment history, usually 10 years or more, you may only be responsible for the premiums associated with Medicare Part B. However, if your employment history is less than the required number of years (or 40 quarters total), then you may also be required to pay fees for Part A as well.

Applying for Medicare automatically enrolls you in Part A hospital benefits and gives you the option to enroll in Part B benefits as well. Part B benefits pertain to outpatient services, preventative care, and regular doctor visits. Both Medicare Parts A & B require a premium, with Part B requiring a certain degree of coinsurance as well as co-pays for doctor visits.

However, you do not always have to accept Part B benefits. One exception to this rule pertains to Part D prescription drug coverage. You must be paying for Parts A and B if you would also like to purchase Medicare Part D. If you decide to go with a Medicare Part C plan, which is Medicare Advantage, you’re technically choosing not to accept Medicare at all. Instead, you’re paying for a private health insurance plan which must offer you the same benefits as Original Medicare at the very least.

This helpful chart outlines basic Medicare Part A and Part B coverage for Medicare plans in Maryland:

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Different forms of Medicare in Maryland

Maryland is home to a substantial number of Medicare beneficiaries – 827,426 in total. Of those, 9% (a total of 74,468 people) are getting their Medicare benefits from a Medicare Advantage plan. An additional 164,198 recipients are supplementing their Original Medicare a Medigap policy. The remaining 73% are either leaving themselves financially vulnerable to the gaps in their Medicare benefits, or may be using some sort of additional form of supplemental coverage available in their area or through their employer.

Before you decide how to supplement your Medicare benefits, you have to be receiving them in the first place. If you are not enrolled yet, click here for Medicare enrollment instructions.

Supplementing Medicare in Maryland

As you age, your health-related needs are going to rise. At the same time, your healthcare expenses will also rise – if not at the same rate, then probably faster. Medicare has been designed to be as comprehensive as possible, but it has its imperfections. These coverage flaws, commonly referred to as “gaps”, may leave you holding a very expensive medical bill if you have an unexpected health emergency. For example, here are some of the fees you could be expected to pay for from gaps in Original Medicare coverage:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

However, purchasing a supplemental policy could protect you from falling victim to these expensive coverage gaps. The two most popular forms of Medicare supplementation are Medicare Advantage, or by purchasing a Medigap policy. 

Applying for Medicare automatically enrolls you in Part A hospital benefits and gives you the option to enroll in Part B benefits as well. Part B benefits pertain to outpatient services, preventative care, and regular doctor visits. Both Medicare Parts A & B require a premium, with Part B requiring a certain degree of coinsurance as well as co-pays for doctor visits.

However, you do not always have to accept Part B benefits. One exception to this rule pertains to Part D prescription drug coverage. You must be paying for Parts A and B if you would also like to purchase Medicare Part D. If you decide to go with a Medicare Part C plan, which is Medicare Advantage, you’re technically choosing not to accept Medicare at all. Instead, you’re paying for a private health insurance plan which must offer you the same benefits as Original Medicare at the very least.

You must make a choice between Medicare Advantage or a Medicare Supplement policy if you plan to protect yourself from Original Medicare coverage gaps. You cannot purchase both. But both of these plans in their own ways help make it so that you don’t need to purchase redundant coverage. The choice comes down to evaluating which options are best for you considering your policy choice.  

Medigap Supplement Insurance in Maryland

Medigap is a separate type of private insurance specifically designed to cover the gaps in Original Medicare. Although sold by private companies, each of the 10 available Medigap plans are designed and regulated by Uncle Sam (the US government). Plans A, B, C, D, F, G, K, L, M, and N are currently available for purchase in all 50 states. Plans E, H, I, and J were weeded out back in 2010 due to reform legislation. The good thing about Medigap policies is that they are uniform – no matter where or what company you purchase your policy from, the benefits for plan G will me the same for you in Maryland as they would be for someone in Alaska. Prices and providers, however, will vary by zip code.

Medicare Advantage in Maryland

In some ways, Medicare Advantage (also sometimes called Medicare Part C) acts more like a replacement for Original Medicare than a true supplement plan. This is because signing up for a Medicare Advantage policy transfers responsibility for your Medicare over to a private company. On the upside, many Advantage plans offer additional benefits, especially prescription drug coverage, for only a slightly higher cost than Original Medicare.

However, it should be noted that some of these Medicare Advantage networks are highly selective in order to try and keep their costs under control. While there’s a small chance this could save you money on your policy, it comes with a large likelihood that you may end up having to switch doctors. For some, this might not matter so much. However, if you have a trusted relationship with your current physician, switching doctors might be more difficult.

For reference, an HMO is a “Health Maintenance Organization”. PPOs are “Preferred Provider Organizations”. 

The Difference Between Medicare Advantage and Medigap in Maryland

Let’s start by going over the basics of Medicare Advantage. Medicare Advantage policies are private insurance policies which are provided to you not through the government, but through a for-profit insurance company. They work very similarly to a private health insurance company, but the benefits you must purchase are the exact same benefits as Medicare Part A and B. From there, you can choose to buy different coverages – including coverage for Original Medicare gaps.

Medicare Supplement insurance, usually referred to as a Medigap policy, has a much different scope compared to Medicare Advantage. These policies are smaller, generally less expensive, and focus exclusively on Medicare coverage gaps. They do not include or provide options for prescription drugs, dental care, or anything like that. There are 10 plans in total, standardized across all 50 states. Depending on how comprehensive the plan is that you purchase, you could protect yourself from tens of thousands of dollars in medical expenses with one low, affordable monthly premium. This premium payment may include Part A & B premiums, too.

In truth, either of these insurance supplements are optional. There’s no legal requirement to supplement your medicare coverage. But what will happen to your finances if you suffer a catastrophic injury and get stuck in the hospital? What about your end-of-life care? What about the ever-increasing costs of medical supplies, coinsurance, and co-pays associated with your Medicare Part B expenses? When you consider how expensive not purchasing a supplement might be, it no longer feels very optional.

That’s why you need to act fast in order to protect yourself and your savings. Calling up one of our customer service representatives can help you figure out exactly what you need to do to get the most affordable option. If you let us help you, we may even be able to find you a quote from local companies who want to help you save money on your health care needs. As a courtesy, we included a Medicare Advantage versus Medigap FAQ chart below. If you still have questions, call us!

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? You share the burden of your monthly premium with the US government. In some cases, you may not have a premium at all. You owe your Medigap provider a low premium each month; the government is not involved in that expense.
Will I still have to pay for Part B? Yes Yes
What will it cost me? You will be expected to pay for things like your monthly premium (if there is one), coinsurance and copay as determined by Original Medicare. As well as out-of-pocket costs for coverage which is not included on your policy. It will cost you the monthly premium of your Medigap plan and any other expenses associated with Medicare gaps for which you do not purchase coverage. Not all plans cover all of these gaps, but the ones with less coverage are less expensive.
What will the plan cover? Medicare Advantage plans start out looking identical to Medicare Parts A & B. From there, it is your choice whether or not to purchase gap coverage, dental, or prescriptions coverage. Medigap insurance focuses only on the potentially expensive coverage gaps in Medicare; you cannot add extra coverage such as vision or prescription drugs.
Is it easy to budget my health care expenses? That really depends on how much health care you need. The less frequently you have to visit the doctor or hospital, the easier it will be to financially prepare. Comprehensive plans which take care of coinsurance and co-pays can greatly increase the ease with which you budget.
Is my plan guaranteed? Or can it be cancelled? Your Medicare Advantage provider can drop your coverage just as easily as any other private health insurance agency can. Medigap is very similar to Medicare in that your coverage has a much stronger guarantee; you won’t lose your Medigap insurance unless you stop paying premiums or the company goes out of business.
Do I have to clear a pre-approval or pre-certification process? While there are many legal restrictions on what Medicare Advantage companies can and can’t do, they are legally allowed to put you through a pre-certification process in order to qualify for coverage. Once you are authorized to receive Medicare benefits, you cannot be turned down for a Medigap insurance supplement plan.
Am I limited to specific doctors or hospitals? Medical networks in most Medicare Advantage plans are fairly restrictive, but this makes the plans less expensive in large cities because there are more choices. Double-check to make sure the doctor or facility you want to visit accepts Medicare. If so, then you are good to go.
What type of plan is best for me? You have to consider factors such as age, the overall state of your health, and what sort of choices you have for medical care in your area. Being young, healthy, and living in an area with more choices can make your plan more affordable. You will have to take the same factors into account with a Medigap Supplement. Older seniors who have more demanding needs and don’t have plentiful, local health care options usually do better with a Medigap Supplement.

Need More Information?

Supplementing your Medicare benefits is no easy task. Thankfully, there are options available for your budget, and Medicare experts you can consult in order to make sure you get the best deal. Below is a directory of contact information you can use to get in touch with people who can answer any lingering questions you may have.

Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

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