Most people have heard the phrase “Medicare coverage gaps” at one or another point in their lives; however, few people really know what Medicare coverage gaps are. For most seniors, Medicare coverage gaps include certain hospital costs and outpatient expenses which are not covered by Medicare alone. The patient – you, essentially – has to then pay for these uncovered medical expenses 100% out-of-pocket. These bills can run very high very quickly if you don’t act now to protect yourself. The best way to protect your savings from being ravaged by these unexpected medical bills is to purchase some type of supplemental coverage.
Facts and Figures
- 28,116 seniors live in Tacoma, Washington.
- There are 9 hospitals in Tacoma where seniors can receive emergency and/or in-patient care.
- 30% of seniors in Washington have a Medicare Advantage plan.
- 21% of seniors in Washington have a Medicare Supplement (Medigap) plan.
- That leaves 49% of seniors potentially uninsured or underinsured against costly Medicare coverage gaps!
According to the above numbers, just about 13,776 seniors in the Tacoma area suffer from a reduced access to healthcare. That is to say that only one out of every two seniors in the area have reliable and affordable access to healthcare. For the remaining 49%, healthcare options are either one or the other, oftentimes being neither reliable nor affordable, particularly for seniors caught in Medicare coverage gaps. Unfortunately, the problems only worsen with age. As people go up in years, their risks of developing age-related illnesses goes up hand-in-hand with their ages, leading to worsened quality of life and deteriorating health in the coming years. This can happen to anybody, regardless of your health today. The chart below showcases the current prevalence of a handful of these age-related illnesses in Tacoma.
|Disease||Prevalence in Tacoma, WA|
|High Blood Pressure||32%|
|Coronary Heart Disease||6%|
Healthcare Costs in Tacoma, WA
Age-related illnesses can also significantly increase healthcare costs, particularly for seniors in the greater Tacoma area due to the relatively low number of hospitals in relation to the total population (with about 24,031 people per hospital). Of course, the lack of additional hospitals is not the only reason for increased healthcare costs. At the same time that age-related illnesses are becoming more common in senior populations, the frequency and severity of their related symptoms are also worsening. Given that seniors are also living longer lives than ever before, the timeline for the progression of those symptoms is also longer than ever before, meaning that the healthcare costs associated with their treatment are – you guessed it – higher than ever before. The chart below demonstrates just how much you could end up paying each year if you get caught in the Medicare coverage gaps.
|Disease||Prevalence in Tacoma, WA||Annual Cost of Treatment|
|High Blood Pressure||32%||$354|
|Coronary Heart Disease||6%||$7,959|
Medicare Advantage Savings in Tacoma, WA
Unlike Medicare, Medicare Advantage plans are provided and managed entirely by private health insurance company, meaning that each company has an incentive to provide the best possible care in order to invite additional enrollees away from their competitors. To do so, they often add more coverage options than just the bare minimum that the law requires them to provide. These additional coverage options can manifest in a variety of different ways, which we’ll get into below. Ordinarily, each additional coverage option will cost you an additional sum of money in monthly premiums; however, there are government programs in place designed specifically to lower those premiums, sometimes enabling seniors to pay as little as $0 per payment period.
One of the most common additions to Medicare Advantage plans is prescription drug coverage. Unlike Original Medicare, Medicare Advantage plans can be as comprehensive or as simplistic as your prescription needs warrant. In fact, many providers even enable you to add coverage for medical equipment and tools that would normally be required by patients suffering from arthritis, high blood pressure, or diabetes, such as glucose monitors and testing strips. These benefits enable seniors suffering from one or more of these illnesses to save thousands of dollars each year, which begins to noticeably add up even more as the illnesses worsen in scope and symptoms.
Additional coverage options available to most Medicare Advantage enrollees are vision care and dental care coverage. That means that you don’t have to go out and find separate dental insurance from a different provider just to get care. Instead, simply call the dentist that your Medicare Advantage plan assigned you to, and make an appointment. Of course, the specifics of each plan are typically going to vary from person to person. One of the most notable differences between Medicare Advantage, Medicare Supplement Insurance, and Original Medicare plans is that the latter two cannot provide additional prescription drug, dental, and vision coverage.
Medicare Supplement (Medigap) Savings in Tacoma, WA
As the name suggests, Medicare Supplement (Medigap) insurance supplements your existing Medicare benefits rather than replacing them, which immediately sets these plans apart from Medicare Advantage. For the most part still privately owned and operated, these plans are otherwise subject to may of the same market forces as Medicare Advantage. There are ten different types of Medigap insurance plans from which to choose.
The first few Medicare Supplement insurance plans are referred to as Medigap Plans A, D, K, and L. Each of these plans provides a different set of benefits and coverage options while sharing the same primary goal: bridging the coverage gap for seniors struggling to pay high Medicare Part A expenses. Medicare Part A expenses are typically highest among seniors with diseases such as chronic heart or kidney disease because those two diseases tend to require more advanced emergency and/or in-patient treatment options. See the chart below for more details.
The next few Medicare Supplement insurance plans include Medigap Plans B, C, F, G, M, and N. Whereas the first four plans mentioned above only provide benefits relating to Medicare Part A coverage gaps, these plans provide coverage benefits relating to both Medicare Part A and Medicare Part B coverage gaps, providing much more versatile care options. Unfortunately, not all of these plans are going to be around forever. Medigap Plan F is no longer going to be available for enrollment as of 2021. If you enroll in Plan F before the 2021 deadline, you might get lucky and get to keep your plan after it is no longer offered; this is called “grandfathering”. But if you miss the deadline, you’ll have to choose a plan with similar – albeit lesser – benefits instead.
As we mentioned earlier in the Medicare Advantage section, only Medicare Advantage plans are capable of adding on prescription drug, dental care, and vision care coverage options directly to the plan. However, that does not mean that seniors who select a Medigap plan are going to be hung out to dry when it comes to those three areas of coverage. In fact, all you have to do in that case is simply select another insurance plan that covers those three areas of coverage specifically, without affecting your Medigap or Original Medicare plans. Oftentimes, you can even find a provider willing to do so for under $100 per payment period.
At the end of the day all of this hassle will be well worth it. By selecting a healthcare insurance plan that adequately protects you against the costly Medicare coverage gaps, you protect far more than just your healthcare. In fact, you protect your financial wellbeing, your psychological health, and even your personal independence against any unforeseen circumstances that may arise in the future. But you have to act as soon as possible. Given the nature of age-related illnesses, a month of procrastination may prove disastrous. So don’t wait! Head over to Medigap.com today and begin speaking with experts on which plan is right for you. Your future self with thank you!
|Medigap Plan||Minimum Monthly Premium||Maximum Monthly Premium||Average Estimated Monthly Premium (Part B Premium Included)|
|Plan F (high deductible)||$44||$88||$202|