Do you live in Wyoming? Are you getting ready to turn 65 years of age? If so, then you should be preparing yourself to enroll in the federal Medicare program. Together, Medicare Parts A and B make up the base plan. Part A covers your hospital needs, such as visits and treatment, and Part B covers your outpatient healthcare, such as doctor visits and non-hospital procedures.
Coverage and Benefits
Although the Medicare program is designed to be as affordable as possible, there are some basic costs associated with enrollment. Part B starts out with a yearly deductible and required monthly premiums for every single enrollee. If you would like to estimate those potential costs, you can research the numbers on this page. Fortunately, Part A can be free, but it depends largely on your employment history. Anything less than 10 years (or 40 cumulative quarters), though, and you will have to pay a deductible for Part A.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
These days, seniors have a few options when it comes to their Medicare: they can purchase Medicare Part A only for hospital and hospice coverage and opt out of Medicare Part B which pays for more common expenses like medical supplies, doctor visits, and outpatient care. However, there are some situations in which opting out of Part B benefits is not optional. But if all you’re concerned with is Medicare Part A coverage, then Medicare Part B is not mandatory. Enrolling in and accepting Medicare coverage though, does mean that you will at least have to accept Part A benefits and pay the premiums for them.
But for many seniors, there aren’t many affordable options for their more common healthcare expenses beyond Medicare Part B. That’s why many choose to accept it and pay the premiums, even if for no other reason than it is the only way for them to be eligible for Medicare Part D prescription-drug coverage. Similarly, choosing to purchase a private insurance plan through Medicare Part C means that you won’t be able to reject that plan’s benefits which is identical to Medicare Part B. Medicare Part C plans are required by law to start with identical benefits to Original Medicare (Parts A & B) and also required to give you the option to add more coverage as you see fit.
Supplementing Medicare Plans in Wyoming
Wyoming has a modest population of only 84,076 residents which are currently enrolled in the federal Medicare program. Of those, the smallest minority have chosen to supplement their Medicare benefits with a Medicare Advantage policy: 3%, or 2,522 individuals. A significantly larger chunk of beneficiaries – 36%, or 29,997 people – are supplementing their Medicare coverage gaps with a Medigap supplement. And the largest percentage, 61%, represents the 51,286 Wyoming seniors who either have some additional form of supplementation, such as that offered through an employer, or absolutely no Medicare supplementation at all.
Don’t forget to enroll in Medicare first before looking into purchasing supplemental coverage. Learn everything you need to know about Medicare enrollment by clicking that link.
How Important Are Medicare Supplement Policies?
Depending on your circumstances, they can be essential to managing your health care needs at the most affordable cost. If something unfortunate were to happen, such as an extended hospital stay or months of rehab from a physical injury, you might be required to pay some hefty out-of-pocket prices which Traditional Medicare won’t cover. Such as:
|Medicare Part A Costs||Medicare Part B Costs|
For many, especially those who are well into their golden years and living on a fixed income, leaving their health care coverage to chance is a gamble they cannot afford to make. Obtaining supplemental health insurance helps protect them from the gaps in Medicare, and eases their worries. There are two main options for supplementing Medicare which we will get into presently: Medicare Advantage, and Medigap.
Even seniors who live in Wyoming won’t be sheltered from the rising cost of healthcare – at least, not in the long-term. You may think that Medicare is affordable now, but what about in the future when you start to require more expensive and more frequent medical care? When that happens, things can get complicated fast. And usually when things get complicated with your healthcare, it means that they will also get very expensive.
If you are recently retired and in good health, then Medicare is a highly affordable and often preferable option to most private health insurance plans. But as you get older, that may change. There are certain gaps in Medicare coverage that won’t cover all of your needs. Multiple doctor visits and extended hospital stays are some of the most common occurrences for older seniors; they’re also some of the most expensive gaps in Original Medicare coverage. And if you want to protect yourself and your savings, you’ll need to purchase some type of supplemental health insurance if you want to save money.
Not doing anything to protect yourself from the gaps in Medicare coverage is like sitting on a ticking time bomb. But you have a few different bomb squads at your disposal to choose from. One of them is referred to as Medicare Supplement insurance, AKA Medigap. The other one is something you may be more familiar with: Medicare Part C, AKA Medicare Advantage.
Both Medigap and Medicare Advantage can help seniors protect themselves from Original Medicare coverage gaps in an affordable way. But, unfortunately, these plans are not created equal. Nor is one plan always superior to the other for every senior. The type of plan you choose and the money you save will largely depend on your personal circumstances. And since every person’s healthcare needs are different, it can be a little bit of a confusing process to choose between the two.
Choosing Medicare Supplement Coverage
Medicare Supplement Coverage, commonly referred to as “Medigap” policies, give you health care coverage where Medicare Parts A and B do not. The 10 federally approved and regulated plans are included in the chart below, and include plans A, B, C, D, F, G, K, L, M, and N. Up until 2010, plans E, H, I, and J also existed, but the Medicare Modernization Act eliminated them from the available choices. The good thing about the way these Medigap policies are structured is that they are the same in every state, through every insurance provider. The only thing that varies across state lines is the price of the policy.
Below are the benefits that every Wyoming resident can expect from their chosen Medigap policy:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$108||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$104||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$98||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$87||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$76||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$99||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$64||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$65||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$43||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$104||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Option #2: What is Medicare Advantage?
Medicare Advantage, Medicare Part C, and ‘Medicare Replacement Policy’ all refer to the exact same thing. Medicare Advantage (or MA for short) is essentially a private Medicare replacement. Instead of getting your claims paid out by Uncle Sam, a private insurer will take over those duties. Legally, though, you will not be losing any Medicare benefits. MA plans have to provide you with the same minimum coverage that you would receive from Traditional Medicare. That is the law.
However, as long as you are getting the bare minimum Medicare benefits, your MA provider can also throw in extras, like vision or prescription drug coverage, in order to sweeten the deal. Many companies do exactly that. Of course, premiums and additional costs will rise to help pay for the extra coverage. In order to balance things out and keep costs low, many MA providers prefer to keep their networks limited. So it’s a tradeoff – you may have access to better coverage at an affordable price with MA, but you may end up having to switch doctors.
The specific networks through which Medicare Advantage plans usually operate are referred to as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).
The Real Differences between Medicare Advantage and Medigap
You can think of Medigap policies as the little brother to Medicare Advantage. They are smaller, often overlooked, and they are more focused specifically on the gaps in Original Medicare coverage than providing you with a bunch of bells and whistles. For many seniors, this can make a Medigap plan much more affordable than a Medicare Advantage plan. But, as we’ve already said, this may not be the case 100% of the time.
Here’s how Medicare Supplement (Medigap) insurance works: you get to choose from one of 10 standardized plans – which is identical in every state – and which will cover different coverage gaps and provide different benefits based on your needs. As long as you qualify for Original Medicare, you don’t need to go through any pre-approval or pre-certification process. Just pay your monthly premiums on time and in full for as long as you decide you want to keep your coverage. As long as you do and as long as the company stays financially solvent, you can carry this policy with you for the rest of your life.
Medicare Advantage works much differently. Like Medigap, it is a private health insurance policy issued by a private company but that is one of only a few similarities between the two. Medicare Advantage completely replaces Medicare Parts A & B with a private health insurance plan. As we stated earlier, by law, your Medicare Advantage plan must be identical to Medicare Parts A & B. From there, you will have the option to purchase riders which close the gaps in Original Medicare coverage. You can also choose to add prescription drug coverage, vision, or even dental coverage to your Medicare Advantage plan. Just remember that the more coverage you purchase, the more expensive your plan will be.
For many, having all of your health coverage under one single unified plan gives Medicare Advantage a certain appeal. But there are some downsides to purchasing Medicare Part C. For one, unlike Medigap, you will have to get pre-approval from your insurance provider before they will offer you the opportunity to purchase their plan. The worse your health is, the more difficult it will be. Furthermore, your Medicare Advantage insurance company has a greater level of discretion when it comes to choosing to discontinue your coverage. There aren’t as many guarantees as there are with Medigap. Lastly, you’ll be limited to a very narrow HMO network of doctors and hospitals with Medicare Advantage. This may keep your costs a little lower, but you could end up losing your doctor or receiving subpar care at the facility of your insurance company’s choosing.
We understand that choosing between the two can be confusing and tedious. There’s a lot of information you need to learn, and not a whole lot of time to do it in. But we would love to help. We’ve been experts in this industry for a long time, and we have helped thousands of people just like you, purchase the best supplemental coverage based on their personal needs. Just call one of our agents and we can help you find the most affordable supplement coverage from a local provider you can trust.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Your Medicare Advantage provider will approach the federal government and ask for a premium payment. The government subsidizes part or all of that premium; whatever they won’t subsidize, you will have to pay for on your own.||Your Medigap provider will offer you a low monthly premium quote which you will pay if you decide to accept the plan and purchase the coverage.|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||If the government doesn’t agree to pay for all of your monthly premium, it will cost you the balance. It will also cost you whatever deductibles, co-pays, coinsurance, and other costs associated with your plan.||If you purchase a more comprehensive plan, like Plan G or Plan F, you may only have to pay for your monthly premium. But less comprehensive plans – especially plans that have fewer coverage benefits could end up costing you more.|
|What will the plan cover?||The plan can cover as much or as little as you want. You can choose to accept bare minimum coverage and get benefits which are identical to Medicare Parts A & B. Or you can choose to add extra coverages such as dental, prescription drugs, vision, and more.||Medigap plans are more specific; you are only purchasing coverage for those few (but potentially expensive) benefits which Original Medicare does not provide for. These include things like extended hospital stays, extra blood transfusions, and certain coinsurance co-pay costs that can get pretty expensive under Part B.|
|Is it easy to budget my health care expenses?||Some Medicare Advantage plans can be a little unpredictable. If you chose a less expensive one with higher co-pays, deductibles, and coinsurance, then the more medical care you need to receive, the harder it will be to budget.||The more comprehensive your plan, the easier it will be to budget. Medigap plans like Plan F or Plan G make budgeting easy; Medigap plans like Plan A or Plan B can make it a little harder.|
|Is my plan guaranteed? Or can it be cancelled?||There are not nearly as many guarantees with Medicare Advantage as there are with Medigap insurance. It is much easier for your provider to cancel your plan if they can find a legal reason to do so.||Qualifying for Original Medicare means that your Medigap policy is guaranteed as long as you pay your premiums on time and as long as your provider stays in business.|
|Do I have to clear a pre-approval or pre-certification process?||Since Medicare Advantage is a private plan, most companies will have a mandatory pre-approval or pre-certification process associated with your policy.||There is no mandatory pre-approval process if you qualify for Original Medicare.|
|Am I limited to specific doctors or hospitals?||Medicare Advantage HMO networks are much more limited than Medicare or Medigap networks are. On the bright side, this can help you keep costs more affordable.||As long as your doctor or hospital accepts Medicare, they will accept your Medicare Supplement insurance policy as well.|
|What type of plan is best for me?||Seniors can benefit most from a Medicare Advantage plan if they have a greater variety of doctors and hospitals to choose from; if they want all of their different types of coverage to be under the same policy; if they are younger and in better health; and if they would rather have their healthcare needs provided by a private entity as opposed to the federal government.||Older seniors with fewer healthcare options to choose from in their immediate area typically fare better on a Medicare Supplement insurance plan. Seniors who are living on a fixed income and who might not be in the best of health also tend to fare better with Medigap coverage.|
Informative Medicare Resources
This article is a broad analysis of Medicare supplemental coverage, and contains just enough helpful information to get you started. From here, you can take it the rest of the way by doing some investigation on your own. Below are links and contact information of various offices which specialize in Medicare. Talking to any of these experts can definitely help you start going down the right path.
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Help with my Medicare options & issues
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Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare 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.