Understanding the Medicare Supplemental Medigap Insurance choices in Orange County can be confusing. Throw in various other choices like Part C, Plan F, Part D and all of sudden you may be feeling a little overwhelmed!
I can help make Medicare Easy.
Most people approaching 65, or those about to lose their health insurance coverage by retiring, need to start planing their Medicare options immediately. The Government has strict penalties for those that procrastinate – which may cost you hundreds, even thousands more over the next ten years of you don’t act when you should.
As a Medicare Agent, I find that most people have heard of and are quite familiar with Medicare Supplemental Insurance plans, also known as Medi-Gap insurance, because they’re designed to fill in the coverage “gaps” that Medicare does not cover. This is typically 20% of all costs associated with any type of health care for those in the Medicare system. The Medigap plan simply pays all costs over and above the 80% that’s covered by the Government. It’s a very simple process, most people select a company to “underwrite” the policy, pay a monthly premium, and go along as if nothing was different.
When the need arises to use health services, and it’s time to pay the bill, the Medicare system will pay for 80% of the bill, and the Medigap policy will pay the other 20%, regardless of how small or big the bill is – there’s no spending limit. Here’s a typical breakdown of what some Medicare Supplement Plans may cover:
Some benefits of a Medicare Supplement Policy:
- Flat premiums each month: seniors can budget around these costs without worrying about any unexpected expenses
- Premiums rise at a set amount each year: another great way for seniors to budget their annual medical costs
- Use any Dr they want: there’s no networks to worry about, if the Doctor accepts Medicare as a form of payment, then the senior can use them
- The Underwriter doesn’t dictate care: the insurance company the policy is held with has no influence or say over the quality of care, or the Doctor that the client has to use – the insurance company is simply there to pay the 20% bill
Some of the drawbacks
- Monthly premiums start at $130 per month in Orange County: most seniors are on a fixed income and this is simply not a viable option
- You still need to purchase a Part D Prescription Drug Plan separately
- Monthly premiums increase each year: this too makes it fairly expensive for the average senior
- You can be denied: outside of your Initial Enrollment Period, if you try to change plans, there is a change the new carrier will deny your application if you have pre-exisiting conditions
- No Extras: you pretty much get what Medicare offers, which does not include things like Acupuncture, Chiropractic, Dental, Vision, Transportation, Personalized services etc.
- Less Doctors Are Accepting Medicare: because the Government continues to eat away at the payments Doctors receive for treating patients paying with Medicare, more and more Doctors are electing to no longer accept Original Medicare as a form of payment.
While Medicare Supplements are very popular, there’s an alternative that is gaining in popularity and giving these Medigap plans a run for their money (or lack of money!).
Medicare Advantage Plans have been around for years, they’re also known as Medicare Pt. C plans and they have to be approved by the Centers For Medicare & Medicaid Services (CMS) in order to be offered.
Part C Plans in Orange County are great! They give you some wonderful benefits and “perks” that you would never see on Original Medicare. The biggest draw for most is the price of the monthly fee in order to have a Part C plan – $0. You’ll still pay your Part B premiums, but I have many plans that cost NOTHING to be in the plan.
Here’s some pro’s and con’s:
- Costs as little as $0 per month in Orange County
- Most plans include extras like Gym Memberships at 24 Hour Fitness, Preventative Dental, Transportation, Chiropractic, Acupuncture, Free meals after hospital discharge, 24 Hour Nurse Hotline and many other benefits!
- Small Co-Pays – since most plans don’t charge a monthly premium, you would have a small $5 to $20 Doctor Co-pay
- Medicare Part D Prescription Drug Plans are often included at no extra cost
- All plans are guaranteed acceptance, unless you have ESRD.
- You can change your plan 1x per year without any fear of losing coverage
- Less paperwork
Some of the cons may be:
- You must stick to a Network of Doctors and Hospitals
- For HMO plans, you must ask for a referral from your primary Dr prior to seeing a specialist
- Some plans have a minimum “per-day” co-payment if you land in the hospital (so shop around!)
- Plans differ by County, so if you move, you must change plans.
With So Many Choices, Which Plan Do I Choose?
As a licensed Life & Health Agent, I’m authorized and certified to sell many Medicare Advantage Plans in Orange County. I would love to discuss all of your options, free of charge. In fact, you’ll never pay me for any of my advice or help. To speak with me, simply call 800-443-9109.