Modern Medicare Supplements

SUPPLEMENTS: that is exactly what they mean. If a charge at a Dr’s office, medical clinic, or hospital is “approved’ by Medicare it will also be processed by the Supplement insurance company. Benefits will be paid if you have met your Part B deductible, or you will informed as to how much to pay the provider.

Let me explain. Part A is the Hospital or in-patient coverage. It does not have a deductible or co-pay that is your responsibility with a supplement. The Part A deductible for 2022 is $1556 for a 60 day ‘benefit period”. You can be readmitted to the hospital during that “benefit period” with just one deductible. Even it is for a completely different diagnosis. If you go into the hospital after that “benefit period” you will be assessed another deductible, all of the admissions will be processed by Medicare and if you have Medicare Supplement G or N, they will be paid at 100%. If you go into the hospital but are not admitted, you can be there for 23-24 hours “under observation”. That is covered under Medicare Part B.

Part B is where there are more frequent claims. This is where you obtain coverage for all outpatient visits to hospital or Dr. You can have surgery in the hospital that will be covered by Part B. You must be admitted for Part A to pay.

Your Part B benefits have a $233 annual, Jan 1 to Dec 31 deductible. If you have a Medicare Plan G plan you will not encounter any co-pays. You may have heard from your parents or grandparents that their Medicare Supplement pays 100%. That plan has been faze out except for individuals who were 65 prior to Jan 1, 2020. If you are just not going on Medicare you cannot buy that plan, what I want to emphasize is that a Medicare Supplement will be dependable coverage in any Dr office or Hospital that accepts Medicare. You will not be asked to pay more than the Part B deductible unless there are unusual circumstances.

You do not have to worry about Networks. Our office in Sterling does not market any Medicare plan that has networks.

Plans: Plan G is the best Supplement plan that is on the market today. We tell our clients that Medicare plus Plan G will be the best health insurance they have ever had. Think about it; just a $233 deductible in 2022 and that is it. No worries.

Plan N is a plan where you pay the Part B deductible then if you go to the Dr. or any other medical provider for outpatient care like rehab, you will pay no more than a $20 co-pay and if you go to the ER you will pay no more than a $50 co-pay. Your supplement will pick up the balance.

High Deductible Plan G has a $2490 deductible plus somewhere in your claims that year you will also have the $233 deductible. We primarily use this for VA applicants as a backup to their benefits.

It may not seem like it, but the Medicare Supplements are simpler and are dependable year after year anywhere you are in the US. You cannot be cancelled unless your insurance company cancels all plans in your state. Yes, their premiums will be more than an Advantage Plan but read my article “Surviving a Medicare Advantage Plan. There is a big difference, and you will see it if you compare each carefully. My wife and I have Plan G and we would not think of buying anything else.

Phil Mattox, CSA

29 December 2021

How to survive buying a Medicare Advantage Plan as my primary plan.

I am going to give you several important points that are essential to you to make your plan work.

           1.    If you have any prescription drugs, make sure that all are going to be covered by the plan you are considering and that you know the deductible and co-pay totals for o the entire year. You need to know what your meds are going to cost you.

              2.    Check to make sure that the clinic where your Dr. practices and the hospital that you would use are both “in network".

If you sign up for an HMO make plans to stay close to your home so that if you need a Dr. or need to go to the hospital and are admitted, you will know that you are going to be treated by an “in network" Dr. and hospital.  You never want to go to a hospital that is “out of network”.  I am seeing a 40% co-pay that will push you to your out of network maximum very quickly.

You are going to see me keep repeating “in network”.  You must be very careful to always be treated by a network provider.

We are seeing too many individuals that are not able to pay the stack of accumulated bills or having to find an attorney to file Bankruptcy for them.  Yes, I have had individuals tell me that exact thing happened to them.  I feel sorry for them because all they heard “its free”.    Yes, some of the benefits in the plan are free but what can get you in trouble is the “out of network” charges.  If you are treated by a local ”in network” hospital then transported to a more advanced hospital for treatment that may save your life you do not have a say in the destination.  They do not pay any attention as to the classification, network or not, of that hospital.

All of the above is for PPO plans.  If you chose an HMO you had better live in a metro location where there are several hospitals and Doctors “in-network”.  I describe HMO plan as a close collection of providers that will give you excellent care, but you do not want to go outside of their network.  You probably will not have coverage if you can even get treated.

All of the above is your responsibility.  Most of the time the individual you interacted with to set up your plan is not available for a review.  They are gone trying to sell someone else a plan.  We pride ourselves on the service after you become a client. 

Now that we have gone over some of the rules for your use of a Medicare Advantage Plan we need to discuss how to set yourself up to financially to survive the plan.

First, take a look at your plan and determine the maximum out of pocket that you are responsible for in a “bad” year.  Take that sum and deposit it in a separate account from which you can pay all co-pays, deductibles, and noncovered charges for Dr and hospital.  Do not pay any drug charges from this account.  That deposit will range from $7500 to $11,500 Yes, yes that is a lot of money,

Now, when it comes to October 15 of the following year you have to start over, check your current drugs and medical providers.  It is up to you to do the look ups because the person that signed you up is not around.  Do not pay any attention to “its free” because that will get you in trouble.  Again, take a look at the “out of network” maximum and be ready to bring your cash account up to that maximum by January 1 when your new plan will began.

Are you sure that an Advantage Plan is right for you?

Phil Mattox, CSA
Certified Senior Advisor