Latest news with #OriginalMedicare
Health Line
18-06-2025
- Health
- Health Line
Switching from Medicare Advantage to Medigap: What to Know
Medicare enrollees have the flexibility to change their coverage as their health and financial needs evolve. If you're considering switching from Medicare Advantage (Part C) to a Medicare supplement plan (Medigap), there are various factors to consider. Medicare Advantage and Medigap have some similarities, but they offer different forms of coverage. Both are available from Medicare-approved private insurance companies. But where Medicare Advantage plans are an alternative to Original Medicare, Medigap plans are a supplement to Original Medicare. To switch from Medicare Advantage to Medigap, you'll need to plan ahead, as there are set periods each year to make this sort of change. First, you'll need to return to Original Medicare. In this article, we discuss when to switch coverage, how to switch, why you may want to switch, and more. Medicare Advantage vs. Medigap Medicare consists of four main parts: Part A (hospital insurance) Part B (medical insurance) Part C (Medicare Advantage) Part D (prescription drug coverage) Parts A and B together are called Original Medicare. Original Medicare covers medically necessary inpatient and outpatient services and procedures. If a person with Original Medicare wants prescription drug coverage, they can buy a stand-alone Part D plan. With Original Medicare, beneficiaries have a variety of out-of-pocket costs in the form of premiums, deductibles, copayments, and coinsurance. To help with these costs, people can buy supplemental insurance called Medigap. Medicare Advantage is an alternative to Original Medicare. It includes the same level of coverage as Original Medicare but bundles this coverage with additional benefits, such as drug coverage and dental, vision, and hearing care. When can you switch from Medicare Advantage to Medigap? Since you can't have Medicare Advantage and Medigap at the same time, you'll need to return to Original Medicare before signing up for Medigap. There are set times during the year when a person with a Medicare Advantage plan can change their coverage and return to Original Medicare. These include the following: Medicare open enrollment period (OEP): This runs from October 15 to December 7 each year. Medicare Advantage open enrollment period (MA OEP): This runs from January 1 to March 31 each year. Special enrollment period (SEP): If a person experiences a life event that affects their insurance coverage, they may qualify for an SEP. The timing and duration of the SEP depend on the event itself. Once you have Medicare Part B, you can sign up for Medigap. Unlike Medicare Advantage, which has set enrollment periods, you can enroll in a Medigap plan at any time. However, the best time to enroll in a Medigap plan is during your Medigap open enrollment period (OEP). If you enroll during your Medigap OEP, you can pick from any plan available in your state without being denied coverage due to a preexisting health condition. The Medigap OEP is a one-time, 6-month window that starts at the beginning of the month when you first get Part B coverage and are 65 years or older. If you miss the Medigap OEP, insurance companies aren't federally required to sell you a plan. Why switch from Medicare Advantage to Medigap? There are various reasons why someone may wish to switch to Original Medicare from a Medicare Advantage plan. With Original Medicare, you have greater flexibility to choose healthcare professionals, as you aren't limited to a regional network of providers, as you typically are with Medicare Advantage. If you travel extensively domestically or abroad, you'll have greater coverage with Original Medicare and Medigap. If your health or insurance needs change, you may not require the additional benefits of your Medicare Advantage plan. You don't require prior authorization or referrals for many services with Original Medicare. Ultimately, the decision of whether to switch hinges on personal factors. It's best to compare your options thoroughly and explore the potential effects of changing coverage. If you'd like to speak with someone about your Medicare coverage options and receive unbiased information about what type of Medicare coverage may be best for you, consider speaking with a representative from your local State Health Insurance Assistance Program (SHIP). You can also contact Medicare directly at 800-633-4227 (TTY: 877-486-2048). How to switch from Medicare Advantage to Medigap? Here are some steps to consider as you plan your switch: Research your Medigap plan options and compare benefits versus costs. Confirm that your preferred healthcare professionals accept Original Medicare. Check your timing and determine whether you're eligible for the Medigap OEP. Review your state's Medigap policies so you understand your rights. Contact your Medicare Advantage insurance carrier during a qualifying enrollment period and request to disenroll from your plan. Then, contact Medicare and enroll in Original Medicare. Once you're enrolled in Original Medicare, you can apply for Medigap coverage. However, prepare for possible underwriting if you're outside the Medigap OEP. Frequently asked questions Can I switch from a Medicare Advantage plan to a Medicare supplement plan? Yes, you can switch from a Medicare Advantage plan to a Medicare supplement plan. First, you'll need to return to Original Medicare during an appropriate enrollment period. Then, after researching your plan options, you'll need to apply for Medigap coverage with your chosen insurance carrier. Yes, you can switch from a Medicare Advantage plan to a Medicare supplement plan. First, you'll need to return to Original Medicare during an appropriate enrollment period. Then, after researching your plan options, you'll need to apply for Medigap coverage with your chosen insurance carrier. Is there a penalty for switching from Medicare Advantage to Original Medicare? No, there's no penalty for switching from Medicare Advantage to Original Medicare. While Medicare does have various possible penalties for late enrollment, there's no penalty linked with dropping Medicare Advantage coverage and returning to Original Medicare. To avoid potential penalties, you'll want to make sure you enroll in Part B and Part D prescription drug coverage after leaving your Medicare Advantage plan. No, there's no penalty for switching from Medicare Advantage to Original Medicare. While Medicare does have various possible penalties for late enrollment, there's no penalty linked with dropping Medicare Advantage coverage and returning to Original Medicare. To avoid potential penalties, you'll want to make sure you enroll in Part B and Part D prescription drug coverage after leaving your Medicare Advantage plan. Summary If you're interested in switching from Medicare Advantage to Medigap, you'll first need to return to Original Medicare. You can do so during the Medicare OEP, the Medicare Advantage OEP, or a SEP, if you qualify. This change will likely affect your costs, coverage, and provider access. So it's important to give it ample thought, explore all its potential effects, and compare your options. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
05-06-2025
- Business
- Yahoo
Health Insurance Not Covering Enough? 5 Reasons To Consider Secondary Insurance
Having insurance doesn't always mean being fully covered, with many Americans still facing big bills for basic care, let alone anything unexpected. According to KFF, annual premiums for employer-sponsored family health coverage hit $25,572 in 2024, with workers paying an average of $6,296 out of pocket. The average deductible for single coverage now stands at $1,787 — money that has to come out of pocket before insurance kicks in. Read More: Check Out: GOBankingRates spoke with two experts about when secondary insurance might be needed and what to know before making a move. Basic policies rarely handle everything. Many treatments, specialists or medications simply aren't included in standard plans. Kris Barber, founder and principal attorney at The Barber Law Firm, explained that secondary insurance can help with expenses 'like vision care, dental treatment, co-payments or even deductibles.' Explore More: High deductibles and frequent co-payments can strain even those with good coverage. When costs start stacking up, secondary insurance 'can relieve your burden considerably' by helping cover what primary leaves behind, according to Barber. Frequent appointments, therapies or medications, especially for chronic conditions, can burn through coverage fast. Patients with recurring care needs may often benefit from secondary plans that fill in those regular, costly gaps. For Medicare beneficiaries, Original Medicare doesn't cover everything. Eligible senior patients can 'consider Medigap policies to enhance coverage for expenses not included in Original Medicare — coinsurance and deductibles,' according to Barber. Secondary coverage doesn't have to be complicated to get. According to Melanie Musson from it's often available through a spouse's employer, via the Affordable Care Act marketplace or even as a separate policy for those on a parent's plan. Private insurance firms and government programs also offer supplemental plans for those who qualify. Sometimes a separate insurance policy isn't the best tool. If secondary insurance isn't an obvious need, a flexible spending account (FSA) or health savings account (HSA) might be the better move. Musson explained it's a good option because 'instead of paying premiums, you can put your money in an account where it grows.' HSAs, for those with high-deductible health plans, offer rollover benefits, investment growth and portability. FSAs, while less flexible, still provide tax advantages for near-term medical expenses. Both options may be better suited for covering moderate, expected out-of-pocket costs, without committing to ongoing premiums. Not every situation calls for secondary insurance, so weighing the cost of premiums and deductibles against the expected benefits is a good place to start. If the numbers line up, coverage can make a real difference. If not, a tax-advantaged account might offer more freedom and financial control. More From GOBankingRates 8 Common Mistakes Retirees Make With Their Social Security Checks This article originally appeared on Health Insurance Not Covering Enough? 5 Reasons To Consider Secondary Insurance Sign in to access your portfolio
Health Line
04-06-2025
- Business
- Health Line
10 Common Medicare Myths Debunked
There is a lot of information about Medicare, which can lead to various misconceptions or 'myths' about the program. Debunking these myths can help you better understand your options and coverage. Medicare is a federal health insurance program for people over 65 or who have certain illnesses or disabilities. There are many options when it comes to Medicare plans and coverage. People may find the various options and enrollment confusing. Explaining some common misconceptions may help you make the best Medicare choices for your circumstances. Glossary of common Medicare terms Out-of-pocket cost: This is the amount you pay for care when Medicare doesn't pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments. Premium: This is the monthly amount you pay for Medicare coverage. Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments. Coinsurance: This is the percentage of treatment costs you're responsible for paying out of pocket. With Medicare Part B, you typically pay 20%. Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications. Myth 1: Medicare Part B is free Medicare Part B helps cover outpatient services and treatments. However, there are out-of-pocket costs involved. Everyone with Medicare is responsible for paying the Part B monthly premium, which starts at $185 and may be higher depending on your income. You are also responsible for paying the $257 Part B deductible. Once you meet this deductible, Medicare will cover 80% of the approved costs for your care, leaving you responsible for the other 20% of the costs. A note on Medicare Advantage If you have a Medicare Advantage (Part C) plan, you are still required to pay the Part B premium, as well as your plan premium. However, your Medicare Advantage plan will set its own deductible. Myth 2: I can enroll in Medicare whenever I want You are eligible to enroll in Medicare when you turn 65 years old. You have an initial enrollment period that runs for 7 months, beginning 3 months before your birthday and ending 3 months after. During this time, you can enroll in any plan. Medicare also has an open enrollment period from October 15 to December 7 each year. During this time, you can join, drop, or switch to a new plan. If you do not sign up for Medicare parts A and B when you become eligible, you may be subject to late enrollment penalties. Myth 3: Medicare plans are only available through the federal government There are four parts to Medicare, and only two of them are available through the federal government. The four parts are: Part A Part B Part C (Medicare Advantage) Part D Part A and Part B make up Original Medicare, which is provided by the federal government. The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program, while the Social Security Administration (SSA) processes your enrollment. Medicare Advantage (Part C) and prescription drug coverage (Part D) are provided by Medicare-approved private insurance companies. The insurance providers and plans vary by area. You can find plans in your area using the Medicare online search tool. Myth 4: Medicare covers all of my medical expenses Medicare does have comprehensive coverage for healthcare. However, there are still out-of-pocket expenses involved. Original Medicare (parts A and B) also does not include prescription drug coverage. You will need to purchase a Part D plan from a Medicare-approved private insurance company. Each part of Medicare has its own costs that you are responsible for paying. These include: premiums deductibles copayments coinsurance Medicare cost examples Most people with Medicare Part A do not pay a premium. However, you are responsible for paying the inpatient deductible and the coinsurance for each day you are in the hospital. $1,676 deductible per benefit period Days 1 to 60: $0 after the deductible is met Days 61 to 90: $419 per day Days 91 to 150: $838 per day while using lifetime reserve days After day 150: all costs Everyone with Medicare must pay the Part B premium. The Part B costs include: Premium: $185 or more, depending on income Deductible: $257 annually Coinsurance: 20% of Medicare-approved costs Myth 5: I will be automatically enrolled in Medicare The only time you will be automatically enrolled in Medicare is if you are already receiving Social Security benefits when you become eligible. Otherwise, you will have to go to the SSA website and enroll in Medicare when you become eligible. Medicare and SSDI Anyone who is receiving Social Security Disability Insurance (SSDI) is eligible to receive Medicare after 24 months of receiving SSDI. »Learn more: How to apply for Medicare Myth 6: Medicare will notify me when it's time to enroll Medicare won't notify you when you become eligible to enroll. It is up to you to sign up when you become eligible. Generally, you become eligible to enroll 3 months before your 65th birthday. However, you have until 3 months after your birthday to sign up without late enrollment penalties. Myth 7: Medicare Advantage and Medicare Supplement plans are the same While both Medicare Advantage (Part C) and Medicare Supplement Insurance (Medigap) are provided by Medicare-approved private insurance companies, they are separate coverage plans. Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B), and the plans within the former offer the same coverage as the latter. However, they often come with prescription drug coverage (Part D) and additional benefits not covered by Original Medicare, like vision, dental, and hearing. Medigap is extra insurance you can purchase from private insurance companies to help cover costs associated with Original Medicare, such as copayments, coinsurance, and deductibles. You cannot have Medigap with a Medicare Advantage plan. You are only eligible to purchase a Medigap plan if you have Original Medicare. Myth 8: Medicare and Medicaid are the same thing Medicare is a federal health insurance program that is generally for people over 65 years old. If you have certain illnesses or disabilities, you may also qualify for Medicare coverage. Since this is a federal program, the coverage and costs are standard no matter where you live, except for Medicare Advantage plans. Medicare is funded through your out-of-pocket costs and taxes as well as two government trust funds. Medicaid is a joint federal and state program that helps pay for medical costs for people with limited incomes. The federal government has certain rules all Medicaid programs must follow. However, each state runs its own program, meaning benefits and eligibility requirements can vary from state to state. People with Medicaid don't typically pay anything for covered medical expenses. However, they may owe a copayment for certain items or services. Myth 9: Medicare costs the same for everyone Many Medicare costs can vary. For example, most people do not pay a premium for Part A. However, if you have not earned enough work credits by working and paying Medicare taxes, you can purchase Part A. Depending on how long you have worked, you will pay either $285 or $518 per month. You may also pay a higher premium for Part B if your income is above $106,000 as an individual or $212,000 as a married couple. The costs of Medicare Advantage (Part C), Part D, and Medigap all vary based on the plan you choose and the area you live in. Myth 10: I can't sign up for Medicare because of my health Medicare will cover you even if you have preexisting conditions. You are eligible for Medicare when you turn 65 years old, even if you have current health issues. You are also eligible for Medicare if you have certain illnesses or disabilities, like end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Takeaway There are various misconceptions or 'myths' about Medicare, so it's easy to become overwhelmed and confused. Understanding the difference between myth and fact can help you navigate Medicare easily and make informative decisions on your coverage. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
03-06-2025
- Business
- Health Line
Understanding Medicare Plan G Supplemental Coverage
Key takeaways Plan G is a Medicare Supplement Insurance (Medigap) policy that helps cover out-of-pocket costs associated with Original Medicare (parts A and B), including copayments, coinsurance, and deductibles (except for the Medicare Part B deductible). Medigap Plan G provides 100% coverage for Part A coinsurance, hospital costs, Part A deductible, hospice care coinsurance, blood (first 3 pints), and skilled nursing facility care coinsurance, plus 80% coverage for foreign travel emergencies up to plan limits. Medigap Plan G does not cover prescription drugs, the Part B annual deductible, or benefits like dental, hearing, and vision that are not covered under Original Medicare. 'Medigap' is another term for Medicare supplement insurance. Medicare Supplement Plan G is extra insurance you can buy to help cover your portion of costs for medical services with Original Medicare, such as: copayments coinsurance deductibles (with the exception of the Medicare Part B deductible) Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Medigap Plan G is one of the most popular of the 10 Medigap policies because of its broad coverage, including coverage for Part B excess charges. Keep reading to learn more about Medicare Part G and what it covers. What are Medicare Part B excess charges? Medicare Part B only covers services from healthcare professionals who participate in Medicare. If you choose a doctor who doesn't participate in Medicare, they may charge up to 15% more than the standard Medicare rate. If your Medigap plan does not cover Part B excess charges, you will pay these charges — known as excess charges — out of pocket.
Miami Herald
30-05-2025
- Business
- Miami Herald
Dave Ramsey sounds alarm for Americans on Medicare
One fundamental fact prevails and persists about Medicare: It's complicated. That said, Americans need to choose from several Medicare options, and one good place to start is to identify the highest priority tasks to understand. As a second step, one can move on to the many other lower-priority choices one must confront. Don't miss the move: Subscribe to TheStreet's free daily newsletter Dave Ramsey, the prominent personal finance author and radio host, emphasizes the complexity of Medicare's enrollment timelines, regulations, and choices. He warns individuals about a potential financial risk, encouraging them to fully understand the system to avoid unnecessary pitfalls. Medicare is divided into four distinct parts, each covering different aspects of healthcare. Part A, which covers hospital insurance, provides coverage for inpatient hospital stays, skilled nursing facility care, hospice services, and certain home health treatments. Medicare Part B, for medical insurance, helps cover expenses related to doctor visits, outpatient treatments, medical supplies, and preventive healthcare services. Unlike Part A, this portion of Medicare comes with a monthly premium, the amount of which is determined by an individual's income level. Related: Shark Tank's Kevin O'Leary sends strong message on Social Security Medicare Part C, often referred to as Medicare Advantage, is an alternative to Original Medicare and is offered through private insurance companies. These plans typically bundle coverage from Parts A and B while also providing additional benefits, such as vision, dental, and hearing care. Some Medicare Advantage plans even incorporate prescription drug coverage, creating a more comprehensive health care solution. Medicare Part D focuses solely on prescription medication costs, offering financial assistance for those who require ongoing prescriptions. These plans, administered by private insurers, come with varying premiums, deductibles, and covered drug lists, making it important to choose one that best fits individual healthcare needs. Ramsey explains that a thorough understanding of Medicare's structure - and enrollment periods - allows individuals to make informed decisions about their health care and to minimize financial burdens. Ramsey stresses that one of the most significant financial missteps individuals can make is failing to enroll in Medicare on time. He underscores the importance of keeping track of key enrollment periods, particularly the Initial Enrollment Period (IEP). Missing this window, unless one qualifies for a Special Enrollment Period (SEP), results in permanently increased premiums. This fact elevates understanding the IEP to priority number one. More on retirement: Dave Ramsey sounds alarm for Americans on Social SecurityScott Galloway warns Americans on 401(k), US economy threatShark Tank's Kevin O'Leary has message on Social Security, 401(k)s And Ramsey warns that the longer a person delays enrollment, the higher the financial penalties become. The Initial Enrollment Period is the first chance an individual has to sign up for Medicare, beginning three months before their 65th birthday and extending for three months afterward. If this timeframe is missed due to circumstances such as living abroad, a person may still be eligible for a Special Enrollment Period. Other situations that can trigger an SEP include leaving a job and losing employer-sponsored health coverage, losing equivalent prescription drug coverage, or relocating to an area where their current Medicare Advantage plan is unavailable. Ramsey emphasizes that understanding these enrollment rules is essential to avoid unnecessary financial penalties and ensure uninterrupted health care coverage. Related: Jean Chatzky warns Americans on Social Security, 401(k)s People who miss their Initial Enrollment Period (IEP) or Special Enrollment Period (SEP) still have the option to sign up for Medicare, Ramsey explains. However, he strongly advises against relying on the steps required to correct this mistake, as it can lead to significant financial consequences. Another opportunity to enroll is available during the General Enrollment Period (GEP), which occurs annually from Jan. 1 to March 31. Ramsey cautions that waiting until this time can result in a costly and long-term setback. He emphasizes that delaying enrollment to this extent is rarely a wise decision and should generally be avoided. "Using the GEP to enroll usually comes with a penalty in the form of higher premiums - and they last for the rest of your life," Ramsey wrote. The Open Enrollment Period (OEP) occurs from Oct. 15 to Dec. 7, but Ramsey clarifies that this is not meant for first-time Medicare enrollment. Instead, it allows current beneficiaries to modify their coverage, including switching plans or adjusting existing options. Additionally, the Medicare Advantage Open Enrollment Period runs from Jan. 1 to March 31, providing opportunities to change Advantage plans, revert to Original Medicare, or update prescription drug coverage. Related: Dave Ramsey sounds alarm for Americans on Social Security The Arena Media Brands, LLC THESTREET is a registered trademark of TheStreet, Inc.
