Mon, Feb 8, 2021

FirstCommunity Answers Your Medicare Questions.

This month, we’ll explore topics like Medigap supplemental insurance and switching from Advantage Plans – some of our most commonly asked Medicare questions.

What is Medigap?

Medicare supplemental insurance policies, or Medigap policies, help to pay the copayments, coinsurance, and deductibles for Medicare-covered benefits under traditional Medicare (Part A and Part B services). Medicare alone only covers about 80% of eligible medical expenses. Some Medigap policies also cover services that traditional Medicare does not cover, such as medical care when you travel outside the country.  FirstCommunity Medicare Supplement even offers a NO COST fitness program called Silver&Fit which gives members access to many fitness or wellness centers in their area. Medigap policies are different from Medicare Advantage plans which require lots of copays and physician or network restrictions.

I’ve been enrolled in a Medicare Advantage plan for several years, but I want to switch to traditional Medicare. Can I make that change during the Medicare Open Enrollment period?

Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year. You can also make this change during the Medicare Advantage Open Enrollment period, which runs from January 1 through March 31. If you make this change and you want drug coverage, be sure to sign up for a Medicare stand-alone prescription drug plan (PDP), unless you have creditable drug coverage from another source. If you do not, and you decide to sign up for Part D coverage later on, you may face a penalty for late enrollment.

You may also want to consider purchasing a Medicare supplemental insurance policy, known as Medigap. Medigap policies help to pay your cost-sharing requirements under traditional Medicare. However, since you have been enrolled in Medicare Advantage for several years, Medigap insurers are not required to sell you a policy if you don’t meet the medical underwriting requirements. You may want to contact FirstCommunity to see if you will be able to purchase a Medicare Supplement plan when you switch to traditional/Original Medicare.

If I join a Medicare Advantage plan at age 65 during the initial enrollment period and then, years later, decide I want to switch to basic Medicare with a Medigap plan, will I still have any special rights regarding acceptance into a Medigap policy? Or will I be subject to underwriting and rejection for pre-existing conditions and poor health?

New Medicare enrollees have guaranteed access to Medigap policies that prevent insurers from either charging them more money or refusing to sell them a policy because of any pre-existing medical condition. However, once this period has passed, a person who wishes to buy a Medigap plan or switch from one plan to another usually will no longer have guaranteed access rights.

Don’t give up though - it may not be hard to find a good deal on a Medigap policy even then. But you should check this out before making any changes in your Medicare coverage. Just give FirstCommunity a call and they’ll be happy to discuss your particular situation.

Summary

A comparison of Medigap versus Medicare Advantage shows that both options have pros and cons. There is no best choice for everyone because people have different health conditions, preferences and requirements.

Medigap offers the most comprehensive coverage and provides greater flexibility in choosing doctors, while Medicare Advantage usually has lower premium costs, and the convenience of all-in-one prescription drug plans. However, MA plans have many copays for various services, plus physician and hospital network restrictions. Depending on your health and medical conditions, seniors considering Advantage plans should add up all the various copays for their possible treatments/services. It is important for a person to examine all the differences carefully before making a decision.

Once an individual has chosen between Medigap and Medicare Advantage, they can enroll in the particular plan that suits their needs. If you need help in making that choice, feel free to call the Medicare experts at FirstCommunity who will be happy to assist you at 256-532-2783 or 256-532-2785.


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