Medicare Supplement (Medigap) Plans

Medigap is Medicare Supplement Insurance that helps fill “gaps” that Original Medicare does not cover and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance policy or Medigap policy can help pay the remaining health care costs, like:

• Copayments
• Coinsurance
• Deductibles

Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:

• Medicare will pay its share of the Medicare-approved amount for covered health care costs.
• Then, your Medigap policy pays its share.
• You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
• A Medigap policy only covers one person, so if you have a spouse and you both want Medigap coverage, you’ll each have to have your own policy. Some insurance carriers offer household discounts if there are two members of a household enrolled with the same company.
• You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one. 
•  Medigap policies are guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.

Are you struggling to understand Medicare? Contact us today at (610) 844-9759 for a no-cost, no-obligation consultation with one of our Medicare insurance experts.

Medicare Part C Advantage Plans

Part C plans are typically known as Medicare Advantage or MA plans. If the plan includes Part D coverage for prescription drugs, it is called a Medicare Advantage/Part D or MA-PD plan.

Medicare Advantage Plans are a Medicare-approved alternative for the delivery and receipt of Original Medicare, it is not a separate benefit. Think of it as “bundling” the coverages and benefits of Parts A and B—and often Part D as well—into an all-in-one plan in which an individual can enroll.

Part C plans are offered by private insurance companies that contract with the federal government to deliver Medicare services, through networks of hospitals, physicians, and health care providers that contract with the insurance company. The private insurance carriers must follow the rules set by Medicare.

In many cases, you’ll need to use health care providers who participate in the plan’s network and service area for the lowest costs. These plans work like individual insurance or group insurance in that you will have a Maximum Out-of-Pocket amount for which you’ll have to pay towards each year for covered services. Some plans offer out-of-network coverage, but typically at a higher cost.

You will have to continue paying your Medicare Part B premium in addition to any premium you may have with your Part C plan. You must use the card from your Medicare Advantage Plan to get your Medicare-covered services because you will not be receiving your coverage through Medicare. However, you’ll want to keep your red, white, and blue Medicare ID card in a safe place because you’ll need it if you ever switch back to Original Medicare or change plans during one of Medicare’s enrollment periods.

Below are the most common types of Medicare Advantage Plans.

• Health Maintenance Organization (HMO) Plans
• Preferred Provider Organization (PPO) Plans
• Private Fee-for-Service (PFFS) Plans
• Special Needs Plans (SNPs)

Strategic Benefits One Group will work with you to find the best plan that is accepted by your providers, where you will have to pay the least amount out-of-pocket for both services and prescriptions, and help you to enroll you in it, even if it is a plan that we do not offer. We never charge anything for our services!

Medicare Part D (Prescription Drug Plan)

Medicare drug coverage helps pay for prescription drugs. Even if you don’t take prescription drugs now, you should consider enrolling in a Part D plan to avoid paying a late enrollment penalty later when you do decide to enroll in one. Medicare drug coverage is optional and is offered to everyone with Medicare. 

If you decide not to purchase a Part D plan when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or the VA) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you are enrolled in a Medicare drug plan. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Plans vary by premiums and each insurance carrier classifies prescriptions differently, as well as specific drugs that are covered. 

Medicare Part D can be a complicated topic. Never assume that just because a plan may work great for one person, that the same plan will work for you. You should NEVER enroll in a plan based solely on it’s premium. Also, a higher premium does NOT mean better coverage.

We have saved our clients thousands of dollars, just by reviewing prescription drug plans. You should evaluate your Part D plan on an annual basis because not only do insurance carriers change the Tier levels of the prescriptions, but they also change preferred pharmacies which can impact how much you pay for your prescriptions. 

Let our experts help you to find a plan where you will have to pay the least amount out-of-pocket for your premium and prescriptions. They will even determine if you qualify for prescription assistance, either through your state or with Social Security, and will help you get connected with their services. 

The best time to change prescription drug plans is during Medicare’s Annual Enrollment Period (October 15th thru December 7th). However, this is NOT the only time that you can change plans. Contact us today for a free evaluation at (610) 844-9759 to see if you are enrolled in the right plan and if not to determine if you qualify for a Special Enrollment Period to get you into a better plan to start saving money.

Dental, Vision, and Hearing Plans:

While Original Medicare will ALWAYS pay to have your eyes examined, Medigap plans do not include coverage for frames and lenses. These plans also do not include dental, and unless hearing aids are “medically necessary”, Medicare will not cover them, nor will your Medigap plan

At Strategic Benefits One Group, we offer several options for dental, vision, and hearing coverage. We have plans through the country’s largest dental insurance providers, as well as plans that combine dental benefits with vision and hearing.

​You don’t have to be alone trying to navigate your way through Medicare’s maze. To get started, please contact us today at (610) 844-9759 for a no-obligation consultation with one of our licensed, Medicare insurance experts. Our services will cost you nothing!