Medicare supplement (Medigap) policies help pay most or all of your out-of-pocket costs that Original Medicare (Parts A and B) doesn’t pay. If you’re striving to cover the cost-sharing requirements, Get a quote right here! Let’s go-over your benefit choices together today!
Each of the 10 standardized Medicare Supplement policies are offered through private companies, labeled Plans A through N, not related to Medicare (Parts A, B, C, or D) — None the less, what they cover is regulated by the federal government.
The only difference between Medigap policies with the same letter, comparing one carrier’s policy to another, is the premium. We have access to most of the top supplement carriers’ in the area. We’d be delighted to team-up and start the process with you, Just call Bud 806-350-7380 — Or better yet, if you want to skip all of the rhetoric just get a quote .
As you consider your supplement choices, it’s important to get acquainted with how each one works, its benefits and your share of the costs.
Here’s a brief look at how Medicare Supplement policies differ from other coverage:
Enjoy low out-of-pocket costs
Your supplement and Medicare Parts A & B work together to minimize your share of approved medical procedures and supplies. Whenever you own a supplement those unexpected medical events aren’t likely to impact your budget so-much.
Plus, as Medicare deductibles, copay’s, and coinsurance increases, your supplement benefits also adjust to keep-up with your eligible expenses (depending on the plan you choose).
No provider networks, no referrals
Keep your doctors and hospitals. Any provider that accepts Medicare patients accepts supplements as well. You won’t worry about finding network doctors, or getting referrals to see a specialist.
Rarely receive a bill
When your providers accept Medicare, they bill Medicare for the approved services. Medicare pays there share and the supplement carrier pays its share (again, depending on the plan you choose — Like plans F, HDF, G, or N, etc).
The entire process is electronic; so. your claims are paid quickly. And, you usually pay very little out-of-pocket.
Keep your coverage as long as you like
Your coverage renews as long as you pay the premiums on time, and you made no material misrepresentations on the application (premiums are subject to change).
What’s more, your Medicare Parts A/B and supplement benefits aren’t impacted by the Medicare Open Enrollment Period (OEP), or the Affordable Care Act annual election period every fall.
Take your coverage coast to coast
Just like Medicare your supplement covers your approved health care services, even across state lines. That way you’re able to visit friends anywhere in the country you choose.
See the world in confidence
Some Medicare Supplement policies provide limited medically necessary emergency care outside the country (benefits are typically subject to a $250 deductible, 20% coinsurance and a lifetime maximum of $50,000).
Keep in mind, Original Medicare Parts A & B usually doesn’t covers any health care services internationally.
Most of the carriers we work with offer household discounts, and some have Select plans that will save you even more on your premium.
One important point we recommend is to compare plans F & G, one to the other, and take advantage of the value in comparison shopping.
The Affordable Care Act gradually lowers your out-of-pocket spending by providing 50% manufacturer discounts on brand-name drugs along with additional plan payments on any covered drugs filled in the gap.
In 2017, Part D enrollees in plans with no additional gap coverage will only pay 40% of the plan’s cost for brands and 51% of the plan’s cost for generics in the gap until they’ve reached the catastrophic coverage threshold.
Medicare will phase in additional subsidies for brands and generic drugs, over the next few years.
Ultimately reducing the beneficiary coinsurance rate to 25% closing the gap in 2020.
“Considering recent events”
In the debate over repealing and replacing Obamacare.
What will happen to the ACA enhancements related to the federal Medicare program?
Let’s look-at these benefit improvements:
What is the coverage gap?
And, how will I know if I’ve reached it?
Most Medicare drug plan enrollees are subject to a temporary reduction in benefits known as the “donut hole”.
This means that after enrollees, and their plan’s, combined spending reaches a certain amount of money for the year, enrollees’ may have to pay more for covered drugs (while they’re in the gap) up-to a certain limit.
Each month enrollees fill any prescription(s) their plan mails an Explanation of Benefits (EOB) notice —itemizing how much has been spent on covered drugs, and letting them know when they’ve reached the coverage gap, referred to as the “donut hole”.
Who can get the savings while in the gap?
Anyone who doesn’t already get “Extra Help” —or, Limited Income Subsidies (LIS), from Social Security.
Benefits in 2017: the Part D standard benefit has a $400 deductible and 25% coinsurance up to the initial coverage limit of $3,700 in total drug costs, followed by the gap. During the gap, enrollees are responsible for a larger share of their total drug costs than in the initial coverage period, until their total out-of-pocket spending in 2017 reaches $4,950.
How does this discount work for brand name drugs?
Companies that make brands must sign agreements with Medicare, to participate in the Medicare Coverage Gap Discount Program.
This voluntary program requires manufacturers to offer discounts on their brands in the gap.
In addition, you will only pay 40% of the plan’s cost for covered brands in 2017.
Again, you only pay the certain percentage; but, your copays (and the manufacturers discount) both count toward moving you into the catastrophic coverage threshold.
Example: Ms Griffin reaches the coverage gap in her drug plan. Her covered brand is $60 and there’s a $2 dispensing fee that gets added. The drug The drug copayment ($60 x .40=$24) —along with the dispensing fee of ($2 x .40=.80) equals $24.80 out-of-pocket cost.
Note: Her $24.80 and the manufacturer discount ($30.00 in this example) both count as TrOOP spending.
The remaining $7.20 which is 10% of the drug cost and 60% of the dispensing fee (paid by the plan) isn’t counted as TrOOP spending.
Will all of my covered brands be discounted?
If a drug manufacturer has signed an agreement to participate in the Medicare Coverage Gap Discount Program, all the covered brand-name drugs they make are included for this calendar year including the brands listed in the plan’s formulary, and those covered by an exception.
Which includes the brands listed in the plan’s formulary, and those covered by an exception.
Participating manufacturers’ make more than 99% of the brand-name drugs used by Medicare enrollees.
How is coverage for generic changing in the gap?
In 2017 you will pay 51% of the plan’s price during the gap. What you will pay for generic drugs in the gap will decrease each year until it’s reduced to 25% in 2020. For generics’ only what you pay counts towards your TrOOP spending.
Example: Mr Adams reaches the coverage gap in his Medicare drug plan. He fill his prescription for a generic. The plan’s cost for the drug is $20 —and there’s a $2 dispensing fee added to the cost. Mr Adams will pay 51% ($22 x .51=$11.22) of the cost.
His TrOOP spending, in this scenario, is the same $11.22 —which will count towards getting him out of the gap.
What if I don’t get a discount, but I think I should?
If you’ve reached the gap and don’t get a discount, review your last EOB notice. If the discount doesn’t appear on the notice, contact your plan to make sure your records are current and correct.
If your plan doesn’t agree, you can appeal. To file an appeal contact your local SHIP office, or call Medicare at 800-663-4227, TTYs should call 877-486-2048.
Visit www.medicare.gov, or look back over your “Medicare & You handbook”, to get the phone number for your local SHIP office.
What if I have other health coverage?
If the other coverage pays second, it’ll pay after you get the discount.
What if I have coverage from a State Pharmacy Assistance Program (SPAP)?
Enrollees in a State Pharmacy Assistant Program (SPAP). Or any other program which gives discounts for Part D drugs (other than Extra Help) will get the gap discount on brands. The gap discount is applied before any other coverage.
I already get discounts from the company that makes my drug(s) … How will this program effect these discounts?
Some manufacturers offer patient assistance programs which are different from the Medicare Coverage Gap Discount Program. Check with the company to find-out if their assistance program will change, whenever you reach the gap.
What if I’m enrolled in a plan that already includes enhanced gap coverage?
You may get a discount after your plan’s coverage has been applied. The program discount will be applied to the remaining amount you owe.
Example: If your plan offers 60% brand coverage in the gap, and you fill a $100 prescription, after the plans savings, the 50% manufacturer discount gets applied to your 40% so, you’ll only pay $20.
Keep in mind, the entire 40% (the $20 you pay plus the manufacturer discount) both count as (TrOOP) spending.
If I get Extra Help from Social Security, will I get the manufacture discount too?
No again, you already get gap coverage.
What happens if only part of the cost is in the gap threshold?
The discount will apply to the part that’s in the gap threshold.
Example:You need a $100 brand and only $50 falls in the gap. The discount and increased coverage only applies to the $50 that’s in the threshold. You’ll pay the normal copayment on the first $50, plus $10 on the gap $50.
How will I know if my brand will be covered at a discount, and what should I do if it isn’t?
Visit with your plan, or ask the pharmacist … If it’s made by a participating manufacturer you’re okay. If not, the drug won’t be covered by Part D at all.
If the drug’s not covered, visit with your doctor or other healthcare provider to find-out if there’s another drug you can take.
Congress proposed the American Health Care Act (AHCA) which recently passed the House Energy & Commerce and Ways & Means Committees, leaving most ACA changes to Medicare intact.
The GOP plan Includes the benefit improvements (no-cost preventative services and closing the Part D coverage gap), and reduces payments to healthcare providers, Medicare Advantage Plans, the independent Advisory Board, and the Center for Medicare and Medicaid innovation.
We’re still waiting on a House vote which Speaker Ryan says “is going to happen soon”.
about modernizing Medicare and made repealing and replacing the 2010 Health Law a priority, which also has significant implications for the federal Medicare program, and its beneficiaries.
An important question, in the debate over repealing and replacing the Affordable Care Act is:
What will happen to the Law’s many provisions affecting the federal Medicare system?
The American Health Care Act (AHCA). Which recently passed the House Energy & Commerce and Ways & Means Committees, would leave most ACA changes to Medicare intact.
The GOP plan includes benefit improvements (no-cost preventative services and closing the coverage gap), reductions in payments to healthcare providers, Medicare Advantage Plans, the independent advisory board, and the center for Medicare and Medicaid innovation, (just to name a few).
On March 24th 2017 Speaker Paul Ryan pulled the Bill from the floor before a vote took place. The consensus was that it didn’t have enough affirmed votes to pass, due-to divided views toward the 2010 Law.
Not surprisingly, views varied by party with most democrats and independents stating it went too far in cutting existing programs, compared to a majority of republicans who say the AHCA didn’t pass mainly because, it did not go far enough to end Obamacare.
Speaker Ryan has promised a vote will happen, soon!
Looking ahead on Medicare:
Amid potential changes to health insurance, support for public health and prevention services, and a viable delivery system that meets the needs of our increasingly diverse population is particularly important.
Learn what insurance companies don’t want you to know! Inasmuch as original Medicare is not designed to cover all of your health-care bills?
Get Medicare Ready! Most enrollees have some source of supplemental coverage.
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Just call Bud (806) 350-7380
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Shedding-light on supplements
These supplement quotes have a July 1st 2017 effective date.
We have access to the top supplement carriers in the Northwest Texas High
Disclaimer: All data obtained from public sources. All rates may contain EFT discounts, if applicable.
2017 market data source: 2016 AIC Medicare Supplement Experience Exhibits and data filed with the National Association of Insurance Commissioners in annual financial statements. CSG Actuarial, LLC does not guarantee or warrant the accuracy of the above market data.
Attestation: private solicitations for Medicare supplement (Medigap) policies are not affiliated with or endorsed by the US government or the federal Medicare program.
Why is it important to use a local licensed agent?
All supplements are standardized by the government. Still, each company charges different premiums for the same exact thing!
Premiums are zip code specific. Ergo, a local licensed agent simply makes good sense because a licensed local agent will be more familiar with the policies available in your zip code.
Are supplement policies the same as Medicare Advantage Plans?
No! Medicare Supplement (Medigap) policies cover your Parts A & B out-of-pocket costs. On the other hand, Medicare Advantage Plans are an alternative way to get basic Medicare coverage. Sometimes Medicare Advantage plan’s offer additional benefits.
With all the choices out-there for healthcare coverage, it’s important to understand how each one works. Here’s a brief look at how supplements differ from other coverage including Medicare Advantage Plans.
Financial Security— Medigap policies can provide you with additional protection against catastrophic health care bills.
Predictability — Standardized coverage helps you budget out-of-pocket costs more predictably.
Choice — Most policies cover any provider that will take Medicare patients, even across state lines. Plus, no referral are needed to see specialists.
Reliability — Any changes in benefits automatically adjust from one year to the next. What’s more, policies are guaranteed renewable.
Equally as important, you as a Medigap policyholder will take comfort in not receiving any bills from providers or suppliers and not having to fill-out claim forms.
Attestation: This information has not been reviewed or endorsed by the federal Medicare program. This website is a non-governmental resource for people wanting general information, articulated in a simple and straightforward way. Provided by Bud Griffin, independently licensed in Texas.
Disclaimer: Medicare supplement policies are standardized, but not affiliated with or endorsed by the U.S. government or the federal Medicare program.