Making Wise Choices with Your Medicare Supplement Plans

Difference Between Medicare Supplements And Medicare Advantage Plans

When it comes to Medicare, there are two main types of plans: Medicare Advantage and Medicare Supplement. Both have their own set of benefits and drawbacks, so it’s important to understand the difference between the two before making a decision.

Medicare Supplements (Medigap):

a. Purpose and Coverage:

• Medigap plans are designed to fill the gaps in coverage left by original Medicare (Part A and Part B).
• They cover out-of-pocket expenses such as copayments, deductibles, and coinsurance, providing beneficiaries with more predictable healthcare costs.

b. Flexibility:

• Medigap plans are standardized and labeled with letters (A through N). Each plan type offers the same basic benefits, regardless of the insurance company selling it.
• Beneficiaries have the flexibility to choose the plan that best suits their needs and budget.

c. Freedom of Provider Choice:

• With a Medigap plan, beneficiaries can typically see any healthcare provider that accepts Medicare, giving them greater freedom in choosing doctors and specialists.

d. No Network Restrictions:

• Medigap plans do not involve restrictive networks. Beneficiaries can receive care from any Medicare-approved healthcare provider nationwide.

Medicare Advantage Plans:

a. Integrated Coverage:

• Medicare Advantage Plans (Part C) are private health insurance plans that combine the benefits of original Medicare (Part A and Part B) into a single, comprehensive package.
• These plans often include additional benefits, such as dental, vision, and prescription drug coverage.

b. Network Restrictions:

• Medicare Advantage Plans typically operate within networks, and beneficiaries may be required to use specific healthcare providers to receive full coverage.
• Out-of-network care may result in higher out-of-pocket costs or no coverage at all, depending on the plan.

c. Cost Structure:

• Advantage Plans may have lower monthly premiums than Medigap plans, but they often involve copayments, coinsurance, and deductibles that can vary depending on the plan and services used.

d. Prescription Drug Coverage:

• Many Medicare Advantage Plans include prescription drug coverage (Part D), streamlining healthcare coverage by bundling multiple benefits into a single plan.

Medicare Supplement plans, on the other hand, are offered by government-sponsored organizations like Blue Cross Blue Shield. They can help cover some of the gaps in Original Medicare, such as deductibles, copayments, and coinsurance.

How to Select an Idaho Medigap Policy

When comparing Medicare Supplement Insurance plans in your area, keep the following considerations in mind:

• Monthly premium: This impacts your monthly cash flow because it is additional to your Part B monthly premium. Paying is required whether or not you use your advantages. The type of plan you obtain, your age, gender, tobacco use, and your state of residence all affect how much your premium will be.
• Benefits: All plan types include hospice care, three pints of blood, basic coverage for Part A copays and coinsurance, and at least some of Part B copays and coinsurance. Make sure to determine which benefits are most important to you as some may not be covered.
• Insurance provider: Examine reviews and prior customer experiences—your own or those of others—with the carrier you are thinking about. Speak with a corporate representative to learn more about their responsiveness and level of customer service.
• Extra discounts: Once you join, several insurance companies and policies give you additional benefits or savings. For example, you might be able to get discounts from suppliers of eyeglasses or hearing aids.

When Idaho Residents Should Enroll in Medicare Supplement Plans

Generally speaking, if you buy a plan as soon as you are qualified for Medicare and enrolled in Parts A and B, you will receive the greatest deal for Medicare Supplement Insurance. Medigap Open Enrollment, which is enrolled in both Parts A and B, begins on the first day of the month that you turn 65 and lasts for six months. Medical underwriting cannot be used by an insurance company to determine whether to approve your application or alter the premium during this period.

Make sure you are in your open enrollment period or have assured issue privileges before enrolling in a Medigap Plan by getting in touch with the insurance provider. Fill out the application and specify the start date of your policy. Certain circumstances may grant you assured issue rights.

Among them are:

• Leaving the coverage region while enrolled in a Medicare or Advantage Plan
• Medicare coverage will end with your current Medicare Advantage Plan.
• Your current non-Medicare insurance plan is coming to an end.
• You are still within the allotted trial period.
• When your plan expires due to circumstances beyond your control,

Idaho Birthday Rule For Medicare Supplement Plans Information

Idaho’s laws and rules for Medicare Supplement policies have changed. The Idaho legislature approved legislation to provide additional options and consumer protections for Idaho seniors. The Idaho Department of Insurance (“the Department”) published a temporary rule on November 3 related to Medicare Supplement policies in accordance with Senate Bill 1143, signed by Governor Little on April 22, 2021. The rule proposed went through negotiated rulemaking as required. 

The rule, IDAPA 18.04.10, was published November 3 in the Administrative Bulletin Volume 21-11, and includes two major changes effective after February 28, 2022:

1. Medicare Supplement policyholders may change their insurance company and/or plan annually regardless of health conditions during a 63-day enrollment period beginning on the policyholder’s birthday; and 
2. Premium rates for new Medicare Supplement policies (including when changing insurance companies) will no longer be based on the age of the applicant. This is referred to as “community rating.”

The proposed rule also prohibits charging application fees, higher premium rates based on the method of payment, and other unfair trade practices.

It is important to know that current Medicare Supplement plans are guaranteed renewable, and current policies will continue unless a change is requested by the policyholder. These rule changes provide flexibility to current Medicare Supplement policyholders who wish to change their policy, but no change is required. After February 28, 2022, existing Medicare Supplement policyholders may choose to shop for comparable community-rated coverage starting the day of their birthday.

The Department hosted public webinars on this topic on November 18, 2021 and February 15, 2022. The presentation slides from the February 15, 2022 event are available by clicking the following link Changes to Idaho’s Medicare Supplement Rules 2022 Update