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What is the purpose of this episode?
This episode continues the discussion with Medicare specialist Melissa Fowler, focusing on Medicare supplements (Medigap) and Medicare Advantage plans for disability recipients. The conversation aims to help listeners understand their Medicare options and make informed decisions about their healthcare coverage.
What are Medicare supplements and how do they work?
Medicare supplements, also known as Medigap plans, are private insurance policies that wrap around Original Medicare to cover gaps in coverage. The most common is Plan G, which has a $257 deductible (2023) but then covers all Part A and B medical treatment with zero copays and coinsurance. Premiums typically start at $100-130 monthly at age 65 and increase with age. Supplements require separate prescription drug coverage through a Part D plan.
How do Medicare Advantage plans differ from supplements?
Medicare Advantage plans are Medicare-approved plans operated by private insurance companies that manage Medicare benefits. They typically have lower premiums ($0-30 monthly) but include networks of providers (HMO or PPO). These plans include prescription drug coverage and often offer additional benefits like dental, vision, and gym memberships. They have copays and coinsurance but include an annual out-of-pocket maximum (typically around $3,900).
What is CBIG’s approach to helping clients choose Medicare coverage?
CBIG uses a four-part matrix:
- Focus on doctors and medications to ensure access to needed care
- Minimize costs through plan selection and subsidy programs
- Reduce potential cost exposure through out-of-pocket maximums
- Consider additional benefits that improve quality of life
What should disability recipients know about Medicare penalties?
Rejecting Medicare Part B or Part D without creditable coverage can result in significant lifetime penalties. Veterans with VA benefits should carefully consider keeping Part B despite VA coverage, as VA benefits aren’t considered creditable coverage for Part B. Additionally, ACA marketplace insurance subsidies end once Medicare eligibility begins.
