Unraveling Medicare and Medicare Supplement Plans

Unraveling Medicare and Medicare Supplement Plans

Congratulations, you turn 65 and are eligible for Medicare. Your monthly benefits from the Federal Government include social security as well as deductions for Part A and B of Medicare.  Below we will give you a brief synopsis and guide you through the first steps of understanding the Medicare options available to you. Under no circumstances is this a thorough review.

In order to completely understand the benefits you will receive under Medicare, read the comprehensive brochure for seniors “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare”.


Original Medicare parts A & B

As we know it, there are 3 parts to Medicare-Part A, B and D. Managed by the Federal Government, Part A (hospital insurance) covers inpatient hospital costs and helps cover skilled nursing facilities, hospice and some home health care costs. Medicare Part B covers physicians and services, outpatient care and some preventative services to help maintain your health when you are ill.

The premium for Part A is $443.00 per month and unless you are disabled or have survivor benefits from a spouse who was covered by Social Security, these costs are the same for everyone and part of the benefit. Part B premium starts at $96.40 (may cost more depending on your annual income) and is withdrawn directly from your social security check. You can opt out of Part B coverage if you choose.

Both A (hospital benefits) & B (Physician and medical benefits) have deductibles, co-insurance/co-payments, and maximum benefits with extra lifetime reserve days. There are gaps in the government plan and payments you will be directly responsible to pay. Selecting a supplemental plan from a private insurer can cover part of these gaps.


Medicare Prescription Drug Coverage (Part D)

Section D, added to law effective January 1, 2006, was enacted under the Bush administration and is funded with taxpayer dollars. If you had a Medicare plan before January 2006, you may have a Medicare Supplement policy that includes drug coverage.  If you are new to Medicare, you may select a separate plan for drugs. There are two ways to buy a Drug plan-as part of a Medicare Advantage Plan or a separate Medicare Prescription Drug Plan.

Since Part D provides basic coverages with large deductibles and co-payments, besides premium differences, these drug supplemental policies must offer Formulary or Generic Drugs in every category of treatment. Deciding which drug plan is best for you may be challenging. Knowing your drugs and dosages before selecting the plan is helpful. For approved drug plans check out the department of insurance site in your state.


Medicare Advantage Part C Plans

Included in the description of Medicare is Part C, which you might assume is an additional benefit you receive –it’s not. Part C is coverage you can select instead of traditional Medicare. Offered by private insurance companies, Medicare Advantage Plans (MA) are private plans that are approved by the federal government. Choosing a MA plan means you will decline coverage through traditional Medicare.

The insurance company has rigorous rules and regulations to follow and can be suspended for misleading material or infractions. An independent agent must be certified separately to sell Medicare Advantage Plans because they are perceived to be an extension of the Federal Government.

These plans can be HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), PFFS (Private Fee for Service), MSA (Medical Savings Accounts, or SNP (Special Needs Plans). With MA plans, you will not purchase a Medicare Supplement plan since the supplemental benefits will be included in the Part C, MA plan.

Which plan is best for you?   Listed below are some of the differences between Medicare Advantage (MA) and Medicare Supplement (a.k.a. Medigap) plans. 


The Physician you choose

Your real choice with a MA versus a traditional Medicare Supplemental plan is to make sure you get the doctors and hospitals you want. Most MA plans are regional and the insurance company may not offer a MA plan in your zip code but may offer a Medicare Supplement plan in your area. MA plans designate the hospital and the doctor you must see. If you like HMO plans, you would probably be satisfied with a MA plan.

If you prefer to select your own doctor and hospital, you would best be served with a PPO/Medicare Supplement plan. Many doctors will take Medicare patients but are not on the list to take Medicare Advantage patients.   Do your homework first and find out what type of plan your doctor will honor.


Guaranteed Issued Rules

A law strictly regulated with Medicare is Guaranteed Issue. You are eligible for Medicare, Medicare Supplement or a Medicare Advantage plan even if you have health problems (preexisting conditions) the first month that you are eligible to be covered under Medicare Part B age 65 or older. However, this guaranteed issue right is good for only 6 months after you are eligible. After that the insurance company can underwrite your medical history and you can be turned down, excluded for preexisting conditions or surcharged.

If you are covered under a group medical insurance program at your work after you are eligible for Part B, you can wait until your group plan is over before you select a supplement or MA plan, guaranteed issued.   You are required to provide proof of enrollment of Medicare Part A and B in order to purchase a supplement. (There are a few other exceptions for guaranteed issue.)

In any case, if you plan on choosing a supplemental plan to fill in the gaps of Medicare or you wish to take an Advantage plan, you are best to choose the coverage when you are first eligible or when group benefits end with your employer.


Medicare Supplement Plans (Medigap Policies)

Medicare Supplement policies are available to fill in the gaps of traditional Parts A & B. These plans are standardized and called Plans A through L and must offer the same benefits, no matter which company sells the plan. Not all companies sell A – L. Premiums and contracted doctors and hospitals are usually the major differences in these plans.  Plans F & J offer the riches coverages for Medigap plans and also cover foreign travel emergencies which may be important if you travel outside the US.

The Department of Insurance in your state can provide a list of companies that provide Medicare Supplemental plans. These supplemental plans are usually less than $180 per month depending on the company you select and most doctors that accept Medicare will accept the supplemental plan benefits you choose as long as the plan is not an HMO or MA plan. Again, consult with your physicians billing department to make sure your plan will be accepted before your final selection.



There are benefits not covered by Medicare. These include: Long Term Care, Vision, Dental, hearing aids, eyeglasses, and private duty nurses during recovery from illnesses.  As you approach age 65, your mailbox will explode with offers for Medicare Advantage and Medicare Supplement plans. Marketing material from A.A.R.P. and other senior organization can be confusing.

Understanding the differences can save you time and money. Choosing an independent agent who is contracted to sell both Medicare Supplement and Medicare Advantage Plans is to your advantage. Call or contact our agency for more details and for your free guide to “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare”.


Unraveling Medicare

Medicare is a federal health insurance program in the United States that provides coverage to individuals aged 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease. It was established in 1965 and is administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services.

Here are some key points to understand about Medicare:

  1. Eligibility: To be eligible for Medicare, you must generally be 65 years of age or older and be either a U.S. citizen or a permanent legal resident who has lived in the U.S. for at least five continuous years. Some younger individuals with disabilities or end-stage renal disease may also qualify.
  2. Coverage: Medicare is divided into different parts, each covering different services:
    • Medicare Part A: Hospital Insurance. Part A helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services.
    • Medicare Part B: Medical Insurance. Part B covers doctor visits, outpatient care, preventive services, and medically necessary supplies. It requires a monthly premium.
    • Medicare Part C: Medicare Advantage. Part C offers an alternative to original Medicare and allows private insurance companies to provide Medicare benefits. It often includes additional coverage, such as prescription drugs, dental, and vision services.
    • Medicare Part D: Prescription Drug Coverage. Part D provides prescription drug coverage through private insurance plans. It helps lower the cost of prescription medications.
  3. Costs: While Medicare provides coverage for various services, there are different costs associated with each part. Part A is generally premium-free for most individuals who have paid Medicare taxes while working. Part B requires a monthly premium, which can vary based on income. Part C and Part D plans have their own premiums, deductibles, copayments, and coinsurance.
  4. Enrollment: Initial enrollment for Medicare typically occurs around your 65th birthday. The initial enrollment period begins three months before your birth month and extends for three months afterward. If you miss this initial enrollment period, you may face penalties and delays in coverage. There are also specific enrollment periods for Part C and Part D.
  5. Supplemental Coverage: Original Medicare (Part A and Part B) may have gaps in coverage, such as deductibles, copayments, and services not covered. Some individuals choose to purchase supplemental insurance, known as Medigap plans, to help cover these costs.
  6. Medicaid and Medicare: Medicaid is a joint federal and state program that provides health coverage to low-income individuals. Some individuals may be eligible for both Medicare and Medicaid, known as “dual eligibility.” Medicaid can help cover Medicare premiums and cost-sharing, as well as provide additional benefits.

It’s important to note that Medicare policies and regulations can change over time, so it’s always advisable to refer to the official Medicare website (medicare.gov) or consult with a qualified Medicare counselor for the most up-to-date information and guidance regarding specific situations.


Medicare Supplement

Medicare Supplement, also known as Medigap, is a type of private health insurance policy that is designed to supplement and fill the gaps in coverage provided by Original Medicare. Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance) and is offered by the federal government to individuals aged 65 and older, as well as some younger individuals with certain disabilities.

While Original Medicare covers many healthcare services, it does not cover all expenses. Beneficiaries are responsible for paying various out-of-pocket costs such as deductibles, coinsurance, and copayments. This is where Medicare Supplement plans come in.

Medicare Supplement plans are sold by private insurance companies and are standardized across different states, with each plan labeled with a letter (e.g., Plan A, Plan B, Plan C, etc.). The standardized plans offer the same basic benefits, regardless of the insurance company you purchase them from. However, the costs and availability of these plans may vary.

These plans help cover some of the costs that Original Medicare does not, such as deductibles, coinsurance, and copayments. Some plans may also cover services that Original Medicare does not, such as emergency medical care when traveling outside of the United States.

It’s important to note that Medicare Supplement plans do not cover prescription drugs. If you want coverage for prescription medications, you would need to enroll in a standalone Medicare Part D prescription drug plan.

To be eligible for a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. You also generally need to apply for the plan during your Medigap Open Enrollment Period, which is a six-month period that starts on the first day of the month in which you are 65 or older and enrolled in Medicare Part B.

It’s advisable to compare different Medicare Supplement plans and their costs before choosing one that suits your needs. Insurance companies can charge different premiums for the same plan, so it’s essential to consider your budget and the benefits provided by each plan.

Please note that Medicare policies and regulations may change over time, so it’s always a good idea to consult official Medicare resources or speak with a licensed insurance agent for the most up-to-date information regarding Medicare Supplement plans.


Insurance is a way to protect against financial loss. It involves paying a premium to an insurance company in exchange for the promise of payment or reimbursement for certain losses or damages. Insurance can help individuals, businesses, and organizations manage risks and protect against unexpected events.

There are many different types of insurance available, including:

  1. Health Insurance: This type of insurance helps cover the cost of medical expenses, such as doctor visits, hospital stays, and prescription drugs.
  2. Life Insurance: Life insurance provides a lump-sum payment to the insured’s beneficiaries in the event of their death. It can help provide financial security for loved ones and cover expenses such as funeral costs and outstanding debts.
  3. Auto Insurance: Auto insurance provides coverage for damage or injury caused by a car accident. It can also provide coverage for theft, vandalism, and other incidents.
  4. Homeowners Insurance: This type of insurance helps protect homeowners against damage or loss to their property, as well as liability for injuries or damage caused to others on their property.
  5. Renters Insurance: Renters insurance provides coverage for personal property and liability for renters.
  6. Business Insurance: Business insurance provides coverage for various types of risks that businesses may face, such as liability, property damage, and employee injuries.

Insurance policies can vary widely in terms of coverage, exclusions, and premiums. It’s important to carefully review any insurance policy before purchasing it and to understand what is covered and what is not.

Insurance companies use various methods to assess risk and determine premiums, including actuarial science, statistical analysis, and underwriting. Factors such as age, health status, driving history, and location can all impact insurance premiums.

In conclusion, insurance is a way to protect against financial loss and manage risks. There are many different types of insurance available, including health insurance, life insurance, auto insurance, homeowners insurance, renters insurance, and business insurance.

It’s important to carefully review any insurance policy before purchasing it and to understand what is covered and what is not. Insurance companies use various methods to assess risk and determine premiums, and factors such as age, health status, driving history, and location can all impact insurance premiums.

Author: Mohammed A Bazzoun


For More Article

Liberty Magazine

Cars   / Games   /   Phone

Movies  /  Cinema & Series  /  Technology

Economy   / General Culture   / Sports News

Travel & tourism

Liberty Magazine / Economic Website

Liberty Magazine


Follow us


Economic             The Magazine           Lebanon Magazine    

Leave a Reply

Scroll to Top