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Medicare SupplementsAmerican Seniors Insurance

Medicare Supplement Insurance

There are now twelve standardized insurance plans for Medicare Supplemental insurance. These plans are listed as A through L and are also known as Medigap plans. They are designed to add coverage for Medicare beneficiaries in the areas in which they are needed. Each of these plans provides different benefits. It is important to understand that not all twelve of these plans are offered in every state. Different states may have different plans, so it is important that you check with your SSA to learn about the plans that are available in your area.

Each company does provide the exact same coverage benefits as the next. The difference is actually in each plan. For instance, Plan A is the least expensive but also offers the least number of benefits. Plan J has the most coverage benefits but is also the most expensive plan. You should determine what you can afford to spend and just what coverage you need before choosing a Medicare Supplement Insurance Plan.

It is recommended that you purchase your Medicare Supplemental Insurance within the first six months after you have enrolled in Medicare Part B. During this time, insurance companies are required to accept applicants regardless of preexisting medical conditions. Those who have preexisting conditions should be certain that they enroll in a supplemental plan before those first six months have passed to ensure that they are accepted into a plan.

You need to understand that the plans are the same from one company to the next. Be certain that you do not pay more for a plan because you are promised additional coverage. The plans are exactly alike from all insurers. You should also note that Medicare benefits change each year on January 1st. Medigap or Medicare Supplemental Insurance may also change. They typically increase a specific percentage each year as Medicare benefits change.

There are different ways that premiums are set for Medigap coverage. Those who have just hit their 65th birthday may find that their coverage is lower than those who have been on Medicare for several years. Your attained age is the most influential aspect of what determines your premium. These premiums will increase as you get older. They typically rise in price each year, three or five years, depending on the plan that you choose.


Your issue age can also affect your premium cost. Medigap premiums are typically based on the age of the beneficiary at the time that they purchase coverage. These premiums are not designed to increase each year although they do increase yearly when Medicare costs increase.

Another way to determine your Medigap premium depends on the area in which you live. This is referred to as community related coverage. Every beneficiary in your area will pay the same premium, no matter his or her age. Premiums may be significantly higher in some areas as opposed to others. It is important that you check the premium rates in your area prior to choosing a Medigap or Supplemental plan.

The best way to receive the lowest premium is to first choose the Plan (A through L) that will offer you the coverage that you need. Once you have selected your plan, choose a policy that is either community related or issue age related to ensure that your premiums do not increase each year as you age.

There are now twelve standardized insurance plans for Medicare Supplemental insurance. These plans are listed as A through L and are also known as Medigap plans. They are designed to add coverage for Medicare beneficiaries in the areas in which they are needed. Each of these plans provides different benefits. It is important to understand that not all twelve of these plans are offered in every state. Different states may have different plans, so it is important that you check with your SSA to learn about the plans that are available in your area.

Each company does provide the exact same coverage benefits as the next. The difference is actually in each plan. For instance, Plan A is the least expensive but also offers the least number of benefits. Plan J has the most coverage benefits but is also the most expensive plan. You should determine what you can afford to spend and just what coverage you need before choosing a Medicare Supplement Insurance Plan.

It is recommended that you purchase your Medicare Supplemental Insurance within the first six months after you have enrolled in Medicare Part B. During this time, insurance companies are required to accept applicants regardless of preexisting medical conditions. Those who have preexisting conditions should be certain that they enroll in a supplemental plan before those first six months have passed to ensure that they are accepted into a plan.

You need to understand that the plans are the same from one company to the next. Be certain that you do not pay more for a plan because you are promised additional coverage. The plans are exactly alike from all insurers. You should also note that Medicare benefits change each year on January 1st. Medigap or Medicare Supplemental Insurance may also change. They typically increase a specific percentage each year as Medicare benefits change.

There are different ways that premiums are set for Medigap coverage. Those who have just hit their 65th birthday may find that their coverage is lower than those who have been on Medicare for several years. Your attained age is the most influential aspect of what determines your premium. These premiums will increase as you get older. They typically rise in price each year, three or five years, depending on the plan that you choose.

Your issue age can also affect your premium cost. Medigap premiums are typically based on the age of the beneficiary at the time that they purchase coverage. These premiums are not designed to increase each year although they do increase yearly when Medicare costs increase.

Another way to determine your Medigap premium depends on the area in which you live. This is referred to as community related coverage. Every beneficiary in your area will pay the same premium, no matter his or her age. Premiums may be significantly higher in some areas as opposed to others. It is important that you check the premium rates in your area prior to choosing a Medigap or Supplemental plan.

The best way to receive the lowest premium is to first choose the Plan (A through L) that will offer you the coverage that you need. Once you have selected your plan, choose a policy that is either community related or issue age related to ensure that your premiums do not increase each year as you age.

At American Seniors Insurance we work to find the best priced Medicare Supplemental "Medigap" Insurance Plans and stay up to date with the latest changes, Laws and Certifications with Medicare and Medigap Insurance Plans so that we can offer all the options available plus answer your questions, allowing American Seniors to be one of Nations leading Insurances Agencies for Seniors aged 65 and up.

Medigap Plans Effective January 01, 2013

Medigap Benefits Chart

Plan
A
Plan
B
Plan
C
Plan
D
Plan
F *
Plan
G
Plan
K
Plan
L
Plan
M
Plan
N
Medicare Part A Coinsurance and Hospital Costs up to an Additional 365 Days After Medicare Benefits are Used Up. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Medicare Part B Coinsurance or Copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes***
Blood (First 3 Pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Part A Hospice Care Coinsurance or Copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled Nursing Facility Care Coinsurance     Yes Yes Yes Yes 50% 75% Yes Yes
Medicare Part A Deductible   Yes Yes Yes Yes Yes 50% 75% 50% Yes
Medicare Part B Deductible     Yes   Yes          
Medicare Part B Excess Charges         Yes Yes        
Foreign Travel Emergency (Up to Plan Limits)     Yes Yes Yes Yes     Yes Yes

Out-of-Pocket Limit **
$4,620 $2,310

What is Medicare?

Medicare is a health insurance program that is set up through the federal government in order to provide health insurance coverage to persons who have reached their 65th birthday. Anyone 65 and older can sign up to receive this insurance, as well as those who have been deemed disabled and/or those who have permanent kidney failure, also known as End Stage Renal Disease.

Medicare provides coverage in four different parts. These parts are listed as Parts A, B, C and D. Medicare Part A provides coverage for those beneficiaries who are admitted to the hospital as well as those who may need skilled nursing, home health care and/or hospice facilities. Most people who have Medicare Part A are not required to pay a monthly premium for coverage.

Medicare Part B often requires a monthly premium for coverage. Part B helps to pay for doctors and some outpatient care as well as other needs that Part A does not pay for. Occupational and physical therapy are often covered under Part B.

Medicare Part C works in conjunction with different PPOs, HMOs and other organizations to provide Medicare plans. Part C requires that the other insurance organization provide the same type of coverage that is available under the different Medicare parts. Those who have Medicare Part C may also receive additional coverage such as vision and dental coverage. However, in order to control the costs of these services, Medicare Part C often limit the choice of a patient’s doctors and medical facilities to those who provide care at lower costs.

Medicare Part D pays for prescriptions through separate private insurance organizations. The premium for Medicare Part D will likely depend on the area and state of the person who receives coverage benefits. Many on Part D are required to pay monthly premiums in order to receive lower cost prescriptions.

It is important to understand that like all health insurance plans, Medicare is not perfect. There are many people who feel that this program does not cover enough of their medical expenses, while others have all the coverage that they need. Most conditions from which patients recover are covered by Medicare. Most home care, nursing homes and other assisted living facilities however are often not covered by Medicare benefits.

Those who do receive Medicare benefits are likely covered under the original plan. This is the plan which requires beneficiaries to pay premiums for Parts B and D as well as some of their health care that is covered under Parts A and C. Coinsurance and deductible fees are required and these fees change each year on the first of January.

For answers to more questions about Medicare coverage, Medicare provides booklets to seniors and those who may qualify for coverage. For those who wish to use Medicare in addition to private insurance, there are different plans that are available. These plans are supplemental to Medicare and help to fill in the gaps where Medicare coverage may not pay for specific needs.

Medicare Enrollment

In order to enroll in Medicare, you will need to contact the Social Security Administration. You can go to your local SSA office, or call 1-800-772-1213 in order to speak to a representative. Alternatively, you can visit the official SSA website at SocialSecurity.gov.

Those who have reached their 65th birthday, are disabled or have other medical problems that qualify them for Mediare should contact the Social Security Administration as quickly as possible in order to apply for Medicare. Even if you are 65 and plan to continue working or if you are nearing age 65, it is important to prepare for your Medicare application. It is recommended that you apply for benefits three months before you turn 65.

Your Medicare benefits should begin on the first day of the month of your 65th birthday. In other words, if you will be turning 65 on September 29th, then your coverage will begin on September 1st. Keep in mind that if your birthday is on the first day of a particular month then your coverage will begin on the first day of the previous month. Therefore, if you will be turning 65 on September 1st, then your coverage will begin on August 1st. This is why it is important to apply three months prior to turning 65, so that you do not have a lapse in coverage after you have turned 65. Medicare Parts A and B both begin on the first day of the month in which you will turn 65. Medicare Part B does require a monthly premium to be paid, so if you do not want this medical coverage, you have the option to turn it down when you apply for benefits. You should receive your Medicare card in the mail approximately two months before your 65th birthday if you apply soon enough.

If you have been receiving Social Security benefits or benefits from the Railroad Retirement Board, your Medicare Parts A and B will be automatic. You will not need to do anything in order to begin receiving coverage. However, if you are not covered under either of these benefits, then you will need to apply for Medicare Parts A and B before you turn 65. You can visit the .gov site online or call the toll-free number in order to get your application started.

If you are under 65 but are disabled and receiving Social Security disability, then you will be entitled to Medicare Parts A and B. This coverage will begin on the 25th month of your disability benefits. You will be automatically enrolled into the Medicare program, so you will not need to apply yourself.

To apply for Medicare Part D, which is prescription coverage, you simply need to enroll in the plan. You can do this in many ways including applying online and on the Medicare website. Choose the drug plan that you feel will best suit your needs and apply online or contact the company and request an application be sent to you.

Medicare Part A

There are four different parts to Medicare, each providing different benefits for enrollees. Medicare Part A is the most common and does not require a monthly premium to be paid in order to receive coverage. This is the hospital insurance and includes skilled nursing, critical care and nursing home coverage as well as hospital stays. There are specific requirements that must be met in order for you to qualify for home health care and/or hospice facilities.

It is important to understand that Medicare Part A, along with the other aspects of Medicare, does not cover every medical need that you may have. Part A does cover hospital stays when needed. Coverage for hospital stays includes meals, nursing and a semi-private room as well as other needs such as in-hospital medication and other supplies. Care in critical access hospitals is also covered as well as mental health facilities. In order for Medicare Part A to cover needed hospital stays however, you must be admitted for no less than three consecutive days or 72 hours. This time will begin at midnight on the day that you are admitted to the hospital and stops at midnight on the last full day that you are there.

In order for Part A to cover nursing home or skilled nursing facility stays, your admittance must be related to your diagnosis during your hospital stay. If, for example, you have a stroke and must have round-the-clock care after your discharge from the hospital, then Medicare Part A will pay for a skilled nursing facility or a nursing home while you are recuperating and during your rehabilitation. This coverage includes all your meals, rehabilitation services, nursing and a semi-private room, along with other care needs that you may have during your stay.
Coverage for skilled nursing facilities or nursing homes is limited to no more than 100 days per each benefit period. The first twenty days of your stay are completely covered. The remaining eighty days require that you pay a co-payment.

Part A also covers certain home health care if it is medically required. Part-time care as well as skilled nursing, home health aides, speech language services, medically needed social services, physical and/or occupational therapy services and certain equipment such as hospital beds, wheelchairs, oxygen and other supplies may also be covered under Part A, depending on the need and the time requirement.

For those terminally ill patients who have less than six months to live, Medicare Part A will cover hospice care. This coverage will include prescriptions for pain and symptom control as well as many medically related support services. Grief counseling and other needed services are also covered under Part A for hospice care. This coverage pays for a hospice representative to visit you at home as well as additional care as needed.

It is important that you fully understand what each Medicare Part covers. You should speak with your Medicare representative who can help you to understand this coverage as well as any additional coverage that you may need. Be sure that you ask questions to ensure that you know what your coverage will pay for and what you may need to pay for yourself.

Medicare Part B

Medicare Part B typically requires a monthly premium to be paid in order to receive coverage. If you want to see if you are qualified to receive help for paying these premiums, you can check with your Social Security office.

Medicare Part B includes coverage for doctor visits and outpatient facilities as well as many other medical services not typically covered by Part A. Some home health care and physical therapy services are covered by Part B as well as many preventive services.

Medicare Part B is designed to pay for medical tests and preventive treatments needed by patients that are not paid for by Medicare Part A. Medicare Part B is not a complete coverage plan so it is important that you understand exactly what is covered and what you may need additional coverage for.

Medicare Part B typically covers medical services such as tests and screenings as well as lab tests, physical exams, tests for glaucoma, bone mass measurements every two years, urinalysis and screenings for things such as diabetes, colorectal cancer and cardiovascular disease. For cardiovascular screenings tests of lipids, triglycerides and cholesterol are typically screened as well.

Hospitals, doctors and home health services are also included in Part B coverage, to a certain extent. Only those home health services that are considered to be medically necessary such as home health aides, social services, skilled nursing and other services are covered by Part B. chiropractic services, ambulances and other medically needed transportation, blood needed during outpatient care, ER services, eyeglasses and other exams are also typically covered by Part B. Physician visits however are not covered for routine examinations except for one exam when you are first enrolled in this plan. Clinical trials may also be covered but only if the trial will help to prevent, diagnose or treat a disease that you have.

Preventive treatments are typically covered under Medicare Part B as well. These may include annual flu shots, pneumonia vaccinations and other preventive care as needed. Medicare Part B also pays for a total of three shots for Hepatitis B, but only if you are considered to be at medium to high risk for the disease.

There are other services that Part B covers as well such as routine examinations for hearing loss, mammograms, pap smears and/or pelvic exams, dialysis, mental health care and medically needed nutrition therapy. Outpatient surgeries and supplies may also be covered as well as many limited prescription drugs as needed, transplants, prosthetic devices and physical and/or occupational therapy services.


Medicare Part B is designed to provide beneficiaries with any additional coverage that they may need to help offset medical expenses. Understanding the coverage that you have as well as any monthly premiums that you are required to pay will help you to ensure that you have all the medical coverage that you need should a medical situation arise. You can check with your Social Security Administration representative to find out what coverage you have and any additional coverage services that you may need.

Medicare Advantage (Part C)

Medicare Part C or Medicare Advantage is basically a combination of Medicare Parts A and B, often providing additional coverage at a much lower cost. Part C is provided to beneficiaries through private insurance organizations. These organizations are approved and funded by Medicare.

There are four types of plans recognized under Medicare Advantage. These are PPO or Preferred Provider Organization Plans, MSA or Medical Savings Account Plans, HMO or Health Maintenance Organization Plans and PFFS, which stands for Private Fee For Service Plans. Each of these four plans offers different ways of providing coverage for beneficiaries.

PPO Plans provide a network of hospitals and physicians from which Medicare beneficiaries may choose. Those in this plan also have the option of choosing their own medical provider, even if he or she is not part of their network, for a higher fee. In addition, some PPO Plans provide prescription drug coverage as well.

MSA Plans have two different parts. One is a higher deductible plan and the other is a savings account. Medicare funds the savings account every year with the amount needed for coverage. This amount is typically less than your required deductible. Under this plan, you are not required to choose a PCP or primary care physician, although your plan may provide a list of preferred medical providers that offer services at a lower cost than your normal physician. Prescription drug coverage is not included in MSA Plans.

HMO Plans provide you with a network of doctors, much like PPO Plans. The difference is that with an HMO Plan, you are only allowed to choose a doctor that is listed within your network. You are also required to choose a PCP and a referral from this PCP is required in order for you to see a specialist. Some HMO Plans do offer prescription drug coverage.

PFFS Plans offer the most flexibility with regards to choosing doctors and hospitals. You are permitted to go to any doctor or hospital that is approved by Medicare. You are not required to choose a PCP under this plan or have a referral from a doctor in order to see a specialist. PFFS Plans have rates for hospitals and doctors that are determined ahead of time, as well as rates for co-pay you may incur. Some PFFS Plans do offer prescription drug coverage.

The cost of Medicare Advantage will depend on many factors. While you are required to pay a premium for Part B depending on your current income, Part C coverage premiums depend on the plan that you choose. Your chosen plan will have pre-determined co-pays and deductibles.

It is important to keep in mind that there may not be Medicare Advantage plans available in your area. It is also important to note that these plans may be canceled at any time by the company providing them, depending on whether or not that company is earning a profit. You should spend some time reviewing that plans that are available in your area and choose the one that will offer you the best options regarding coverage, physician choices and price.

Prescription Drugs (Part D)

Beginning on the first day of January 2006, CMS extends coverage now to include prescription drug costs for those currently on Medicare. This program is known as Medicare Part D. In order to be enrolled in Part D, you are required to pay a monthly premium. Premiums typically run less than $40 per month. Those who elect to purchase this coverage are required to choose a PDP or Prescription Drug Plan or a Medicare Part C Plan that includes prescription drug coverage.
Those who are not able to meet their monthly premium may also qualify for additional help for monthly payments, co-pays and deductibles.

Medicare Part D coverage is available for both generic and brand name prescriptions, provided that the pharmacy you choose participates in this program. Those who incur expensive drug costs each month often find this program very helpful. Everyone who is eligible for Medicare in general is eligible to enroll in Medicare Part D coverage. This is regardless of any high cost prescriptions that are currently being taken as well as any preexisting medical conditions.

Once you have enrolled in Medicare, typically three months before your 65th birthday, you can enroll in Medicare Part D prescription coverage. Those receiving Medicare due to renal failure or disability have the option of joining this program as well. Keep in mind that if you choose to enroll in Part D, it is best to do so when you originally enroll in Medicare. If you wait, you may be required to pay a penalty. These plans typically have a monthly premium. These premiums will likely vary depending on which plan you choose. Yearly deductibles and co-pays will also vary from plan to plan.

In order to choose a prescription drug plan, there are a few factors that you should keep in mind. Cost, convenience and coverage should all be considered before you choose your Part D plan. If you are required to pay a premium, be sure that your premium is not more each month than the cost of your prescriptions. Co-pays and coinsurance should also be taken into account before you choose your Part D plan.
The coverage that you receive for your prescriptions may be the most important factor to consider. You should ensure that your plan covers all the medications that your doctor has prescribed to you. If you typically have a high monthly prescription cost, you can find plans that offer a percentage of payment until you reach a certain amount. For instance, some plans will pay 100 percent of your prescriptions once you have spent a certain amount of money each year out-of-pocket.

Remember that if you wait to join a Medicare Part D prescription plan, you may be required to pay a late fee. It is best to choose your prescription drug plan when you first enroll in Medicare. It may also help you to receive a lower monthly premium if you enroll in Part D when you enroll in Part A.