Medicare without confusion is a clear and concise way to understand the government-funded health insurance program designed for individuals who are 65 years of age or older, as well as those with certain disabilities or illnesses.
With its Four parts – Parts A, B, C, and D – Medicare provides coverage for hospital stays, doctor visits, prescription drugs, and more. While it’s important to note that Medicare does not cover all health care costs, enrolling during the initial enrollment period or a special enrollment period can help ensure you have access to the coverage you need. With our guide “Medicare without confusion”, individuals can better navigate their health care options and make informed decisions about their health care needs.
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My name is Brian Monahan. I am the owner of the YouTube channel Medicare 365. I have helped thousands of people understand Medicare and how it works by cutting out confusing information. It’s actually easier than it seems.
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At the time of writing this book, I have been helping people with all of their Medicare questions for over 15 years.
Please call our office at 1-844-552-7426 and let us guide you through this crucial time. Our services are free of charge.
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If you don’t find the answer to the question you have in this book, check out my YouTube channel and I’m sure you will find it there. https://www.youtube.com/@medicare365.
This book was written for people who are 64 years old and older. If you are disabled and getting on Medicare under the age of 65, please call my office.
The first thing many people must realize is that you sign up for Medicare through the Social Security Office, not through Medicare. The easiest way to do this is to call Social Security (your local office) 4-6 months prior to your 65th birthday and make an appointment with them either to go in person to sign up, or have them do it over the phone. You also can do it yourself on ssa.gov.
Watch my video- Signing up for Medicare:
Next, if you are collecting a Social Security benefits check before the age of 65 (62-64), you will automatically be enrolled in Medicare Part A and B starting the 1st of the month on your 65th birthday month.
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For example: You turn 65 on June 13, 2023 and you have been collecting a Social Security check since the age of 62. You will receive your Medicare Card in the mail with the start date of June 1, 2023 for both Medicare Part A and B.
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*If you are 65 years old and have medical coverage, you don’t have to start Medicare. If your existing medical coverage is less expensive, you can postpone your Medicare Part B. (How is this possible?)
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If you have health insurance through your (or your spouse’s) employer and your company employs 20 or more individuals, you can postpone enrolling in Medicare Part B past the age of 65.
THIS IS EXTREMELY IMPORTANT!
The reason this is so important is that you don’t want to pay for Medicare Part B if you don’t have to… and you’ll also lose your initial enrollment status for a Medicare Supplement Plan and for a Medicare Part D prescription drug plan. You don’t have to know the ins and outs but just beware and speak to a knowledgeable agent about this when you are 64 ½ years old.
If you waited to sign up for Medicare because you or your spouse were working, watch this video and it will explain exactly how to sign up.
Click on this video link:
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Chapter 2:
Terms:
Medigap – This is the same thing as a Medicare Supplement Plan. An example would be Plan F, Plan G, or Plan N.
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Copay – An amount you may be required to pay for a medical service like a doctor’s visit, outpatient visit, or a prescription drug.
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Deductible – The amount you must pay out of pocket before your insurance plan “kicks in” and starts paying.
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Premium – The payment you make to Medicare for your Medicare A and B card, or to an insurance company for a Medigap Plan, an Advantage Plan, or prescription drug coverage.
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Max Out-of-Pocket – This is the most you will pay in a given year to the hospital, doctor, etc. All together. If your MOOP (Max Out of Pocket) is $5,000, this is the maximum amount you will pay.
Underwriting – Health questions insurance companies ask you to determine if they are going to approve you for a plan. They also run a digital check on your health records.
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Chapter 3:
4 Parts of Medicare
Medicare Parts A and B are known as Original Medicare. This is your red, white and blue card (see below) that you receive from Medicare. You pay the Federal Government for the coverage this card gives you (around $170 a month). You will pay this to them unless you are in a special circumstance. 90% of you will pay this amount.
But this Medicare Part A and B card doesn’t cover everything… below you will see the 4 steps to complete your Medicare package.
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Steps Include:
1. Sign up for Medicare A and B through the Social Security Office.
2. Choose a Medicare Advantage plan or Medigap Plan
(Plan F, G, N, HDG).
3. If you choose a Medicare Advantage plan you are finished. Most of them have the hospital, doctor, prescription drug, vision, dental and hearing coverage.
4. If you choose the Medigap plan, you will also choose a Part D prescription drug plan and a vision, dental, and hearing plan.
*See the chart on the next page. There are only 4 steps for 90% of people going onto Medicare and it is extremely simple.
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Chapter 4:
Advantage Plans vs. Medigap Plans
This is the big argument. Which one of these plans do I get to cover the big-ticket items? The crazy thing about 2023 is that about 50% of Medicare-eligible people are on an Advantage Plan and the other 50% are on a Medigap Plan.
The easiest way to make this decision is to see “what suits you the best”. This is why an honest insurance broker is so important to have. They can tell you the good and bad of each plan. But… for the purpose of this book let me go into the top pros and cons of both the Advantage Plans and the Medigap Plans.
Advantage Plans
Pros:
1. $0 premium PPOs and HMO’s
2. All in one package
3. Covers hospital, doctor, drugs, vision, dental, and hearing
4. Gym memberships and perks like chiropractic care, over-the-counter supplements, and transportation services
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Cons:
1. High Copays
2. Hospitals and doctors might not accept the plan
3. Skilled Nursing possibly limited to only 20 days
4. Max out-of-pocket can be $7550- $11,000 per year
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Medigap Plans
Pros:
1. Coverage anywhere in the country with no networks
2. Some plans have little out-of-pocket costs outside of the premium
4. Most comprehensive coverage for hospital and surgery
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Cons:
1. Cost of Premium can be $100+
2. Must purchase drug plan separately
3. Must also purchase vision, dental, and hearing plan separately (optional)
4. You must be approved by underwriting in certain situations
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I have always said that a Medigap Plan (Plan F, G, N or HDG) is far superior to an Advantage Plan for medical coverage. Medigap Plans are accepted anywhere Medicare is accepted. If you ask a hospital, skilled nursing center, doctor, etc., “Do you accept Original Medicare?” and they answer “YES”, then they must accept any Medigap Plan you have. The vast majority of hospitals and doctors take Original Medicare which means they will take any Medigap Plan. Unfortunately, this does not apply to Advantage Plans. This means that even if Original Medicare is accepted by a certain hospital, for example, they do not have to accept an Advantage Plan.
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Chapter 5:
Only 4 Medigap Plans are worth it
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After speaking to thousands of people about Medicare, only 4 Medicare Supplement Plans (Medigap Plans) are worth considering (in my opinion).
These are:
Plan F, Plan G, Plan N, and
Plan HDG (High Deductible G).
Take a look at this short video on the
Top Medigap Plans:
Plan F*: This plan covers all the “gaps” and “holes” in Medicare Part A and B. There are no copays or deductibles for visits to the hospital or doctors with Plan F.
* Plan F- Only available if your 65th birthday occurred before January 1, 2020, or you qualified for Medicare due to a disability before January 1, 2020.
Plan G: This plan covers “gaps” and “holes” in Medicare Part A and B. There is only one deductible for this plan which is $226 on an annual basis. Other than this cost, the plan is the same as Plan F.
Plan N*: This plan covers “gaps” and “holes” in Medicare Part A and B. There is the same $226 annual deductible as Plan G but also a $50 emergency room fee (waived if you’re admitted) and up to $20 copay per outpatient visit with a doctor, etc.
* Plan N could have an excess charge in certain states but less than 3% of the doctors in the country charge this.
Plan HDG (High Deductible Plan G): This plan has the same coverage as Plan G but you must pay 20% of the cost of your coverage up to $2700 in the year 2023.
An easy way to look at Medigap Plans is that after Medicare Part A and B pick up 80% of medical costs, Medigap Plans will help cover the remaining 20%.
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Chapter 6:
Enrollment Periods
I already discussed your initial enrollment period in Chapter 1: When and How to Sign Up for Medicare. There are also other very important enrollment periods that you should know about.
Number 1: You can switch your Medigap Plan (Medicare Supplement Plan) to another Medigap Plan on ANY day of the year! There is no enrollment period for going from one Medigap Plan to another Medigap Plan. You can do this 365 days of the year. The thing to remember is that many times you must apply and pass underwriting (health questions) to do this. But many times you DON’T! I discuss this in later chapters and also throughout my YouTube videos. https://www.youtube.com/@medicare365.
Number 2: Medicare Advantage Plans and/or Medicare Part D Drug Plans have specific enrollment periods.
Call us at 1-844-552-7426 if you want me to explain this in detail.
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Here they are:
Open Enrollment Period (OEP)
October 15–December 7
• Allows Medicare Advantage enrollees to either switch to Original Medicare and add a Medigap Plan (plus a Part D plan) or switch to a different Medicare Advantage Plan.
• Allows those who are on Original Medicare or a Medigap Plan to switch to a Medicare Advantage Plan.
• Allows you to change your Part D drug plan (PDP)
• Your coverage will begin on January 1 (as long as the plan receives your application by December 7).
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Medicare Advantage Open Enrollment Period
(MA-OEP)
January 1–March 31
• Allows individuals enrolled in a Medicare Advantage plan a one-time option to go to either a different Medicare Advantage Plan or Original Medicare with a Medigap Plan and PDP.
• If you have Original Medicare only, you cannot use this Open Enrollment Period to select a Medicare Advantage Plan.
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Special Enrollment Period
Year-Round (YOU MUST QUALIFY!)
You may be able to join, switch, or drop a Medicare Advantage or Medigap and Part D prescription drug plan outside the basic enrollment periods in certain situations, for example:
• Left coverage from an employer or union
• Need extra help paying for prescription drugs
• Moved to a new address that is not in your plan’s service area
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Chapter 7:
Prescription Drug Plans
“Part D”
This is sometimes the easiest and sometimes the most difficult part of Medicare. If you choose a Medicare Advantage Plan (MAPD) it will come with a drug plan, so you won’t have to look any further. You will give your agent your drug list, and he/she will tell you what you will pay per month for your medications.
If you choose the Medigap Plan route, it is different. You can choose to attach any Part D plan available in your zip code (usually around 30 plans).
If you are taking a few Tier 1 generic drugs like a statin drug and/or blood pressure medication and nothing else, it’s simple, choose the least expensive drug plan that covers those drugs. This will most likely cost you around $10 for the monthly plan premium and the drugs will most likely cost between $2.00 and $5.00 copay at the pharmacy when you pick them up. If you take several drugs including brand drugs or Tier 3 and above, choosing a plan can be more difficult.
I put together a step-by-step YouTube tutorial to help you choose your plan with ease.
Click on this video link:
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Chapter 8:
Vision, Dental, and Hearing Plans
Once again, if you choose a Medicare Advantage Plan, they will more often than not give you a vision, dental, and hearing (VDH) plan with it.
For example, if you purchase an AARP (UHC) Medicare Advantage Plan, and it is an MAPD, they will give you an AARP (UHC) drug plan, and an AARP (UHC) vision, dental, and hearing plan. You can’t mix and match companies and plans like you can with Original Medicare and a Medigap Plan.
If you get a Medigap Plan and want a VDH plan, my advice is, to ask your dentist which plans he/she accepts and start from there. Your agent can then help you find the right plan. Dental coverage is the hardest because many dentists only accept certain plans.
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Chapter 9:
Pricing of Medigap Plans
I get a lot of phone calls asking about community-rated and issue-age-rated plans. Most states have attained-age-rated plans. Some do have community-rated and issue-rated plans and I will go over this below. Call us at 1-844-552-7426 if you want me to explain this in detail.
Attained-Age Rated:
Most plans are attained age by. This means the premium is based on your current age when you buy the Medigap policy and the premiums go up as you age.
Community-Rated:
The same monthly premium is charged to everyone who has the Medigap policy, regardless of age. Certain states have these types of plans.
Arkansas
Connecticut
Massachusetts
Maine
Minnesota
New York
Vermont
Washington
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Issue-Age Rated:
The premium is based on the age you are when you buy the Medigap policy. The premiums won’t go up because of your age. They might go up because of other factors such as inflation. Certain states have these types of plans.
Florida
Arizona
Idaho
Georgia
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Chapter 10:
Average Costs of Medigap Plans
My number one video on YouTube explains the costs the best way possible.
Click on this video link:
You will have to speak to an agent if you want specific pricing for each of the Medigap Plans in your area. Most of the time it goes by age, zip code, gender (yes, women are less expensive), and tobacco use.
On average someone who is 65 years old will pay what is on this chart for each plan in 2023. Once again, this is an average. I urge you to watch my video or call us at 1-844-552-7426 because I will explain this in detail.
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Chapter 11:
Trial Rights
(Very Important)
Trial Rights are very important and many people don’t know about them. I am going to discuss two that I feel are the most important.
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These rights are law and can be found on page 23 in the book by the
Centers for Medicare and Medicaid Services.
*See the Book Cover Below
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Trial Right #1: You joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65 and within the first year of joining, you decide you want to go back to Original Medicare and get a Medigap Plan. This is very important! Your first year of Medicare is more important than you can imagine. Call us at 1-844-552-7426 if you want us to explain all of this in detail.
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Trial Right #2: You have never been on a Medicare Advantage Plan before. You dropped a Medigap Plan to join a Medicare Advantage Plan and within 1 year wanted to go back to the Medigap policy. You can do this without underwriting (health questions).
These two Trial Rights have saved many of my clients from problems with their Medicare coverage and they should be taken seriously.
I would like to thank you for reading this and hope the information has helped you in your Medicare Journey.
CMS (2022). Choosing a Medigap Policy. US Dept of Health and Human Services
*Disclaimer:
The information provided in this book is for educational purposes only. It is not intended to be a source of financial or legal advice for Medicare Insurance. Making adjustments to an insurance strategy or plan should be undertaken only after consulting with a professional licensed insurance agent. The author makes no guarantee of the results obtained by using this book.
