Guide to Choosing the Best California Medicare Supplement Plan

Medicare can be scary to a new enrollee. There are lots of terms and what's with all the letters?? (A, B, F, etc...just missing Y but give them a few more years). Many people are coming off of group health coverage through an employer of an individual family plans (including Covered California).

So...how can a person new to Medicare know they are making the best decision for both their pocketbook and their future (maybe decades) of health care needs and costs.

You're in the right place!!

We're going to break it down into what's really important and in the next article, we'll cover the process, timetable, and important notes for enrollment.

Most importantly, we're going to make it E.A.S.Y. to understand.  Let's get started.

First, what does Medicare cover by itself?

There are two parts to Medicare.

Part A is the part you've probably paid into all your life. It shouldn't cost you anything to enroll and in fact, many people are automatically enrolled when eligible.

Part A covers facility costs (think hospital) and this is where the real costs are today.

Part B covers physicians costs. Think doctors and labs. Part B is not automatic. You have to "opt in" for Part B coverage and there is a monthly cost for this coverage which can change based on your income.

So Part A is hospital and Part B is doctor coverage. We'll get into what these parts cover below but first - Medication.

Prescription Coverage - Part D - Late to the party

Part D was added after the other two parts and it covers prescription drugs. It also requires a person to sign up and there is a monthly cost. This coverage is offered through private companies while Part A and B are through Medicare directly.

What does the Part D benefit for Rx look like?

Each carrier has slightly different benefit options but there are some key standardizations by Medicare. Here's what you can expect:

1. Each carrier may offer 2-3 options and price levels
2. Some plans have deductibles while others do not
3. Copays can vary based on generic or brand RX
4. You generally have copays until you meet the "donut hole"
5. You pay full price during the "donut hole" until max out of pocket

This may all sound confusing but we have a great service where plug in your medication costs to Medicare and their system will generate a best value report including monthly premium and out of pocket. We do all of this at no cost to you!

Okay. Those are the key parts. So why not just have Medicare alone?

There are some major "holes" in the Medicare coverage that people use Medicare Supplements or Advantage plans to "fill in". Here are the main concerns we want to address.

1. Both Part A and B have deductibles which go up each year. This means, you have to pay the deductible amount first before getting help.
2. Both A and B have a 20% coinsurance which means that you after you meet the deductible, you will pay 20% of the charges INDEFINITELY. No back end cap.
3. Doctors are allowed to charge 15% than higher than what Medicare allows. This is called "Excess". Some Supplement plans covers this while others do not. Very important. (Hint - this is why the F plan is so popular).

There are other small holes but the above three are really why were here to begin with.

You don't want to pay 20% of a $50,000 hospital bill!

Okay, so that's the bad news. Enter the solution!

There are two ways to address the concerns above: Medicare Supplements or Advantage Plans. What's the difference?

Quick Comparison between Supplements and Advantage Plans:

Cost
Networks
Benefits
Prescription

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The Medicare Supplement Intro

Key Points on Supplements

1. Benefits are standardized by Feds. An F plan is an F plan regardless of carrier
2. Works like a PPO...more flexiblity on doctor choice and you have more control over medical care.
3. Nationwide network. As long as doctor accepts Medicare, you're good.

There are different Medicare supplements available with different levels of benefits (and monthly costs).

Here's the take away:

The F Plan, G plan, and F deductible have been the best values.

Quick comparison:
1. Part A Deductible
2. Part B Deductible
3. Doctor Visit Benefit
4. 20% co-insurance

The F plan is by far the most popular Medicare Supplement (as opposed to Advantage plans below). It covers all the major holes in Medicare but it's real value is coverage of Excess.

Most people are unfamiliar with this term as it's specific to Medicare.

What is Excess and why is it important to cover it?

By law, Medicare providers can charge up to 15% higher than what Medicare allows and still technically "accept" Medicare. This is the "excess". The F plan covers "excess". Most other supplement plans do not.

So big deal...don't most providers accept Medicare rates anyway?

Yes, a vast majority of providers accept Medicare but there is also a great deal of pressure on Medicare financially. That means a squeeze on doctor re-imbursement over time and each year, more doctors are charging the excess amount.

Here's the big deal...there's no cap on the 15% excess charge.

With insurance, we like "caps" meaning, I'll pay an amount until I hit some amount and then it goes 100% to the carrier. The excess has no cap unless our Medicare supplement plan covers it. Okay...now it matters. You don't want to pay 15% of $10,000. Excess is important. Best to cover it if you can.

So that's the Medigap side of things. A quick review:

1. Part A and B are through Medicare
2. Part D (medication) and Supplement are through a private carrier (we help you there)
3. F plan is very popular and covers most costs. F plan deductible includes deductible to reduce cost.
4. You can quote all major carriers and plans side by side here.

What should we expect in terms of total cost for Medicare, Part D, and a Supplement

Good question. In fact, THE question.

Medicare supplement plans increase with age but let's look at a 65 year old since most people become eligible then.

Part A - Should be no cost for most people who had income in the U.S.
Part B - Expect about $110/month; may go up based on income
Medicare Supplement - Approximate $140 depending on area
Part D - Approximately $50 depending on plan option

All told, an average monthly cost for full coverage might be approximately $300.

Again, that's a rough estimate, you can quickly get your exact costs at our Medigap quoting engine.

That's the supplement side of things...what about Advantage Plans?

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The Medicare Advantage Plan Intro

Here's why Advantage plans are so popular::

Most plans are no or low cost.

That's right, no premium depending on availability in your area.

What's the trade-off?

Control and access. The Advantage plans are just a new take on HMO's. You'll have more narrow network of doctors and control of health care decisions will rest more with the carrier or doctor.

That being said, for many people on a fixed income, there's no real decision.

Advantage Plan or no coverage!

Some Advantage Plans cover Medication as well. The market is more varied for Advantage plans so the best option is run your quote here and let us do the work. We can compare the plans, benefits, and find the best value for YOUR situation.

The net net in your decision is this.

Again, it's the classic HMO versus PPO comparison but with a Medicare touch!

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What about Prescriptions and Part D

Glad you asked. There's a basic framework for benefits but each plan is slightly different and there are LOTS of carriers. We can change plans regardless of health at the end of each year.

So how do we compare the Part D options?

Here's the best news. You can send us your RX needs (medication name, dosage, # of pills/month) and we can load it into the Medicare website. This will then generate a report with the best value (including monthly premium and RX copays) for your situation. Very easy. We can quickly generate this report for you. Email us at help@californiamedigap.comom

Lots of Questions Still? Not surprised and we're happy to help you.

First, check out our Medicare Supplement Process page to find out the when and how's of enrolling Medicare and Supplemental coverage in a clean and easy to understand format.t.

We also have more detail on Advantage Plans to help dig a little deeper.

quote Medicare Supplements and Advantage Plans all from one page. Instantly and Free! We believe in giving you all the information and all the options. There's no fee for our service as Licensed California agents with all the major carriers.

How can we help! Our services are free to you and our people are friendly, helpful, and patient!t!

We'll make Medicare easy and we'll make the out of pocket costs lower. That's our job. Let us get to work. Call us at 800-320-6269 or email to help@californiamedigap.com

Run your Free California Medigap Quote - Medicare Supplements and Advantage Here