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Pennsylvania Medigap Plans

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Pennsylvania Medigap plans can be an important part of your financial plan if you live in PA and are on Medicare. If you are enrolled in Original Medicare only, your coverage provides for hospital stays and doctor visits, but does not cover you for all these costs. In addition, there may be deductibles and copayments.  As a result, these amounts (generally 20% of what Medicare doesn’t pay), can add up substantially and eat into your pockets deeper.  For PA residents, that’s where a Pennsylvania Medigap plan can help.

Medigap insurance (also called Medicare Supplement insurance) is private insurance that covers the gaps that Medicare doesn’t cover.  As an example, if you were admitted to the hospital and receive a bill, the amount that is approved by Medicare will be paid before your Medicare Supplement insurance company pays any other costs, i.e. deductibles or copays.

Each of the 10 Medicare Supplement plans offered in Pennsylvania are identified by a letter (A-N).  All Medigap plans are standardized – not only do they have to follow federal and state laws implemented to protect the consumer, but they must be clearly marked as “Medicare Supplement Insurance”.  All plans with the same letter offer the exact same benefits, no matter which insurance company sells the plan.  However, premiums rates can vary considerably from company to company.  The type of benefits and how many benefits covered by each plan determines how expensive it is.  Below is a table outlining the various benefits provided by each plan:

medigap coverage chart

In addition to standardized benefits for Medigap plans, there are no “networks” of doctors/health care providers you must go to.  You can see any provider that accepts Medicare patients.  The same is true for the claims process.  All claims, no matter which insurance company provides the plan, are paid the same according to Medicare’s “crossover” system.  For example, claims are paid in the same manner and through the same system, whether you have an Aetna Plan G, Cigna Plan G, or a Pennsylvania Medigap Plan G with any other company.

As far as differences between Pennsylvania plans and other states, please see below:

  • There are over 30 insurance companies currently offering Medigap plans in the PA. Not all these companies offer plans in other states.  Some are well-known names, i.e. Mutual of Omaha, AARP Medicare Supplement from United Healthcare, Aetna or Cigna.  On the other hand, others are smaller, regional or local companies as Highmark and Capital BCBS.  Competitive rates and the reputation of the company are two factors that will help to narrow down your options for going with one company over another.  At present, the companies with the most competitive PA Medigap rates are Mutual of Omaha, Aetna and CSI Life. To get a Pennsylvania Medigap quotes by email, you can request Medigap quotes.
  • Another unique feature of PA Medigap rates is how those rates are determined. Most premiums are calculated based upon age, gender, and zip code.  However, in PA, there are between two and three geographical rate areas depending on the company.  Generally speaking, although there are exceptions, Medigap rates in highly populated cities are higher.
  • For those who are under 65 years of age, the availability of Medigap plans varies from state to state. Some states do not even offer plans to the under-65 population.  However, PA under-65 plans are available, if you are applying during your open enrollment period, which starts when you enroll in Medicare Part B. Also, under-65 Medigap rates in PA are often the same as over-65 rates, which is not the case in most states.
  • Tobacco use rates during open enrollment can also vary from state to state. In PA, whether you use tobacco or not, does not apply here.

To get a plan with the most competitive rates, you should enroll in a Pennsylvania Medigap plan during your open enrollment, 6-month period.  Otherwise, you may have to pay more for your plan.  After your 6-month window closes, you will have to medically qualify for a plan and if you have any serious health conditions, you can even be declined.

Finally, there is a misconception that you can only apply for a Medicare Supplement during the annual enrollment period (Oct. 15-Dec. 7).  This only pertains to Part D, prescription drug plans and Medicare Advantage plans.

If you have any questions about Pennsylvania Medigap plans or want to get a PA Medigap comparison, you can contact us online or call us at 877.506.3378.

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Reducing Your Medigap Costs – 4 Steps to Replacing Your Plan

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If you have been on the same Medigap plan for more than a year, it is highly likely that you can reduce your Medigap costs for the same exact coverage. If this is you, or if you’ve already decided that it’s time to switch your Medigap policy, there are several steps you can take to make sure you are on the right track.  medigap plans

Maybe you have recently had life events which have now caused your financial situation to change; or it could be a change in your health status.  Have you recently acquired a new health condition, and now you need additional coverage?  Or have you recovered from a health disorder and now your health is in much better condition?  Whatever the reason for the change, there are several steps you can take to arrive at a logical, sound decision that can give you the best possible Medigap coverage for the lowest possible price.

1) Compare plans

All Medigap plans are standardized – they must follow the same guidelines to protect you by abiding by federal and state laws. However, Massachusetts, Wisconsin and Minnesota are not standardized in the same way.  Medigap policies are Federally-standardized, so you can easily choose which one meets your needs.  The most popular plans are F, G and N.  Your financial situation may dictate whether you choose one plan over another based on the Medigap costs, i.e. Plan F over Plan G, or Plan G over Plan N.  If you are on a budget and cost effectiveness matters to you, then consider a plan with a lower premium. (How to decide what is the best Medigap plan)

2)   Run Medigap comparisons between companies

  1. Cost (far and away, the most important factor) – Although Medicare Supplement (Medigap) plans are standardized, they may vary widely in cost. It’s like buying a name brand product at the supermarket over the store brand.  They both have the same ingredients, but the name brand cost more because you’re paying for the popularity of the product in the market. Same thing with certain Medicare Supplement companies – some have higher Medigap costs, which is why it is important to compare Medigap prices.
  2. Claim payments – Since all companies pay claims through the Medicare “crossover” system as required by law, claims payments are identical with every company. One company will never pay claims any faster than another or in a greater amount, etc. Furthermore, you can keep all your same doctors, regardless of what company you have for your Medigap plan.
  3. Customer service – it is not uniformly the same with each company. Depending on the size of the company, the customer service people may spend a short time assisting you or some take a lengthy amount of time.  If it’s a large call center environment, you probably won’t get the same person twice and won’t have that special relationship, you would with a smaller company.
  4. Company Ratings – AM Best is a global credit rating organization with a unique focus on the insurance industry. Best’s Ratings are recognized as an indicator of insurer financial strength and creditworthiness. These criteria are important when making your decision, but not the ultimate reason you would choose that company.
  5. Rating Class – A company writes its policies using the community, attained age or issue age rating. The community rated policy carries the same premium amount regardless of age or health condition.  It is based solely on your zip code.  The attained age policy is based on your current age and the premium progressively increases as you get older.  The issue age policy is less expensive when you first buy it as you are younger.  But is increases as you get older, not because of your age, but due to other factors such as inflation.
  6. Years in the market – As the AM Best ratings, this factor does carry importance, but it is not the major reason why you should choose one company over another.

    Receive current Medigap costs by email

    Where should we email the list of plans?

     
    I hate spam too, so I will never send such to you!
    See if you can reduce your Medigap costs by reviewing a list of the plans for your age and zip code.

3)   Apply for your new Medigap policysign up for Medicare

  1. Once you’ve made your choice with which company you want to enroll and which plan, you can apply for your new policy. You can do that either by calling the company or going to their website and completing your application online.  Some companies may only have the call option available and take your information over the phone.
  2. You can also enroll through an independent insurance agent, who will help you compare the options, complete and process your application, and serve as an ongoing resource for you if you have problems or questions. This does not cost you anything.
  3. Most companies will send you a temporary ID card while you wait to receive your new policy and permanent insurance card in the mail.

4)   Cancel your old Medigap policy

You should not cancel your old policy until you get approved for your new policy!  Once that happens, you can then go ahead and let your current insurance company know that you want to cancel your existing policy and by which date.  It is best to give a one week or more notice for cancellation, especially if you are paying your premium by bank draft. Plus, it usually takes 7-10 business days for a new policy to be approved. This means that, ideally, you would apply for a new policy with at least a 3-week lead time in order to facilitate getting the new policy in place in time.

When Can You Change Medigap Plans?

You can change your Medicare Supplement plan whenever you want to, but unless you are in a special enrollment period, your application will have to go through underwriting.  There is a possibility that you may be declined depending upon the status of your health.  Therefore, if you are thinking of changing while you are in good health, it would be wise to do that now rather than later.

If you do have health problems, however, it would definitely be advantageous to work with someone who knows the variations between companies. Different companies ask different health questions and will “accept” different pre-existing conditions. An independent broker can advise you on these differences.

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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Should You Shop for a Medigap Plan?

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Five Things You Must Know When You Are Turning 65

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Turning 65 is a whirlwind.

You may be retiring or thinking about retiring soon, and you’re probably getting hounded with emails and mail about Medicare and what you should do about it.

If you’re trying to figure it all out on your own… well… you don’t have to.

Our agents are ready to give you a hand at absolutely no cost to you whenever you’re ready.

But, if you’re just starting to get a feel for your new responsibilities, here are 5 things that all 65ers need to know.

5. Enroll in Medicare Part A and Part B.turning 65 paperwork

When you turn 65, Medicare is officially available to you. You’ve been paying into it for long enough, so why not reap its benefits?

Part A cover inpatient care, and it’s completely free. No monthly premium for you.

Part B covers outpatient care, and it’s monthly premium, as of 2017, is $134. Note: that cost is higher if you make more than $85,000 per year (or $170,000 per year as a household).

If you’re on group coverage, and you’re still working, you need to weigh your options. You can read more about that here: https://65medicare.org/should-you-keep-your-group-insurance-when-you-turn-65.

Here’s what your timeline looks like:

→ 3 months before you turn 65, your birthday month, and 3 months after you turn 65.

If you miss this 7-month window, you’re going to be hit with some late enrollment penalties.

Here’s how to sign up, straight from Medicare.gov:

You can choose to opt out of Medicare Part B if you want, but you should discuss it with your agent first.

4. Look into Medicare Part C (Medicare Advantage).Medicare Advantage vs. Medigap

Medicare Advantage is an alternative to Medicare and Medigap plans. It often has a very low monthly premium, but it also comes with its downsides.

The first problem is the limited network. There are a lot of doctors that don’t accept Medicare Advantage. It could leave you with either no doctors in your area, or a doctor that’s not your favorite.

Also, the premium may look like a good sticker price, but there’s still hefty deductibles and co-pays. We’ve seen those range anywhere from $3,000-$7,000.

Medicare Advantage can be a good option for those in large cities. Large cities often have more doctors to choose from.

If you’re in a smaller city, you may not have any doctors, meaning you’ll have to drive a distance to see a doctor.

It’s always best to weigh your options  (Read our Medicare Advantage vs. Medigap article), so don’t rule anything out until you check out your own situation and your own network of coverage.

3. Sign up for Medicare Part D.

Medicare Part D, also called a prescription drug plan, or PDP for short, helps a lot of people save money on drug costs.

The dilemma here is that many turning 65 aren’t on any prescriptions yet. Why then would you pay a monthly premium for drug coverage that you don’t need?Part D Plans

Great question, and here’s the answer: For every month you delay signing up for Part D, you receive a 1% penalty on the premium.

We realize that may sound a little confusing, so here’s an example.

If you had signed up for Part D when you turned 65, let’s say your monthly premium would’ve been $50.

For each month you delay signing up, your monthly premium goes up by $0.50. So, by the end of the year — 12 months later — your premium has gone up to $56. Now, you’re not paying that premium yet, but when you do sign up for Part D, that penalty will go into effect.

If you had signed up for Part D, your premium would’ve stayed at $50.

It’s often a choice that takes time to make. If you end up needing prescriptions and you don’t have a Part D plan in place… well, we all know how expensive prescriptions are. It’s a gamble — are you willing to take the risk? And the penalty?

2. Choose a Medigap plan.

Medicare does cover a good portion of your medical expenses, but you’re still left behind with a nice chunk of risk.

To put things simply, Medicare covers about 80% of your medical expenses. A Medigap plan picks up that other 20%. That’s a generalization, and it’s more complicated than that, but that’s the simple way of putting it.

To “fill in the gaps of Medicare,” many will buy a Medigap plan. This is also called a Medicare Supplement.

You can buy a policy of your choice up to 6 months after you enroll in Medicare Part B. After that — you guessed it — penalties.

One of our agents can help you choose a plan that fits your budget.

1. Consider long-term care insurance.

Long-term care insurance is a big decision to make, and it definitely shouldn’t be made in haste. However, as time goes on, your ability to even purchase it starts to decrease.

Long-term care is only available to  those that can pass the rigorous health questions. As we get older, that becomes less likely, and some carriers even cap off the age you can apply right around 65.

Also, the other you get, the more expensive it gets. After the age of 65 or so, long-term care insurance starts to become very pricey, often more than many are willing to pay.

Long-term care itself is extremely expensive — it can be around $100,000 a year in many cases — so if you’re interested in getting some insurance coverage, you ought to start thinking about it now.

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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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