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The best way to shop for Medicare Insurance
Written by Eric Greth
Licensed Agent
Last updated on September 25, 2021
Shopping for Medicare Insurance can be a daunting task. Depending on your situation and zip code you may only have a few choices or as many as 300. Typically the more rural your zip code the fewer choices you have, while large urban areas can have 50 or more choices.
Starting Point
You need Medicare Part A & Part B before you are allowed to purchase Part C (Medicare Advantage) or a Medicare Supplement plan also known as a Medigap plan. Follow the link below to check your status.
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You can create an account at Medicare.gov and check your Medicare status
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call Social Security (l -800-772-1213):
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Visit www.socialsecurity.gov and apply online:
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Visit your local Social Security office: or
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Call Medicare with questions: I —8OO-MEDICARE
What is your current situation?
Situation Enrollment Period
New to Medicare IEP | OE | SEP
Not new to Medicare AEP | OEP | GI | SEP
Deferred Part B SEP
New to Medicare
IEP - Initial Election Period - Medicare Advantage
The first time you are eligible to enroll in a Medicare Advantage plan is called your Initial Election Period. It's when you're new to Medicare. You have a 7-month window known as 3-1-3 to enroll. Your Medicare IEP starts three months before your turn 65, includes the month you turn 65, and extends 3 months after your birthday month.
Coverage starts the first day of the month you turn 65 unless your
birthday is on the first day of the month. If you are born on the first of the month, you will be Medicare-eligible on the first day of the month before you turn 65.
OE - Open Enrollment - Medicare Supplement
Once your Medicare Part B starts you have 6 months of Open Enrollment to obtain a Medicare Supplement plan without medical underwriting. It is very important that you don't miss this window especially if you have health problems or a pre-existing condition. Generally, the idea is that Medicare Supplement policies are available for either "new to Medicare" or older people who are healthy. If you miss the 6-month window, you might not qualify for a Medicare Supplement policy again. But as with most government programs, there are a few exceptions. Guaranteed Issue rights or Trial rights are a few possible ways to obtain a Medicare Supplement policy later in life. I wouldn't count on this though.
SEP - Special Enrollment Period - Part B
If you missed your IEP you may have a chance to sign up for Medicare during a Special Enrollment Period. Leaving group (employer) health coverage creates the most common reason for a SEP for Part B. Most people choose to enroll in part A even if they are still working past age 65. There's usually no premium for Part A. But why pay a premium for Part B when you have coverage?
There is an 8-month period to sign up for part B that Starts the month after the employment ends or the group health plan insurance ends, whichever happens first. If you're covered under a group health plan based on current employment, you have a SEP to sign up for Port B any time, as long as you or your spouse is working and are covered by your employer's plan.
GEP - General Enrollment Period - Part B
If you did not sign up for Part B when first eligible, and you are not eligible for a Special Enrollment Period (SEP), you can sign up during the General Enrollment Period (GEP).
The General Enrollment Period is between January l- March 31 Of each year and your Part B coverage will start July 1. Keep in mind that you will generally need to pay a higher premium for late enrollment in Part B. Regardless of the enrollment period, Medicare Parts A and B take effect on the first day of the elected month.
What is the Part B Late Enrollment Penalty?
Medicare will penalize you for not getting Part B when first eligible, that is if you are not enrolled in coverage that is considered to be at least as comprehensive as the coverage provided by Medicare. This is what Medicare calls "creditable coverage".
How much does the Part B penalty cost?
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10% Of the premium for each full 12-month period that You could have had Part B, but didn't sign up for it and didn't have creditable coverage.
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The late enrollment penalty never leaves you. It is with you for as long as you have Medicare.
Example: Part B Penalty
Josh became eligible for Medicare on August 1. 2019. He decided to delay
Part 3 because he was is in good health and could not afford the premium.
In February of 2021. Josh developed back issues and needed surgery. He
signed up for Part B on February 15th using GED since he had not had creditable coverage since 2019.
Unfortunately. when his Medicare starts in July. Josh will pay a penalty in addition to his Part B premium. Medicare will penalize him for going without coverage since December Of 2019 — the end Of this ISP. The penalty applies to a FULL 12-month period. so he will not be penalized for the months of December 2020 — June 2021. However, he will have to pay 10% of the premium for the remaining months.
This penalty will remain with Josh as long as he has Part B coverage.
Not New to Medicare
If you have a Medicare Advantage plan or a Prescription Drug Plan (PDP), also known as Part D, then you can use AEP each year to make changes.
AEP - Annual Election Period - Medicare Advantage & PDP
Medicare Advantage plans and Perscription Drug Plans (PDP) are one-year contracts that run from January 1st to December 31st. They are also guaranteed renewable. And because of this, most people don't realize that each year their plan can change. Benefits can be added and dropped, and costs can change. Your plan might be the best one year but one of the worst the next year. This is why there is an AEP that runs from October 15th to December 7th every year. This is when you can change Medicare Advantage plans by enrolling in a new plan. It's one of the busiest times of year for Medicare providers and brokers.
OEP - Open Enrollment Period - Medicare Advantage
If you're not happy with your new Medicare Advantage plan that started January 1st, then you can change to another Medicare Advantage plan once during OEP between January 1 - March 31. You can also drop your Medicare Advantage plan and go back to Original Medicare and apply for a Medicare Supplement plan. Unless you have a Guaranteed Issue right you will need to qualify through medical underwriting, so be careful. Changing your Prescription Drug Plan (PDP) is not allowed during this timeframe.
GI - Guaranteed Issue - Medicare Supplement
Guaranteed Issue Rights, also known as "Medigap Protections" are rights that you have based on certain situations. Insurance companies that offer Medicare Supplement policies in your area are required to sell you a policy, must cover all pre-existing health conditions, and can not charge you more for a policy because of past or present health problems.
Situations for Guaranteed Issue Rights
1) Losing credible coverage
Retiring and losing your group health plan including retiree, COBRA, or union coverage that pays after Medicare
2) Open Enrollment Period
When you are new to medicare you have guaranteed issue rights.
a. Trial Right 1
b. Trial Right 2
4 Important issues to know before you enroll or change plans.
Written by Eric Greth
Licensed Agent
Last updated on September 19, 2021
#1) Which plan is better, Medicare Advantage or a Medicare Supplement?
We get this question a lot, so let's get right to the point after a quick disclosure.
Disclosure
We don't have a dog in this fight. Go here to see how we are compensated and how we work for you and NOT the insurance companies. Our advisors can and do enroll clients in both plans. It's absolutely imperative that you compare plans and make your decision based on what fits your needs and budget. We can help you make that decision but we do admit that we have a bias. This is based on extensive research, many years of experience, and our proud mission to do what's best for our clients. Here's the bottom line.
A Medicare Supplement plan is far superior to a Medicare Advantage plan.
Did you just raise an eyebrow? That's probably because most agents, agencies, and insurance companies are aggressively pushing Medicare Advantage plans. Medicare Agents and Agencies see these plans as a "layup", "slam dunk", and "easy money". I'm sure you've noticed the media blitz starting in October, running through the Annual Enrollment Period (AEP). The top 5 insurance companies spend millions to shape the way they want you to think about Medicare. It doesn't stop there. Go to any Medicare website and you'll notice the tricky ways they nudge consumers toward Medicare Advantage. Why are they doing this? It's where the money is. Keep reading and we'll show you behind the curtain and you can see for yourself. We're here to clear up the misinformation and help you make a better and more informed decision.
Let's look at the differences between the two plans.
#2) Medicare Advantage vs. Medicare Supplement
In addition to Part A and Part B of Medicare, most will choose additional coverage through a Medicare provider. This is a very critical choice depending on your health, finances, and where you live. Medicare Supplement plans also known as Medigap plans are greatly different from Medicare Advantage plans. There are consequences for choosing poorly.
Medicare Advantage
When you choose Medicare Advantage you are abdicating your Original Medicare part A and part B for an insurance plan. Medicare Advantage is an "all in one" alternative. The law states that Advantage plans have to cover what is covered by Original Medicare. The most important thing to understand is that Medicare Advantage is administered by private insurance companies and is a managed care plan. That means that the insurance company now makes the decisions about your care. Follow the money. Medicare pays the insurance company a fixed amount per enrollee each year to manage the care provided. What they don't spend they keep. These plans are the new "cash cow" for insurance companies all at the beneficiary's expense.
Below are some of the key "Selling" points that make Medicare Advantage plans look attractive. Insurance companies aggressively market these plans. As you read, keep in mind that there's no "free lunch". You will be paying for it in some way or another.
Pros
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The yearly limit on Out-of-pocket cost
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Drug coverage can be included
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Some include dental, vision, hearing, over the counter, and transportation benefits
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Optional benefits like gym membership and meal cards
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Some plans are $0 premium
The following is why we believe that Medicare Advantage is a big disadvantage.
Cons
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It's "managed care" You're abdicating Part A & Part B of your Original Medicare to an insurance company
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Hospital network
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Doctor network
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Prior authorizations
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Referrals may be required to see a specialist
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Out-of-pocket cost varies from plan to plan
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Copays and additional premiums
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Step Therapy for Part B or D
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Requires a monthly premium
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Most are not $0 premium
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Difficult to compare - Not standardized
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At some point, health may preclude you from qualifying for a Medicare supplement plan
Types of Medicare Advantage Plans
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Health Maintenance Organizations (HMO)
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Health Maintenance Organizations Point-of-Service (HMO-POS)
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Preferred Provider Organizations (PPO)
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Special Needs Plan (SNP)
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Dual Special Needs Plans (D-SNP)
Medicare Supplement
Medicare Supplement plans are standardized by the government. They are very easy to compare and evaluate which is best for your situation. Currently, the three main plans are F, G, and N. There are also a few high deductible versions available. The main reason that we like these plans over Medicare Advantage is that you keep Original Medicare Part A and Part B, the supplement coverage is accepted anywhere that Medicare is accepted, and you know exactly what you have (standardized).
Pros
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Not a managed plan
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No hospital networks
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No doctor networks
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No pre-authorizations
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No referrals required
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Designed to pay copays, coinsurance, and deductibles
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Guaranteed renewable
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Easy to compare and understand
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Some cover travel outside the US
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Can apply for a different plan anytime
The biggest negative is that you will need to add Part D (drug plan) and any other ancillary benefits.
Cons
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Requires a monthly premium
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Does not include a standalone drug plan
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Does not include dental, vision, and hearing benefits
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In later years, will require underwriting to change
Additional insight
Many seniors love their Medicare Advantage plan up until their health starts to decline and they start relying on the coverage. Referrals and pre-authorizations become incredibly frustrating. That's when they realize they might have made a mistake. Most take the logical step and start investigating Medicare Supplement plans because they don't have these restrictions. Unfortunately, it might be too late because they no longer qualify for a Medicare Supplement plan. Here's the really bad news. Acceptance into a Supplement plan isn't always guaranteed. If you don't have a guaranteed-issue right, then you will need to medically qualify and go through the underwriting process.
#3 - When can I change from a Medicare Advantage to a Medicare Supplement plan?
If it's the first time you joined a Medicare Advantage plan, and you are not happy with the plan, you will have a special right under federal law to buy a Medicare Supplement plan. However, you will have to return to Original Medicare within 12 months of joining. Here are some important issues.
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If you had a Medicare Supplement plan before you joined Medicare Advantage, you might be able to get the same policy back if it's still available. If it's not, you can buy another Medicare Supplement plan in your service area.
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If by chance your previous Medicare Supplement plan had drug coverage, you will not be able to keep that one. You will be able to buy a Medicare Drug plan (Part D).
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Some states have additional guaranteed-issue rights.
#4 - How Medicare Supplement plans workThe Basics
Medicare Supplement or (Medigap) Plans are sold by insurance companies like United Healthcare, Aetna, Humana, and about 1,000 other insurance companies. These plans supplement Original Medicare parts A and B in order to fill the gaps. There are several different plans. The three most common are plans F, G, and N. Each insurance company offers coverage that is standardized by the government to offer the exact same benefits. What this means is that if you have plan F it doesn't matter if the coverage is with United Health care or Manhattan Life, because the benefit is the same.
Nationally Accepted
Medicare Supplement plans stay with you when you travel. There is never an "In or Out of network" hassle. Also, you will never need a referral or preauthorization. You can be across the country from where you live and any doctor and/or hospital that accepts Medicare will accept your supplement plan. They don't care if it's provided by a small insurance company that they've never heard of. Your bill will be paid according to the standardized benefits set by the government.
Flexibility
Disregard all the Medicare commercials (noise) telling you that it's Open Enrollment October through December. This applies to the Medicare Advantage plans and doesn't matter if you have a Supplement plan. You are allowed to change your supplement plan to a new or different plan (F, G, N...) anytime you want and any time of year. The catch is this, in most states, you will need to medically qualify to change from one insurance company to the next. If you happen to live in a state that has a Guaranteed Issue (GI), then you can change plans regardless of your health. Be careful mindful that pre-existing conditions can be excluded. In Washington state, insurance companies can deny claims for the first 90 days.
Compare
This cannot be overstated. Just look at page 73 of the 2021 Medicare & You guidebook. It clearly states "It's important to compare Medigap policies since the costs can vary between policies for exactly the same coverage, and may go up as you get older."
Medicare National Standardized Cost Breakdown Most Recent Figures (2019)
This information is produced by the Centers for Medicare & Medicaid Services (CMS) Office of Enterprise Data and Analytics (OEDA) and can be found at CMS.gov. In 2015 the national number of people on Medicare was 33,551,417. The standardized per capita cost was $9,486 and the percentage of eligibility for Medicaid was 20.95%. These figures changed for 2019. Beneficiaries numbered 33,172,265, standardized per capita cost was $10,409, and the percentage eligible for Medicaid was 18.87%.
2015
National
2019
National
