An Essential Guide for Medicare Supplement Plans

by | Jan 30, 2025 | Medicare Supplement, Rules & Enrollment

As your dedicated team at Emerald Medicare, we understand that navigating the Medicare enrollment process can be overwhelming. That’s why we’re here to provide clarity on one of the most valuable options available to Medicare beneficiaries: Medicare Supplement Insurance, also known as Medigap. This comprehensive guide will walk you through what Medigap plans are, how they work, and how they can benefit you by filling the gaps left by Original Medicare.

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What are Medicare Supplement (Medigap) Plans?
A Comprehensive Guide

A Medigap plan (Plan G, Plan N, etc.) is private health insurance designed to work alongside Original Medicare (Parts A & B).

While Original Medicare provides broad coverage, it doesn’t cover everything. For example, beneficiaries are still responsible for certain deductibles, co-pays, coinsurance, and out-of-pocket costs. Medigap plans help cover these “gaps” in Medicare, providing financial protection and peace of mind.

Here’s how it works:

  • Original Medicare pays for its share of covered healthcare services (typically 80% of approved costs).
  • Medigap plans help pay for the remaining out-of-pocket costs, like the 20% co-insurance on doctor visits or hospital stays.

What Do Medigap Plans Cover?

Medigap plans can help pay for various out-of-pocket expenses that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may cover:

  • Medicare Part A coinsurance and hospital costs
  • Medicare Part B coinsurance or copayments
  • The first three pints of blood used in a medical procedure
  • Part A hospice care coinsurance or copayments
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible (for some older plans)
  • Part B excess charges
  • Foreign travel emergency coverage (up to plan limits)

Each Medigap plan is standardized, meaning that the benefits for each plan type are the same no matter which insurance company offers the plan. For example, Medigap Plan G from one insurance company will offer the same benefits as Medigap Plan G from another. However, premiums can vary based on things like your home state, income, and more, so it’s essential to compare offerings or work with a Medicare broker, like our team at Emerald Medicare, to find the best plan for your needs and budget.

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Why Should I Choose a Medigap Plan?

Medigap plans, as opposed to Medicare Advantage (Part C) plans, are particularly beneficial for individuals who:

  • Want predictable healthcare costs: If you want to avoid unexpected out-of-pocket expenses, a Medigap plan can provide peace of mind by covering those costs.
  • Travel frequently: Some Medigap plans offer coverage for medical care when traveling outside the U.S. (a benefit not offered by Original Medicare).
  • Need frequent medical care: If you visit doctors or specialists regularly or require frequent hospital stays, Medigap plans can help reduce the financial burden of these services.
  • Prefer flexibility in healthcare providers: Unlike Medicare Advantage plans, Medigap plans don’t have network restrictions. You can see any doctor or specialist nationwide who accepts Medicare.

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Medigap vs. Medicare Advantage: What’s the Difference?

It’s essential to understand that Medigap and Medicare Advantage plans are different, and you cannot have both – only one or the other.

  • Medigap works with Original Medicare (Parts A and B) to cover out-of-pocket medical costs, like co-insurance and/or certain deductibles. However, as prescription medications are not covered by Medigap plans, you are also required to enroll in a Part D plan (Prescription Drug Plan) when enrolling in a Supplemental plan. In tandem, A Medigap plan + a Prescription Drug Plan is a highly comprehensive option for a higher monthly premium – with less restrictions than Medicare Advantage. Any doctor’s office in America will accept your Medigap insurance as long as their office accepts Medicare.
  • Medicare Advantage (Part C) is an alternative to Medicare Supplement + Part D coverage that combines hospital, medical, and drug coverage into one all-encompassing plan, often including additional benefits like dental or vision. However, Medicare Advantage plans all have their own unique network of ‘preferred’ medical providers that beneficiaries are limited to, meaning the patient will be 100% financially responsible for services received from Out-Of-Network doctors. Furthermore, some Medicare Advantage plans provide less comprehensive drug coverage when compared to dedicated Prescription Drug Plans (Part D) and their formularies.

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How to Enroll in a Medigap Plan

You can enroll in a Medigap plan during your Initial Enrollment Period [IEP] – which begins as you approach age 65 – after enrolling in Original Medicare (Parts A & B). This six-month IEP window is critical because during this time, you have guaranteed issue rights, meaning insurance companies can’t deny you coverage or charge higher premiums based on your health status. After this period, you may still be able to apply for a Medigap plan, but insurers can use medical underwriting to determine your eligibility and rates.

How to Choose the Right Medigap Plan

Choosing the right Medigap plan depends on your specific healthcare needs, budget, and lifestyle. Here are a few tips to help you decide:

  1. Assess your current health needs: If you frequently visit doctors or specialists, a Medigap plan that covers Part B copayments and coinsurance can be very beneficial.
  2. Consider your travel habits: If you travel frequently, especially outside the U.S., look for a Medigap plan that includes foreign travel emergency coverage.
  3. Plan for the long term: While some Medigap plans may have higher premiums, they can save you money in the long run by limiting out-of-pocket expenses.
  4. Consult with a Medicare broker: A licensed Medicare broker, like the experts at Emerald Medicare, can help you compare different Medigap options, review costs, and find the plan that best suits your needs.

For advice on choosing a Prescription Drug Plan, read our Blog Post to learn more:  

Blog: How to Choose a Part D Plan

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Explore Medigap Options with Emerald Medicare

At Emerald Medicare, we’re here to help you make informed decisions about your healthcare. Medigap plans can be a great way to secure financial peace of mind while ensuring that you get the care you need. Our team of licensed Medicare experts will guide you through the process, helping you understand your options and choosing a plan that fits your unique needs.

If you’re interested in learning more about Medigap plans or need help finding the right one for you, we’re here to help. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly:

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

Medicare’s Annual Enrollment Period: Key Dates and What You Need to Know

by | Oct 18, 2024 | Medicare's Annual Enrollment Period

Medicare Open Enrollment is one of the most important times of the year for Medicare beneficiaries. It’s your opportunity to review your current healthcare coverage, make changes, or enroll in a new plan to better suit your needs. As your trusted Medicare experts, Emerald Medicare is here to help guide you through the process with objectivity and always with your best interest in mind.

 

What Can You Do During Medicare Open Enrollment?
During AEP, you have several options for updating your Medicare coverage, including:

1. Switching from Original Medicare to Medicare Advantage
If you’re currently enrolled in Original Medicare (Parts A and B) which is only 80% medical coverage and no Part D coverage and may want to explore additional ancillary benefits and look at the option of a Medicare Advantage (Part C and D) plan. Medicare Advantage plans often offer coverage beyond Original Medicare, such as dental, eye exams, hearing, and prescription drug coverage.

2. Switching from Medicare Advantage back to Original Medicare
If your Medicare Advantage plan no longer meets your needs or you prefer the flexibility of Original Medicare, you may be able to switch back to Original Medicare during AEP based on the state you live in and the pre-existing rules for each state. You may also want to consider enrolling in a Medicare Supplement (Medigap) plan to help cover more of the out-of-pocket costs but with a higher premium cost. These plans are offered without some of the ancillary benefits the Medicare Advantage plans offer.

3. Changing Medicare Advantage plans
If you’re already enrolled in a Medicare Advantage plan but are unsatisfied with your coverage, you can review your doctors and medications to consider a change to a different Medicare Advantage plan during AEP that best suits your health and your needs . This is the best time of year to compare plans and ensure you’re getting the best benefits that you need or want at the cost that fits your budget.

4. Enrolling in or changing your Medicare Part D (Prescription Drug Plan)
If you’re not currently enrolled in a Medicare Part D plan and need prescription drug coverage, you can sign up for one during AEP. Also, you can change to a different Part D plan when you are on Original Medicare if your current plan’s formulary, premiums or co-pay costs has changed.

 

Key Dates for Medicare Open Enrollment

  • October 15: Open Enrollment begins. This is your first chance to review your current coverage and make any changes or enroll in new plans for the upcoming year.
  • December 7: Open Enrollment ends. After this date, you won’t be able to make changes to your Medicare coverage unless you qualify for a Special Enrollment Period (SEP). Check with your broker if you have the need to change any of your plan decisions after this date.
  • January 1: Any changes made during Open Enrollment will go into effect on this date.

 

Tips for Making the Most of Medicare Open Enrollment

  1. Review Your Current Coverage
    • Before making any changes, take the time to review your current plan’s coverage for the new year. A Annual Notie of Change is the document that was sent to you with any changes that your plan is offering for the new year. Ask yourself if your needs or budget have changed over the past year. Have you been prescribed new medications or seeing any new doctors? Do you need additional coverage, such as dental or eye exam coverage?
  2. Compare Plans on Medicare.gov
    • One of the best tools for comparing Medicare plans is the Medicare Plan Finder on Medicare.gov. This website allows you to compare costs, coverage, and carrier ratings of different Medicare Advantage, Part D, and Medigap plans. The Emerald Medicare team uses this trusted resource to help our Medicare enrollees find the best options for their healthcare needs.
  3. Consider Your Medications
    • Prescription drug coverage is a critical component of Medicare. If you take medications regularly, it’s important to ensure that your Part D plan’s formulary (the list of covered drugs) still covers your prescriptions at an affordable cost. Make sure to compare different Part D plans to avoid surprises in the new year.
  4. Check Your Providers
    • If you’re considering a Medicare Advantage plan, it’s important to confirm that your preferred doctors, specialists, and facilities are in-network. Provider networks can change from year to year, so always verify that your healthcare team will be covered by the plan you choose.
  5. Look for Changes in Benefits
    • Medicare Advantage plans often update their benefits from year to year. During AEP, review the benefits offered by different plans, such as coverage for dental, vision, hearing, and fitness memberships. Be sure to choose a plan that offers the additional benefits you value most. Review your Annual Notice of Change documentation that you received in the mail. Called a ANOC.
  6. Get Help from a Medicare Broker
    • The Medicare Open Enrollment period can feel overwhelming, but you don’t have to go through it alone. By working with a Medicare broker, you can get expert, personalized advice based on your healthcare needs and budget. At Emerald Medicare, we can walk you through all your options and help you make the best choice for the coming year.

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Stay Prepared for Open Enrollment with Emerald Medicare

The Medicare Annual Enrollment Period is your best chance to review your healthcare coverage and make the changes that will benefit you in the year ahead. By taking the time to compare plans, review your current coverage, and explore new options, you can ensure you have the right plan for your needs.

Need help navigating Medicare Open Enrollment? At Emerald Medicare, we’re here to provide the expert guidance you need to make informed decisions. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly at the number or email below.

 

Contact Us:

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

How To Choose A Part D Plan

by | Oct 1, 2024 | Medicare Supplement, Prescription Drug Coverage

As your go-to team of Medicare experts, we’re here to help you navigate your options with confidence. We understand how crucial it is to have the right prescription drug coverage. Choosing a Medicare Part D plan can be overwhelming with so many options available, but with the right guidance, you can find the best available drug plan that fits your needs and budget each year. In this post, we’ll provide tips on how to select the best Medicare Part D plan based on your individual needs, ensuring that you have access to the medications you require without unnecessary expenses.

What is Medicare Part D?

Medicare Part D is the prescription drug coverage component of Medicare. It helps cover some of the cost of prescription medications, which are not included under Original Medicare (Parts A and B). Part D plans are offered by private insurance companies, whom have been approved by Medicare. These plans are typically combined with a stand-alone Medigap plan, or in some cases, a Medicare Advantage plan. The specifics of each plan—such as the drugs covered, co-pay costs, and pharmacy networks—can vary significantly depending on the plan year, insurance carrier, and more.

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Tips for Choosing the Right Part D Plan

1. Assess Your Prescription Drug Needs

Evaluate Your Medications: Start by making a list of all the prescription medications you currently take, including the dosage and frequency and your preferred pharmacies. This list will be important when comparing different Part D plans, as each plan has its own formulary (the list of covered drugs and costs).

Consider Future Needs: Think about any potential changes in your medication needs since you last made this Medicare decision. If your doctor has mentioned that you might need new medications in the future, choose a plan that includes those medications.

2. Compare Formularies

Check Drug Coverage: Not all Part D plans cover the same medications. With the assistance of a broker or by your own research, review the formularies of each plan to confirm that your current medications are covered and at what cost. Some plans may cover certain drugs at a lower cost than others, which can significantly affect your out-of-pocket expenses throughout the year.

Understand Tiers: Many Part D plans categorize drugs into tiers, with each tier having different costs. Typically, generic drugs are in lower tiers and are more affordable, while brand-name and specialty drugs are in higher tiers and cost more. Knowing what tier your medications fall into on each plan’s formulary is helpful when looking at yearly costs or discussing options with your doctor.

3. Evaluate Costs Beyond Premiums

Look at the Big Picture: Calculate your expected annual costs based on the medications you take and the coverage each plan offers using medicare.gov. If you notice a very expensive drug, look at discount cards such as GoodRx for lower cost options.

4. Review the Pharmacy Network

Check Preferred Pharmacies: Each Part D plan has a network of pharmacies where you can fill your prescriptions. However, some plans offer lower medication costs at partner, “preferred” pharmacies. It’s essential to compare drug prices from multiple pharmacies.

Mail-Order Options: If you prefer the convenience of having your medications delivered, look for a plan that offers a mail-order pharmacy option. This can in many cases save you money but certainly can save you time.

5. Use Medicare.gov for Research

The best way to compare Part D plans is by using a reliable Medicare broker or by accessing Medicare.gov, the official Medicare website. This is the same tool that your Emerald Medicare team utilizes to research and identify the best coverage options for your specific health needs. The website allows you to enter your medications and compare plans based on costs, coverage, tiers, pharmacies, zip code, and more.

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Block Out the Confusion with Emerald Medicare

Choosing the right Medicare Part D plan is a critical step in managing your healthcare costs and ensuring you have access to the medications you need. By carefully considering your medication needs, costs, and pharmacy preferences, and using trusted resources like Medicare.gov, you can make an informed decision on your Part D coverage each year.

As Medicare’s Open Enrollment Period approaches, the Emerald Medicare team is here to help. This will be an especially challenging year for changes occurring with Medicare Part D plans. We’re committed to delivering personalized assistance and finding the best Part D plan options to meet your needs for the current year. Click below to schedule an appointment with one of our expert Medicare advisors through Calendly, or contact us directly at the number / email below.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

Medicare Eligibility & Enrollment

by | Sep 13, 2024 | Original Medicare, Rules & Enrollment

As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.

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Who Qualifies for Medicare?

1. Age-Based Eligibility

The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.

2. Disability-Based Eligibility

If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.

3. End-Stage Renal Disease (ESRD)

Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.

4. Amyotrophic Lateral Sclerosis (ALS)

If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.

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How to Apply for Medicare

1. Automatic Enrollment

Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.

2. Manual Enrollment

If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues. 

3. Initial Enrollment Period (IEP)

The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.

4. Special Enrollment Period (SEP)

If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.

5. General Enrollment Period (GEP)

Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.

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Understanding Medicare Parts A and B

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B. 

An Essential Guide for Medicare Parts A & B

Take Charge of Your Medicare Journey with Emerald Medicare

Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly

What to Expect from Medicare in 2025

by | Sep 5, 2024 | Industry Shifts & Updates

As your go-to team of Medicare experts, we’re committed to keeping you informed about the latest developments and trends that could impact your healthcare decisions. With 2025 on the horizon, there are key changes and trends affecting Medicare that you should be aware of. These shifts are likely to influence everything from your premiums to the cost of your care, to the benefits available under different Medicare plans. Let’s explore what you can expect from Medicare in 2025.


Rising Healthcare Costs and the Impact on Medicare

Healthcare costs to both consumers and insurance carriers continue to be a significant concern in the United States, especially for those aged 65 and older. In fact, 50% of all medical costs in the U.S. are related to prediabetic conditions, insulin care, or medications. Additionally, $1 in $5 of the Gross National Product (GNP) in America is spent on healthcare, highlighting the growing financial burden on the system and its users. With healthcare being the top concern for 63% of people aged 65 and above, making the right Medicare decisions is more crucial than ever (per seniorliving.org).

In 2025, we anticipate further adjustments to all Medicare plans to address these rising health care costs. For instance, the Inflation Reduction Act will impact Medicare Advantage benefits, cost-sharing, and Medigap premium prices, particularly affecting Part D premiums and co-pays. These changes are still being worked out and expected to be finalized by October 2024, so staying informed and connected with your Medicare broker will be essential for all Medicare beneficiaries.

Changes to Medicare Advantage (MA) Plans

As you may know, Medicare Advantage (MA) plans have come under scrutiny for deceptive marketing practices, leading to increased oversight from the Centers for Medicare & Medicaid Services (CMS). In 2025, CMS is expected to introduce new regulations aimed at improving service delivery, reducing marketing abuses, and cutting down on the number of unsolicited calls to consumers. These changes are designed to protect enrollees and ensure they receive the coverage and benefits they deserve without being misled.

One significant trend in MA plans for 2025 is the standardization and simplification of ancillary benefits. Beneficiaries can expect changes to over-the-counter benefits, the exploration of in-home benefits, non-emergency transportation, dental benefit enhancements, and even expanded mental health coverage. Additionally, gym membership benefits may be adjusted to include home-based fitness options, reflecting the growing demand for flexibility in how Americans exercise and stay fit.  

The Prescription Drug Cost Cap and New Payment Plans

Another significant change being rolled out for 2025 is the introduction of a $2,000 limit on prescription drug costs for each individual for the calendar year. This cap will provide much-needed relief to many Medicare beneficiaries who struggle with the high cost of medications. Alongside this, new payment plans for expensive medications will be introduced, making it easier for enrollees to manage their healthcare expenses over time. This development is particularly important given the rising costs of prescription drugs and the growing reliance on medications to manage chronic conditions.

Enhancements in Medicare’s Star Ratings and Family Caregiver Support

Medicare plans are rated based on feedback from real policyholders, which covers areas such as customer service and chronic condition management. In 2025, carriers are likely to focus on improving these star ratings by encouraging enrollees to take full advantage of the benefits offered under their plans. This could lead to more proactive communication and support from your plan provider, ensuring you’re getting the most out of your coverage.

Another important change on the horizon is the introduction of training for family caregivers by medical professionals. CMS recognizes the vital role that family caregivers play in the healthcare system and is planning to offer more resources to help them manage their important role in support of their loved ones.

The Role of Artificial Intelligence (AI) in Medicare

Artificial Intelligence (AI) is set to revolutionize healthcare and Medicare services in 2025. AI will enhance efficiency in various tasks, such as Part D reviews, marketing, and virtual assistance. These advancements are expected to streamline some of the administrative aspects of Medicare, making it easier for beneficiaries to find answers to their individual questions about their plans and their medications.

Special Programs and Benefits for Dual-Eligible Individuals

For individuals who are eligible for both Medicare and Medicaid, Dual-Eligible Special Needs Plans (DSNPs) will continue to offer a range of additional benefits in 2025. These plans include support for utilities assistance, extra transportation, healthy foods and wellness items, hearing aids, pet supplies, a personal care team, and more. As these benefits expand, DSNPs will become an increasingly attractive option for those who qualify.

Prepare for the Near Future with Emerald Medicare

As we look ahead to 2025, it’s clear that the landscape of Medicare is evolving in ways that will impact beneficiaries across the board. From changes in healthcare costs and prescription drug coverage to advancements in AI and enhanced support for caregivers, staying informed will be key to making the right decisions.

At Emerald Medicare, we’re here to help you navigate these changes with confidence. Our team of experts is focused on providing you with the education and guidance you need to make the best choices for your healthcare. 

 

Click below to schedule an appointment with one of our Medicare Experts.

Mark Brownstein, CSA® | Calendly
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