We will help you choose the right Medicare Advantage, Medicare Supplement and Part D prescription drug plans to meet your health needs. Our Advisors have helped thousands of people across Wisconsin & Minnesota choose from top rated Medicare Insurance Plans.
Medicare Supplement plans do not require referrals and provide freedom to see any provider that accepts Medicare, but will require separate Prescription Drug plans, and they only have a one-time Medicare Supplement Open Enrollment without underwriting requirements.
Medicare Advantage plans have network restrictions, usually include drug coverage and additional benefits (i.e., dental, vision, hearing etc.), all Medicare Advantage plans have a maximum out-of-pocket limit.
Medicare Part A and Part B are supported by Medicare Supplement (also known as Medigap) plans. This indicates that the Medicare Supplement insurance pays after Medicare has covered its portion of the medical bill. With a Medigap plan, you must continue to be a beneficiary of Original Medicare, and the remainder of your medical expenses are sent to the supplemental insurance carrier by Medicare. The supplemental insurance carrier then pays its portion of the medical bill.
Except in the event you need emergency care, Medicare Advantage Plans require you to use their provider network. When you utilize the plan’s services, you’ll have to make copayments for your medical care. These plans are an alternative to Original Medicare.
Medicare supplement plans are also known as Medigap plans. When you have a supplement policy, you are still enrolled in Original Medicare and Medicare is your primary payor.
You are entitled to visit any Medicare-eligible practitioner. Unlike Medicare Advantage plans, there is no requirement to select a primary care physician. There is no referral needed to see any Medicare providers nationwide. Your Medicare Supplement plan will provide the same coverage as Medicare for doctor visits, specialist visits, office visits, surgeries, medical treatments, and exams.
When you have a Medicare Supplement plan, Medicare pays their portion of the bill first and then sends the remainder of the bill to your Medicare Supplement plan automatically.
Medicare Supplement insurance policies also offer you the most freedom of access to providers. You have the freedom to choose your own doctors and hospitals from among the 1 million Medicare providers in the country. Patients do not need referrals to see specialists on this type of coverage.
Medicare Supplement plans allow you to see any doctor in the US that accepts Medicare. They offer the most freedom and flexibility, which is why the premiums are higher than Medicare Advantage plans.
Rates will depend on the Medicare Supplement plan chosen and whether that individual is a tobacco user. Plans and rates also vary by State, age, and sometimes gender. We will check to see which carriers offer household discounts that might give you the opportunity to reduce your monthly premiums.
Some Medigap plans provide foreign travel emergency coverage/riders for coverage outside of the US. Insurance companies will cover 80% of the cost for emergency services after the enrollee pays the $250 deductible.
Medicare Supplement plans cover medications administered in a hospital setting, such as chemotherapy drugs, infusions or other injectables. They do not cover medications prescribed at the pharmacy, so beneficiaries usually enroll in a separate Medicare Part D plan to cover their prescriptions. If you do not enroll in a Part D plan and do not have creditable coverage, you will be subject to a late enrollment penalty when enroll in the future.
If you choose to enroll in a Medicare Supplement plan during your one-time enrollment window (within 6 months of your Part B effective date), there are no health questions or underwriting. The insurance company will approve your application, the majority of Medigap enrollees choose to enroll during this window.
There are no waiting periods or pre-existing condition exclusions when you apply during this 6- month period. If you apply at a future date, then you will usually be required to go through medical underwriting. The insurance company can accept or decline you based on medical history.
In the US, around 46% of beneficiaries enroll in a Medicare Advantage plan. The premiums for Medicare Advantage plans are typically lower than those for Medicare Supplement plans, and many times there are $0 premium plans available. There are different types of Medicare Advantage plans such as HMO, PPO, PFFS (private-fee-for-service), Chronic Plans (must have certain qualifying health conditions for example I.E diabetes) and Dual Special Needs Plans (Dual SNP plans require that you have Medicaid to be eligible).
When a plan has a $0 premium, it means that you will not have to pay additional monthly premiums. You still must pay for Medicare Part B premiums every month. Eligibility for a Medicare Advantage Plan will require that you have both Medicare Part A and Medicare Part B to stay in the plan. Most Medicare Advantage plans already have Part D prescription drugs included.
With Medicare Advantage plans we must verify your doctors are in the plan’s network and the medical facilities you use.
Advantage plans will require you to pay copays for the services obtained from providers in the plan’s network. Certain services provided by Medicare Advantage plans will require prior authorization.
One big mistake people make is assuming that all their medications are covered by every plan. Each Medicare Insurance Plan that offers prescription drug coverage has a drug formulary. Before choosing a plan, we need to make sure your prescriptions are covered.
Medicare Advantage plans have a maximum out-of-pocket in order to protect you financially, this will limit your cost during the year.
Many people are relatively healthy when they first enroll in Medicare, so they opt for the lowest cost Medicare Advantage plan with the mindset that when their health declines they can then simply sign up for a Medicare Supplement policy.
If you are outside the enrollment window, you will be subject to medical underwriting and the insurance underwriter has the right to deny your application for the Medicare supplement policy. Certain health conditions and even certain medications can cause the underwriter to deny you. There are certain circumstances and exceptions to this.
There is a trial period if you try Medicare Advantage for the first time you are eligible for Medicare. If you feel the Medicare Advantage plan is not for you and you decide to dis-enroll within the first 12 months of your Medicare Advantage coverage, then you may select a Medicare Supplement plan with no underwriting. After this 12-month period is over, then you are subject to underwriting.
Wisconsin and Minnesota offer an exception for those who are under 65 who are eligible for Medicare due to a disability. The insurance companies must offer Medicare Supplement plans to those who qualify due to certain disabilities. An individual who is already enrolled in Medicare when they turn 65 will have the option to select a Medicare Supplement plan during their Initial Election Period 2 (IEP 2) without having to undergo underwriting.
Anyone on Medicare can enroll in a Medicare Advantage plan without being subject to underwriting.
Still debating what plan is right for you? It is critical to get help with analyzing the cost and benefits of each type of plan in relation to your heath needs and finances.
AmeriChoice Group has worked with thousands of people across Wisconsin & Minnesota to help them select the right Medicare Health Insurance coverage, making the process painless and stress free! We will check doctor and provider networks for you, make sure that your prescriptions are covered by the plan’s drug formulary, and save you hours of research. Our advisors can help you weigh the pros and cons of various plans, so you do not select a plan that is not a good fit.