The Definitive Guide to Medicare Supplement Insurance in Florida
If you or a loved one are reaching the age of 65, it is time to start looking into what Medicare is, and how it can assist with healthcare needs and costs. Medicare is a single-payer health insurance program that is offered by the federal government, funded primarily by taxpayer dollars. Medicare is made up of several different programs, some that you will benefit from for free, some that require you to sign up for intentionally and require paying a premium. Because there are many different programs and all feature different advantages, it is helpful to talk through your supplemental Medicare insurance needs with a licensed professional, to ensure that your unique healthcare needs are covered as efficiently as possible. Continue reading for a brief overview of Florida Medicare supplement plans, what does Medicare cover, and how to apply for Medicare.
Overview of Florida Medicare Part A
Florida Medicare Part A is available for no premium and covers services and supplies that have been deemed medically necessary for your particular medical condition or disease. While what is included may vary depending on condition or settings, as a general rule Medicare Part A will cover things like:
-Care from a skilled nursing facility
-Certain conditional Nursing home care (you must need more than just custodial care)
-Home Health Services
If you have chosen to enroll in a Medicare Advantage, or other Medicare supplemental plan, there may be additional services that are covered under your plan, however, there will never be fewer requirements covered. By law, your supplemental insurance coverage must have at minimum, the same coverages afforded to you by an original Medicare plan.
Overview of Florida Medicare Part B
While Medicare Part A covers most things regarding hospital or short/long term stays in a skilled nursing center, Florida Medicare Part B is geared towards medical services, such as the services or supplies necessary for diagnosing and then treating your particular medical condition, and preventative services measures, which is any medical procedure that works to prevent a illness (like receiving a flu shot to guard against the flu) or check ups designed to watch for diseases or illnesses that benefit from early detection and treatment. If you are attending a physician’s office that accepts Medicare Part B, you will not be required to pay for any preventative services rendered.
Medicare Part B covers things such as:
-Durable medical equipment
-Mental health, whether inpatient, outpatient, or partial hospitalization
-Second opinions, should you desire one before a surgery
-Some approved prescription drugs
As with Part A, should you choose a supplemental Medicare plan, the plan is required legally to cover at bare minimum the items listed above. Many will offer more, or better services, but will never offer less.
Overview of Florida Medicare Part D
Florida Medicare Part D is also known as Medicare Prescription Drug Coverage. Because Part B only covers a handful of medications, individuals often find that purchasing Part D coverage is necessary for keeping their prescription drug costs reasonable. Each Medicare Part D plan will have a list of the drugs covered, which is known as a formulary. Within the formulary often exist differing “tiers,” and depending on where drugs fall on this tier, one can determine the price of the medication.
For example, if your prescription medication is found on a low tier, it will cost you less than would a similar drug that is located on a higher tier. To avoid high drug cost, it is helpful to work with your doctor to determine if alternatives are available for high tier medications. If this is not possible, there are times when plans will allow for an exemption and grant a lower copay for the drug in question.
Unfortunately, a Medicare Part D plan is allowed to alter its formula during the course of a year (within certain guidelines set by Medicare). If the drug that you are currently prescribed is affected by these chances, your plan is required to do one of the following:
-60 days before any change becomes effective, your plan must send out a written notice alerting you to the change.
-When you make a request for a refill, the plan must not only provide a written notice but allow for a 60-day supply of your medication under the same rules that you signed up under.
Lists are available on plan web sites to ensure that the plan you choose covers your prescription medications.
Medicare Supplement Insurance
Medicare Supplement Insurance, sometimes referred to as a Medigap policy, are those sold by a private insurance company. These are used to help offset some of an individual’s health care expenditures that are not otherwise covered by Medicare. This can include copays, coinsurance, and any deductibles.
Additionally, some Medigap plans will carry coverage for expenses or services that traditional Medicare does not offer. This may include things like coverage for any medical expenses that you obtain when you are traveling outside of the United States. When you are covered by both traditional Medicare, and also a Medicare Supplemental plan, Medicare will first pay on any approved expenses, and then, the supplemental insurance will swoop in and pay what it covers.
Medicare Supplement plans are often confused with Medicare Advantage Plans. However, while an Advantage plan is used to obtain Medicare benefits, Supplement plans only provide additional coverage for the same benefits as your Medicare plan.
There are nine important things to understand about Medicare Supplements in Florida:
1 – To have a supplemental plan, you have to already have Part A and Part B
2- If you are enrolled in a Medicare Advantage Plan, it is possible to switch to a Supplement plan. However, you need to be sure you can end the Advantage plan before a Supplement policy begins.
3- You will be paying a monthly premium to a private insurance provider for your supplemental insurance, in addition to what you pay Medicare for your Part B premium.
4- Supplemental plans will only cover one person. If an individual and his spouse would both like a supplemental insurance plan, they must both individually purchase a plan.
5- As long as an insurance company in your state is licensed to sell a supplemental plan, you may buy from them.
6- Supplemental plans are guaranteed renewable, which ensures that even if you have new health problems, as long as you are making your payments you can keep your plan.
7- Supplemental plans do not cover prescription medications. To receive prescription coverage, you must purchase Medicare Part D.
8- If you have a Medicare Medical Savings account, it is illegal for someone to sell a Medigap policy to you.
9- Supplemental policies do not cover everything. For example, they do not usually cover any long term care, vision, dental, hearing aids, private nursing or eyeglasses.
Florida Medicare Advantage Plans
Should you choose to purchase a Medicare Advantage Plan, all services that would be provided with a traditional Medicare coverage will be covered, but often with additional services.
Medicare pays out a fixed amount of money each month to insurance companies that provide your Medicare Advantage plans. This helps offset the cost but also ensures that the companies adhere to Medicare regulations. That being said, companies providing Advantage Plans are allowed to charge different costs for out-of-pocket expenses. They are also able to determine their own rules for service, such as:
-Plans determine whether or not a referral or pre-approval is necessary for a specialist
-Whether or not doctors or facilities are within network
Any rules are subject to annual change.
Florida Medicare enrollment charges for Medicare Advantage Plans depend on many individual factors. Your insurance professional will be able to walk you through what does Medicare cover, and how much it will cost.
As opposed to a Medicare Supplemental Insurance plan, Advantage plans often include prescription drug coverage. If your Advantage plan does not offer prescription coverage, you can join other Part D plans should your plan:
-Be unable to offer any drug coverage
-Has chosen to not provide drug coverage
Who is eligible for supplemental Medicare insurance, and how does one apply?
Those who are eligible for a Medicare supplemental insurance plan are most simply put, any who qualify for a traditional Medicare plan. This includes anyone who is over the age of 65, is a valid United States citizen, and who have paid into the Medicare system via their payroll taxes. Those who did not hold a job, and therefore did not pay into the system will still be able to receive Medicare, as long as they are/were married and their spouse paid into the system. Those in this category are eligible for both plans A and B, and will not be required to pay a premium for their Part A enrollment. Everyone must pay a premium for Part B, as well as their supplemental insurance plan, should they choose to purchase one.
If you are not in the previous category, there are still ways to be eligible for Medicare. However, a monthly premium may be required for coverage. This includes any individual who is over the age of 65, who did not themselves pay into the system, nor did a spouse. Certain individuals who are under 65 may also be eligible, such as those who have been diagnosed with an End Stage Renal Disease and those with Lou Gehrig’s Disease. Individuals with either of these diseases become Medicare eligible at the moment of diagnosis.
Should you have decided to look into a Medicare supplemental insurance, the best time to enroll is during what is called “open enrollment.” This is a period of 6 months, beginning with the month in which you will turn 65, and following your enrollment in Medicare Part B. During this period, any plan available in your area will be available for purchase, regardless of whether or not you have health problems. Should you choose to wait until after this open enrollment period, you may not be able to purchase a supplemental plan, and if you are able, it may end up costing you significantly more.
There are allowances in place for special events in your life that may require you to make chances to your supplemental insurance. These times are known as Special Enrollment Periods and can include situations such as an out of state move or a loss of other insurance. Each Special Enrollment reason follows a different set of rules, so it is important to thoroughly discuss your needs with an insurance professional. A professional will also be able to adequately answer questions such as how much does Medicare cost.
Why should you use our agency for your Florida Medicare enrollment needs?
Our company is independently owned and operated. This distinction allows our company the ability to put you and your particular Medicare requirements and financial limitations before the needs of an individual Medicare Supplement provider. By communicating with several insurance providers, we work to ensure that the plan you end up with is the one that is a perfect fit for you.
Not only do the benefits covered by Florida Medicare Advantage plans vary from company to company, but pricing does as well. Allowing us to present your needs to the many companies who provide Florida Medicare Advantage plans can save you significant amounts of time and money.
Navigating plans, determining what do Medicare supplement plans cover, and breaking down Medicare costs can not only be time-consuming, but confusing. Our professional team is well versed in Medicare requirements, and can quickly help you narrow down what is truly necessary for helping you financially and legally manage your health care insurance needs. Additionally, answers to how much does Medicare cost are not always straightforward and need to be carefully considered.
If you have further questions regarding Florida Medicare supplement plans, have further concerns about what do Medicare supplement plans cover, are unsure how to apply for Medicare, or are ready to receive a quote, please feel free to contact us at our office or request a free quote via our website today.