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How to compare Medicare supplements

It is important for Medicare insurance agents as well as Medicare enrollees to understand how to compare Medicare supplements.  Medicare supplements (Medigap) insurance provides coverage to fill the gaps after Original Medicare pays its share of covered medical expenses.

Medicare supplement plans are standardized

Because CMS standardizes all Medicare supplement plans, they must provide the same benefits.  It does not matter which company offers the plan or what state you live in. In many states, beneficiaries have a choice of ten different plan choices.  The plans are named by the letters: A, B, C, D, F, G, K, L, M & N. Please note, plans with the same letter name only differ by price.  Insurance companies decide the pricing of their plans based on letter name and coverage area.

Comparing Medicare supplement plans

Before a Medicare beneficiary signs up for a Medicare supplement plan, it is important to consider your health care needs and your budget.  When possible, future healthcare needs as well.  Choosing the right plan can save you money as well as provide peace of mind.

Because the cost for plans varies so greatly, it is a good idea to work with a licensed Medicare agent who has access to the most competitive plans in your area.  Licensed agents can provide a cost comparison and go over coverage details that you may not consider.

Find out the value of using a Medicare agent

Although friends and relatives are often a great help with many things, please remember, each individual has their own health care needs.  What works for one person may not be good for another.

Consider the customer satisfaction record of each carrier

Additionally, in some instances, it may be worth a few extra dollars to have peace of mind and feel confident with your choice of insurance carriers.

Because health care coverage is such an important decision, beneficiaries need to consider all their needs and the options available.

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Medicare enrollment periods

In order for agents to sell Medicare plans, one of the first things they need to understand are the Medicare enrollment periods.  There are many different enrollment periods available to beneficiaries. Each one depends on their personal circumstances.

If a beneficiary already receives Social Security benefits, they will automatically be enrolled in Original Medicare.  In other words, they do not need to sing themselves up for Medicare Part A or Part B.  Beneficiaries who do not qualify for automatic enrollment should enroll during the Initial enrollment period.

There are three enrollment periods available for Original Medicare

1. The first and most commonly used is the IEP or initial enrollment period.
2. Second is the AEP or annual enrollment period which can be used for a number of different reasons.
3. Third is the GEP or general election period that beneficiaries use to enroll in Original Medicare if they missed their IEP for some reason.

Medicare IEP (Initial Enrollment Period)

The Medicare IEP (Initial Enrollment Period) is a seven-month window available to beneficiaries to enroll in Medicare Part A & Part B.  The IEP is based on either your 65th birthday or once a qualified beneficiary receives their 24th Social Security disability payment. This enrollment period starts 3 months before the qualifying event and continues through the month of the event.  The IEP ends 3 months after the month of the qualifying event.  If the beneficiary’s birthday falls on the first of the month, The IEP begins 4 months before the 65th birthday of the beneficiary and ends 2 months after the beneficiary’s birth month.

Coverage for beneficiaries who enroll in the months before their birthday begins the first day of their birth month.  If they enroll either during or after their birth month, coverage begins the first day of the month after they enroll.

During the IEP, beneficiaries can choose to either enroll in both parts of Original Medicare or they may choose to delay enrollment in Part B if they have other credible coverage such as from their own or a spouse’s employment.

Medicare AEP (Annual Enrollment Period)

The AEP starts each year on October 15 and runs until December 7.  AEP is an opportunity for anyone on Medicare to make changes to their Part C or Part D coverage.  Please note: changes made during this enrollment period will go into effect January 1 of the following year.

Click here to learn more about the AEP

Medicare GEP (General Enrollment Period)

If a beneficiary neglects to enroll during their IEP and does not have other credible coverage, they may need to use the GEP to enroll in Medicare.  The GEP starts January 1 and runs through March 31 each year. During the GEP, coverage begins the first day of the month after you enroll.  Beneficiaries who enroll during the GEP may have to pay a late enrollment penalty depending how long they have gone without credible coverage.

Other Enrollment Periods

There are still more enrollment periods available.  There are the Medicare Advantage Open Enrollment Period as well as the Medicare Supplement Open Enrollment Period. Each if these enrollment periods apply to the specified type of coverage.  Although some individuals qualify for one of the many SEPs (Special Enrollment Periods).

Medicare Supplement Open Enrollment Period

The Medicare Supplement Open Enrollment Period starts the day their Medicare Part B is effective and runs for 6 months. This enrollment period gives beneficiaries guaranteed issue right to enroll in any Medigap plan available to them. Several supplement carriers let beneficiaries apply for a plan up to 6 months before their Part B start date.  The supplement will not start until the day Part B benefits are in place.  If the beneficiary misses their Medicare supplement open enrollment period, they can apply for a Medicare supplement plan any time of year.  Keep in mind, they may have to go through underwriting and can be denied coverage.

Medicare Advantage Open Enrollment Period

When a beneficiary first enrolls in Medicare Part A and Part B during their IEP, they are eligible to enroll in a Medicare Advantage plan.  If they do not choose to enroll at that time, they have to wait until the AEP (Annual Enrollment Period) unless they have an SEP available to them.

There is a specific Medicare Advantage Open Enrollment Period available to those who are already enrolled in a Medicare Advantage change their coverage.  This enrollment period runs from January 1 through March 31 each year.

To learn more about the Medicare Advantage OEP, click here

Special Enrollment Periods for Medicare

The most difficult to understand enrollment period may be the Special Enrollment Period. This enrollment period can apply to several different circumstances and does not apply to all Medicare beneficiaries. SEPs may require the beneficiary to provide proof of eligibility.

The most common reason for enrolling during an SEP is loss of employer coverage due to the fact that many benficiares choose not to enroll in Medicare PArt B because they have employer coverage.

Find out the rules for SEPs

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Medicare costs 2024

Both agents and beneficiaries need to know what the Medicare costs 2024 are in order to accurately plan for the year ahead.  The CMS announced the 2024 Medicare Part A and Part B premiums, deductibles and coinsurance amounts on Oct 12, 2023.  As you will see, the premium for Part B is higher than last year and so is the deductible.  Although the Part A premium has not increased.

Almost all Medicare beneficiaries (over 99%) receive Medicare Part A premium-free.  A very small number of Medicare beneficiaries (fewer then 1%) must pay their Part A premium.  This is due to the fact that they have not worked for a minimum of 40 quarters in a job that qualifies as Medicare-covered employment.

Medicare enrollees who paid their Medicare taxes fewer than 30 quarters must pay $505 per month for their Part A premium in 2024.  This amount is less than the 2023 premium of $506 per month.  As you can see, this premium has gone down by $1. Medicare beneficiaries who have either paid Medicare taxes for at least 30 quarters or were married to someone who have worked for at least 30 quarters and paid their Medicare taxes will pay $278 for their Part A premium per month in 2024.  This is the same cost as it was in 2023.

The deductible for an inpatient hospital stays (Medicare Part A in 2024, will be $1,632.  In 2023 the inpatient hospital deductible was $1,600.  This is an increase of $32 for 2024.  The benefit period for each hospital stay ends 60 days after your release from care.

Medicare costs 2024 – Part B

Starting in January of 2024, the premium for Medicare Part B will be $174.70.  This is up $9.80 from the 2023 cost of $164.90. The Medicare Part B deductible is also due to increase by $14 to $240 in 2024 from $226 in 2023. The total increase amounts to $14 over the cost in 2023.

Beneficiaries who have income above a certain level will pay an IRMAA in addition to the standard Part B monthly premium of $174.40.  The chart below shows the income limits, the IRMAA amount as well as the Part B premium in each income bracket.

It is important to remain up to date with any information that directly impacts your clients. Any agent who wants to provide his clients with the best service stays informed and educated so clients know they can trust your advice.  This is why some agents get so many referrals and build a large book of business.

Learn about Medicare Part D changes coming in 2025

Watch a quick video on YouTube about what we offer our agents

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Who Needs Medicare Supplemental Insurance

One of the most common questions you will have to answer from your clients will be, “why do I need supplemental insurance?” This is a good question, and will allow you to explain exactly why supplemental insurance and/or Medicare Advantage plans make financial sense for many seniors.   Seniors have the option of adding Medicare Supplement or Medicare Advantage plans to fill the coverage gaps.

Medicare Part A and B cover many of the typical medical expenses of senior citizens. Some of these include visits to primary care doctors or specialists, laboratory tests, or hospitalization. These original parts of Medicare also cover stays in skilled nursing facilities, surgical procedures, and outpatient procedures.

However, Parts A and B do not cover all of a typical senior citizen’s expenses. For example, despite the near ubiquitous use of hearing aids in old age, Medicare does not cover hearing care, hearing exams, or hearing aids. Also not covered are dental care, dentures, vision care, routine foot care, or long-term care. Additionally, prescription drugs, for the most part, are not covered under the original Medicare but by Part D, which has to be purchased separately as supplemental insurance.

Therefore, if a senior citizen knows or anticipates that they will need any of the typical healthcare used by their demographic, such as hearing aids, glasses, dentures, or prescription medication, they would benefit from purchasing a supplemental insurance plan.

This video will help you determine whether a Medicare Supplement or Advantage plan best suits the needs of your client.   Click here to view. 

Already a licensed health insurance agent appointed to sell Medicare?   Learn what we offer our agents.

Interested in marketing Medicare Supplements and Advantage plans?   Click here to learn how to get started.

Signing up for Medicare A and B

We want to give you some help when you are Signing up for Medicare A and B.  This can be a stressful time for some people with all the mail and calls they receive.

• Medicare A and B will begin the first of the month someone turns 65 years old.
• If you receive social security payments for at least 4 months before the month you turn 65, you will get Medicare A and B automatically.  Those not receiving payments will need to sign up for A and B online or at the local social security office.
  • If you have not been receiving Social Security payments for the 4 months before you turn 65, you will need to sign up for both A and B.  You will not get it automatically.
  • Here is the link for those that need to sign up  CLICK HERE TO SIGN UP FOR MEDICARE ONLINE  The online enrollment is simple and only takes about 15 to 20 minutes
  • Please Note:  If you are past the age of 65 and want to sign up for Medicare part B, it cannot be done online.  You must go to the local social security office to sign up.  We suggest that you call the office first to make an appointment.

• Signing up for Medicare A and B – Medicare billing for part B

  • If you are already receiving Social Security payments, the part B premium will be deducted from your SS payments.
  • If you currently do not not receive Social Security payments, you will be billed quarterly for part B.  Medicare will allow you to pay the premium automatically if you fill out a form to set it up.

Signing up for Medicare A and B – Who should enroll in Medicare Part B

• If someone is working and receiving health benefits through work or if they receive health benefits through a working spouse, they do not need to sign up for part B of Medicare. (Assuming they will continue to get work benefits)
• If either they or the spouse they get benefits through stops actively working, they need to sign up for Medicare Part B.  Note: Those with groups of less than 20 employees may need to sign up for part B when they turn 65 regardless of work status.
  • Retiring is a special election for Medicare Part B.  You will need to take a completed Employment verification form to the Social Security office to sign up for B.  The effective date will be the first of the month after you retire.
  • If you are still actively working but no longer receive coverage, that is also considered a special election to sign up for Medicare Part B.
  • You have an 8 month window to sign up for Part B.  The 8 months start from the date you either retire or lose coverage
  • If you fail to sign up for part B under either of the scenarios above, it will result in a  Part B penalty  The penalty is 10% of part B premium for every 12 months you did not have part B. If you delayed part B enrollment and missed your special election period, you should sign up during the Medicare Part B general enrollment period.  The general enrollment is  from Jan 1 through March 31  to sign up for a July 1 start date. Those that miss the general enrollment will need to wait for the next general enrollment to sign up unless they qualify for a special election period,
• click here for employment verification form.

• According to Medicare, someone employed by a group with less than 20 employees needs to sign up for both Medicare A and B at age 65.  This is true even if you have health coverage from work and are still working.  In reality, I have had a number of people who work in groups less than 20 delay part B.  Those people have not paid a penalty when they enrolled in B later down the road.  They also did not have any issue with the special election to enroll in B.  Regardless, the Medicare rule says they should enroll when turning 65.  It is up to you how you choose to proceed in this situation.

• Those with Medicare A and/or B are advised not to contribute to an HSA account. If you are selected for an audit, you may be receive a penalty.  This means your contributions are included in your taxable income. You will also pay a 10% penalty on the contribution.

If you want to get a quote for Medicare Advantage or Supplement plans, click here.

Medicare Employer Information Form

Medicare Part A Coverage –

Are you working and Medicare eligible with insurance either through your own or your spouse’s employer?  If this is the case, you should consider taking Medicare Part A (hospital Insurance).  In most instances, there is no cost to you for the extra coverage Part A provides.  We have included a link at the bottom of the page with the Medicare Employer Information Form.  This form helps both you and your employer start your Medicare Part A coverage.

Should you take Medicare Part B coverage?

Before you sign up for Part B coverage there a few things you need to be aware of.  First of all, Part B is medical insurance, this coverage is not free and you will be charged a monthly premium.  You also need to know; when you are Medicare eligible your employer insurance may change to some extent. Check with your human resources department or benefit coordinator so they can explain any changes in coverage or concerns you have. You will also need to double check insurance information with the Social Security Administration and Medicare.

Health insurance is very important to us all.  You don’t want to make mistakes with your healthcare coverage, as that could be costly.  Each person has different needs, therefore it is entirely up to you to decide what coverage is best for you.  You also have to decide if the costs will be reasonable with regard to your coverage needs.

Primary and Secondary Insurance –

In fact, if you have primary insurance coverage with your employer, most likely you do not need Part B. If you are not satisfied with the coverage your employer provides, you may want to think about Part B coverage.  If you choose to add Medicare Part B to your employer insurance you need to find out which insurance will be primary and which one secondary.  Primary insurers will pay your approved medical claims first.

Secondary insurance will normally pay the part of your expenses left over after the primary has paid.  The amount secondary insurers pay can be either all or some of the unpaid balance. This amount may be the remaining 20% of the doctors fee after primary has paid.  If you are not enrolled in a primary insurance plan, but only a secondary plan, you will have little to no coverage.  When employer insurance becomes secondary you may be better off if you take Medicare both Parts A and B.

Enrollment Period

Medicare offers a Special Enrollment Period without penalty when you first qualify for coverage.  You may enroll in Medicare, without penalty, at any time while you have group health coverage. This enrollment period is also good for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first.

Sometimes your employee coverage will automatically move into a Medicare Advantage Plan (private health plan).  If you have health coverage from either a union, a current or a former employer when you become Medicare eligible.  You can keep the Medicare  Advantage Plan or switch to either Original Medicare or a different Medicare Advantage Plan.  You should know that if you switch plans, Your employer or union could lessen or even terminate your health benefits or the benefits of your dependents.  Discuss any healthcare plan changes you may want with your employer or union to make sure your coverage is safe.

Click the link below for the employer medicare Forms.

Employer Medicare Forms

What is Medicare?

This blog will attempt to answer “what is Medicare?” by  providing a basic understanding of the Medicare program and how it works. In addition, it will detail the other parts of Medicare such as C and D.  First of all lets start with the official definition:   Medicare is the federal health insurance program for people who are 65 or older. It is also for certain younger people with disabilities and with End-Stage Renal Disease.  Most people are eligible for Medicare at age 65.

Medicare is made up of four components which can cause confusion.  Original Medicare (Red, White and Blue care with a Medicare ID on it) is Medical coverage with parts A and B.    This is what provides basic medical coverage for those on the program.   Medicare Part C is different than Original Medicare.   Part C is a Medicare Advantage Plan and is something a member can enroll in if they want.  Medicare Part C replaces Medicare A and B for those that enroll in it.   Another part of Medicare is part D which is prescription drug coverage (Also called a PDP). You can enroll in Medicare part D using a stand alone drug plan or access Medicare part D through the drug benefits on an Advantage plan.

Medicare Part A (Hospital Coverage)

Medicare Part B (Medical Coverage)

Medicare Part C (Medicare Advantage Plans)

Medicare Part D (prescription drug coverage)

Medicare Eligibility

Medicare Eligibility is available to anyone turning 65, disabled prior to the age of 65 or with ESRD.  People turning age 65 need to have 40 quarters of working credits or have a spouse with 40 quarters. You must also be a U.S resident or be legally in the U.S. for 5 concecutive years.  The CMS website has a lot of very detailed information on this topic.   Click for CMS details on Medicare A and B enrollment

Steps for Medicare eligible people

Currently enrolled in Medicare: Click here to check your enrollment 

Medicare Eligibility: Other Resources

Sign up for Medicare after age 65 ( Medicare general enrollment period)

Medicare Part D Rx income penalty

Medicare A and B Benefits

Medicare A and B Benefits become available to most people when they turn 65.   Other people become eligible due to a state disability after 2 years.   Most people are automatically enrolled in Part A and pay no premium for it.  In fact, the majority of people (if they are drawing social security payments) are enrolled in part B.  In most cases, there is a cost of 104.90 a month for each person who is enrolled.  Some people pay more for part B, this amount is based on their income.  In some instances if you qualify for assistance, there will be a lower cost to no cost for Part B coverage.  This is also based on your income level.    You must apply through your state for this assistance in order to qualify for it. Read more

We receive a lot of questions about original Medicare, Medicare Supplement, Medicare Advantage and Medicare part D plans.  A Q and A of the more common questions has been provided below.

Question:  When does my original Medicare A and B plan start?

Answer: Generally, Medicare A and B starts the first of the month you turn 65.  It never starts on the day you turn 65 unless your birth day happens to be on the 1st.  Example:  Bob is 65 on July 18th 2013.  His Medicare A and B will start on July 1, 2013

Question:  Do I need to sign up for Medicare A and B

Answer:  If you are currently taking Social Security payments, you will automatically be enrolled in Medicare A and B.  If you are not taking Social Security payments, you need to call the social security office and sign up for part B of Medicare or enroll online.

Question: How will I be billed for Medicare?

Answer: If you have elected Social Security payments, the part B premium will be taken out of your check automatically.  If you have not elected Social Security, you will be billed quarterly.

Question: How much is Medicare A and B?

Answer:  Part A cost nothing if you or a spouse worked at least 40 quarters (10 years) and contributed toward payroll taxes.  Part B cost $104 per person (will go up in 2014) and increases for those earning higher incomes.

Question: Do I have to enroll in Part B?

Answer: No, you do not need to enroll in part B of Medicare but you will pay a 10% penalty for every year you are eligible and do not enroll.  The exception to this is if you are actively working  and receiving health benefits through your employer.

Question: Do I need part B if my employer gives me retiree benefits?

Answer:  Its a trick question.  If you are retired and getting retiree benefits, you do not have to enroll in part B BUT, you will still have a penalty if you need to enroll in part B down the road. (for example: The employer drops your retiree coverage)  The only valid waiver to the penalty is if you are getting benefits and are actively working.

Question: Does Medicare A and B give me drug coverage?

Answer:  No, Medicare A and B is for medical only.  Drug coverage needs to be purchased through a Part D plan offered by a private insurance company.

Question: What levels of coverage do Medicare A and B provide?

Answer: Generally speaking, Medicare Part A provides hospital coverage and Medicare Part B provides coverage for physicians, testing and other outpatient care.  For a full summary click the link MEDICARE A AND B BENEFITS

Question: How do people cover the things that Original Medicare does not cover?

Answer: They can purchase a Medicare Supplement plan (Also called Medigap) and a part D rx plan or they can purchase a Medicare Advantage plan (MAPD plan). Some people stay on A and B only and simply purchase a stand along Rx plan. (More often they take a supplement or MAPD plan however)

Review our MEDICARE FOR DUMMIES blog for additional information