MedicareFAQ

Are Medicare Advantage plans bad? If you've heard that they are, don't go anywhere. We're going to unbox the truth about Medicare Advantage plans.

Intro (0:19)
How Medicare Advantage Carriers Afford Low Premiums (1:26)
Giveback Benefit (2:53)
How Provider Networks Work With Medicare Advantage (3:59)
Prior Authorization (4:44)
Maximum Out-Of-Pocket Limit (5:19)
Annual Changes (6:24)

You've probably seen a few commercials for Medicare Advantage plans, especially during the fall Annual Enrollment Period. They usually start by asking if you're happy with your Medicare benefits, telling you Advantage has many more benefits. Some even throw a jab at Medicare Supplement plans, which come with monthly premiums. Others say there's no premium with an Advantage plan and that they could even return $140 or more to your Social Security check.

When something sounds too good to be true, that's usually the case. However, the issue is less with the plans and more with the advertisements. The commercials can be extremely misleading and create misconceptions. This is why doing your research is important.

So, how can Medicare Advantage carriers afford to offer such low-premium plans? It helps to understand how the plans work. When you enroll in an Advantage plan, the carrier is paid by Medicare to take on your risk. Because you're leaving Parts A and B, the private carrier manages your benefits instead of Medicare.

Medicare Advantage carriers also make their money through cost-sharing. Just because you don't have to pay a monthly premium doesn't mean the plan is free. You'll still have to pay out-of-pocket in the form of deductibles, copays, and coinsurance. Advantage plans must provide the same coverage as Parts A and B, but it's important to be aware that the carrier gets to choose how much of that service to cover and what you'll need to pay out-of-pocket.

Also, don't assume you won't have to pay your Part B premium anymore if you pick up an Advantage plan – this is not true. Regardless of whether your Advantage plan comes with a premium or not, you'll still need to pay your Part B premium.

This is where the giveback benefit comes into play. Some carriers in some ZIP Codes offer a Part B reduction, reducing the amount you pay for your premium – ranging from a few dollars to the full amount. However, it's not a reimbursement. Carriers can afford to do this because they get paid by Medicare. Keep in mind that the less you pay in monthly premiums, the more you'll pay out-of-pocket as you use your benefits. Thus, plans with the giveback benefit involve more cost-sharing. That's how the carrier recoups their money.

Benefits on an Advantage plan work differently from Original Medicare paired with a Medigap plan. First, Advantage plans come with doctor networks, so it's important to make sure your doctors are included. Advantage also doesn't travel with you – restrict coverage to your county. On the other hand, Original Medicare and a Medigap plan travel with you across all 50 states, as most doctors accept Medicare assignment.

When enrolling in an Advantage plan, it's important to understand prior authorization. Before you receive a service or treatment, the carrier may want to make sure it's medically necessary. So, you may be required to get prior authorization, which can take weeks. If the carrier doesn't think it's medically necessary, your request could face denial. On the other hand, Original Medicare paired with a Medigap plan doesn't require prior authorization so you won't be dealing with a wait.

Next, maximum out-of-pocket (MOOP) limits come with Advantage plans. They protect you from paying too much for services. Yet, the amount can be up to $7,500 and resets annually on the first of the year. So, unfortunately, if you're diagnosed with a serious illness or condition halfway through the year and end up getting close to or e

Medicare comes with many different parts and plans. We're going to break down Medicare Parts A through D in a simple way so that you know which parts to enroll in.

Medicare comes with 4 different parts, Part A, Part B, Part C, and Part D. Part A and B are both run by the Federal Government. Part C and D are offered through private insurance companies. When talking about Medicare plans, you're usually referring to supplemental Medicare options such as Medigap and Medicare Advantage. 

Part A is your hospital coverage for inpatient care. This includes room and board, nursing care received while at the hospital, meals, and diagnostic tests. Part A also covers skilled nursing and hospice. 

Part B is your coverage for outpatient care. This includes services at the doctors and other health care providers. Part B also covers preventive services, home healthcare, and items such as durable medical equipment. Basically, Part A will cover your services received at the hospital. Part B will cover any services received at the doctor's office. Part A and Part B is what makes up Original Medicare.

Now we're going to go over Part C. Also known as Medicare Advantage. Part C or Medicare Advantage is not part of Original Medicare. It's another way to get Part A and Part B coverage. It's Medicare coverage offered through private insurance companies. Since Part A and Part B don't cover 100% of your medical cost, most beneficiaries opt to enroll in additional supplemental coverage to fill in the gaps. This is done through either a Medicare Supplement Plan or Medicare Advantage plan. 

Medicare Advantage plans are a form of managed care. With these plans, you opt to receive your Part A and Part B benefits through the carrier's network of providers instead of Original Medicare. To be eligible for Part C, you still must enroll in both Part A and Part B, as well as live in the plans service area. It's important to remember, Part C is optional. Not every Medicare beneficiary will choose to enroll in a Part C plan.

Last but not least, is Part D. Part D is your prescription drug coverage. Part D plans are also offered through private insurance companies. It covers the prescriptions you pick up at your local pharmacy. Part D is also optional. However, if you don't have another form of prescription coverage that's considered creditable under Medicare, you could face enrollment penalties if you choose to enroll later. Part D plans do change annually. That's why it's important to compare all the options in your area each year during the fall Annual Enrollment Period.

Resource Links:
https://www.medicarefaq.com/original-medicare/medicare-parts/
https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-a/
https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-b/
https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-c/
https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-d/

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If you're unsure what the differences are between Medicare and Medicaid, don't go anywhere. In today's video, we're going to explain the difference between the two, as well as additional Medicare Savings Programs you could be eligible for.

Medicare is a federally funded program for those who are over 65 as well as those who are under 65 with a disability. With Medicare, the benefits are the same across all 50 states, and your income is not an eligibility factor.  With Medicaid, It's funded both on the federal level and the state level. You're eligible at any age and benefits and criteria do vary from state to state. With Medicaid, you must meet the low-income criteria within your state to become eligible.

If you meet the eligibility criteria for both Medicare and Medicaid, that means your dual-eligible. Those who are dual-eligible can qualify for a Medicare Savings Program. These programs help pay for your Medicare cost including deductibles, co-pays, and coinsurance. In addition, all of those who are eligible for Medicare Savings Program are also eligible for a program called Extra Help.

Extra Help provides assistance with your prescription drug cost under Part D. Also, if you delayed enrolling into Part D and incurred a late enrollment penalty because of it, that penalty will be waived if you're eligible for Extra Help. To qualify for Medicare Savings Program you must be already enrolled or at least eligible for Part A and your income and resources must meet the federal and state limits set for the program. 

There are four different types of Medicare Savings Programs. The first type of Medicare Savings Program we're going to go over is called the Qualified Medicare Beneficiary Program, or QMB. With the Qualified Medicare Beneficiary Program, you will have coverage for the Part B premium. If by chance you were not eligible for premium-free Part A then the Qualified Medicare Beneficiary Program will also cover your Part A premium. Medicare will be your primary coverage and your QMB will be your secondary. This means you won't need any Medigap plan since your QMB will cover your premiums, co-pays, and deductibles. The Qualified Medicare Beneficiary Program is the highest level of Medicare Savings Program you can get. 

The second type of Medicare Savings Program available is the Specified Low-Income Medicare Beneficiary or SLMB. The Specified Low-Income Medicare Beneficiary Program will pay for your Medicare Part B premium. 

The next type of Medicare Savings Program is Qualified Individual or QI. The Qualifying Individual Program will also pay for your Medicare Part B premium. The only difference is that you must apply for this program each year. It's on a first come first serve basis. 

The fourth and final type of Medicare Savings Program is the Qualified Disabled and Working Individual, or QDWI. If you're under 65, disabled, and working and you can qualify for the QDWI. This program will pay for the premium for your Part A. The most common question we get about the QDWI program is if you must be working? And the answer is yes, you must be under 65 disabled and still working to qualify.

Keep in mind, each state may have a different name for these types of Medicare Savings Program. So don't be confused if your local Medicaid office refers to them with a different name. You can apply for any of the Medicare Savings Programs at any time of the year at your local Medicaid office. 

The list of what you need to apply can vary by state, but in general, you'll need to provide:
- Proof of residence
- Proof of age
- Other forms of insurance, like Medicare
- Checking and savings accounts
- Retirement accounts
- Stocks and bonds
- Mutual funds

Resources that aren't counted would include:
- Your primary residence
- Household items
- Any furniture
- One car

If you're a resident of Minnesota and eligible for Medicare, don't go anywhere! In this video, we discuss the Medigap plans available in your state.

Minnesota has two different types of Medigap plans, known as the Basic Plan and the Extended Basic Plan. Both of these plans include what are known as Basic Benefits.

The Basic Benefits both Minnesota Medigap plans include are:
• Coverage for any coinsurance that falls under Part A and Part B
• Coverage for the first three pints of blood per year
• Coverage for some hospice and home health services

Additionally, both Minnesota Medigap plans also include:
• 80% coverage for foreign travel emergencies
• 20% coverage for mental health care in an outpatient facility
• 20% coverage for physical therapy

Additionally, there are state-mandated benefits that come with both the Basic Plan and the Extended Basic Plan:
• Cancer screenings
• Reconstructive surgery
• Immunizations
• Diabetic equipment

The Basic plan includes the state-mandated benefits along with 100 days in a skilled nursing facility.

The Extended Basic plan comes with all of the previously mentioned benefits, plus some additional benefits as follows:
• Coverage for the deductibles that fall under Part A and Part B
• 20 extra days of skilled nursing facility care
• 80% coverage for usual and customary fees
• 80% coverage while in a foreign country

Additionally, on the Extended Basic Plan, once you spend $1k out-of-pocket, all benefits will be covered 100%.

With the Basic Plan (not the Extended Basic Plan), you can increase coverage by adding any of four riders. The four riders are as follows:
• Part A deductible rider
• Part B deductible rider – only available to those Medicare-eligible before 2020
• Usual and Customary Fees Rider
• Non-Medicare Preventive Care Rider

Good news for Minnesota residents: the state does not allow excess charges from doctors not accepting Medicare.

Although you can enroll in Medigap at any time, the best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period.

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If you're a Medicare beneficiary in Wisconsin, don't go anywhere! We're going to go over how Medigap plans in Wisconsin are different from the rest of the country.

Wisconsin is one of three states where Medicare Supplement plans are standardized differently. The state offers a Basic Plan along with additional riders you can pair it with for additional coverage.

The Basic Plan is excellent for covering what Medicare doesn't. Riders allow you to add additional benefits to a policy. They can help you with deductibles, copays, and other coverage gaps.

The Basic Benefits included in Wisconsin Medigap plans include:
• Coverage for the coinsurance under Part A and Part B for both inpatient and outpatient services
• Coverage for the first three pints of blood each calendar year
• Coverage for the Part A hospice coinsurance or copayment
• Coverage for the coinsurance at a skilled nursing facility
• Additionally, benefits for 40 home health care visits that are added to the amount already paid for by Medicare plus an extra 175 days of inpatient health care beyond Medicare


There are also state-mandated benefits that Wisconsin Medigap plans must include. Wisconsin requires insurance companies to offer specific mandated benefits that provide additional coverage to protect beneficiaries. These state-mandated benefits include:
• Extra coverage for skilled nursing facility care
• Kidney disease care
• Diabetic treatment
• And more

State-mandated skilled nursing facility care coverage:
• Must include coverage for 30 days of care at a skilled nursing facility with no prior hospital stay requirement
• The facility does not have to be certified by Medicare and the stay does not have to meet Medicare's definition

The state-mandated benefits also include extra coverage for kidney disease care:
• Coverage for both inpatient and outpatient dialysis treatment
• Coverage for transplants and donor-related expenses
• Up to $30,000 of coverage for kidney disease care in any calendar year

State-mandated diabetic treatment coverage includes diabetic supplies including self-management training and insulin infusion pumps. Lastly, the state mandates chiropractic care; Medigap policies cover the usual and customary expense for services provided by a chiropractor under the scope of a chiropractor's license. In Wisconsin, this benefit is available even if Medicare doesn't cover the claim. The care must also meet the insurance carrier's standards as medically necessary.

Some additional state-mandated benefits include:
• Breast reconstruction surgery
• Colorectal cancer screening
• Coverage of certain health care costs in cancer clinical trials

Please note that Medicare Advantage plans aren't required to provide coverage for the above-listed, state-mandated benefits. The seven additional benefits that you can pair with your Basic Benefits in Wisconsin are available à la carte and can be added to the Basic Plan to customize coverage. If you stick to the Basic Benefits, the plan is similar to Plan A.

The Wisconsin riders include:
• Coverage for the Part A deductible
• Coverage for 50% of the Part A deductible
• Additional home health care
• Coverage for the Part B deductible (available only to beneficiaries eligible prior to 2020)
• Coverage for Part B excess charges
• Additional coverage for foreign travel emergency
• Coverage for any copayments or coinsurance under Part B

You can add these riders to make your coverage equivalent to the most popular standardized Medigap plans. If you prefer a cost-sharing plan with a lower monthly premium, there are plan options that include 25% and 50% cost-sharing, similar to Plans K and L. A high deductible plan that is similar to High Deductible Plan G is also available in Wisconsin.

We hope you enjoyed this video and fo

You've likely seen commercials for the Medicare give back program, which is also known as the buyback benefit – some commercials even refer to it as a Medicare reimbursement plan. Yet, this benefit actually isn't a reimbursement at all, but a reduction. In this video, we'll explain what you need to know about the Part B premium reduction benefit that's available with some Medicare Advantage plans.

The Part B reduction plan is, well, just as it sounds. You enroll in a Medicare Advantage plan, and the carrier pays either part or your entire Part B premium. In the summary of benefits or evidence of coverage, you'll see a section that mentions the Part B premium buy-down. This is where you can see how much of a reduction you're going to get. This benefit is also referred to as the giveback benefit.

The giveback benefit has become very common across all states and is now available in the majority of areas. However, there are some ZIP Codes that do not offer this benefit in their Medicare Advantage plans.

Many carriers, both large and small, offer a Part B premium reduction plan. These include Humana, Cigna, Aetna, and many more. Carrier coverage depends on your county and ZIP Code. You should always consider the plan ratings before you enroll.

The Part B premium reduction plan only participates with Social Security. You won't receive any checks directly from the carrier. Anyone enrolled in Medicaid or another form of assistance helping to pay for their Part B premium will not be eligible to enroll in a Medicare Advantage plan with this benefit.

Most pay their Part B premium through their Social Security check. If your Part B premium currently comes out of your Social Security check, you'll see the reduced amount reimbursed in your check. If you're not paying your Part B premium through your Social Security, then you'll have to pay Medicare directly the reduced amount. If you pay Medicare directly anything over the benefit amount, your carrier will not send you a check to reimburse you; it is a reduction, not a reimbursement.

The amount you get back can range from 10¢ up to the entire Part B premium amount so you pay nothing. This amount depends on your area.

Part B Reduction Plan Eligibility
• You must be enrolled in both Part A and Part B of Original Medicare
• You must not be accepting any government assistance that currently helps you pay your Part B premium
• If you don't qualify for a Part B premium reduction plan, there are many other options available to you

It's important to know that a Medicare Advantage plan is not the best option for everyone. As great as it is to have your Part B premium reduced to save you money in your Social Security check, you might find that if you visit the doctor's office often, you could pay more out-of-pocket than you initially expected. Before you enroll in a plan, be sure to weigh out the pros and cons of Medicare Advantage and Medicare Supplements.

Thank you so much for taking the time to watch this video. If you have any questions, please leave them in the comments section below or give us a call.

Resources:
- https://www.medicarefaq.com/faqs/medicare-part-b-give-back-plan/
- https://www.medicarefaq.com/faqs/pre-enrollment-medicare-advantage-checklist/
- https://www.medicarefaq.com/faqs/medicare-advantage-open-enrollment-period/
- https://www.medicarefaq.com/faqs/medicare-annual-enrollment-period/

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Medicare Part D is the part of Medicare that covers your prescription drugs. This coverage is available either through a standalone prescription drug plan or a Medicare Advantage (Part C) plan. These plans renew and reset annually, on January 1.

So, what is this "donut hole" term you keep hearing being thrown around? The donut hole is one of the four phases of Medicare Part D. What many don't realize is that the Part D program is not funded by premiums. Instead, it is funded mostly through the Medicare program.

In order to keep the Part D program sustainable, Medicare had to find a way to convince beneficiaries to choose generic drugs over brand-name drugs. That's why Medicare created the donut hole, also known as the coverage gap.

When the donut hole (or coverage gap) was first created, beneficiaries had to pay 100% of the cost of their medication. In order to avoid the donut hole, beneficiaries would switch to the generic version of their brand-name medications.

Yet, there isn't a generic version available for all medications. Thus, beneficiaries who couldn't find a generic version could be put in a financial bind once they reached the donut hole. Thankfully, legislation has stepped in and reduced the amount that the beneficiary must cover from 100% to 25%.

Now that you know why the donut hole was created, let's go over the four phases of Medicare Part D.

Phase 1: Deductible Phase
• Part D plans come with an annual deductible
• You pay the full cost of medications until the annual deductible amount is reached
• It's possible that the deductible won't apply to you if you're taking generic medications or tier 1 and 2 medications
• However, if you take brand-name medications that are tier 3 or higher, you will likely have to pay the full cost of your medication until you reach the plan's deductible amount

Phase 2: Initial Coverage Phase
• You only have to pay a set coinsurance or copay set by your drug plan
• How much you pay in coinsurance and copays will depend on what tier your prescription fall within
• Tiers vary from one drug plan to another – you can find these tiers in your plan's drug formulary 
• Most beneficiaries stay in this phase until their plan renews the following year (~85%)

Phase 3: Donut Hole (Coverage Gap) Phase
• Most people do not ever reach this phase
• You fall in the coverage gap (donut hole) after a certain spending amount reaches a set threshold
• The total amount includes both what you pay for your medication and what your insurance pays for the medication
• While in the donut hole, you will have to pay 25% of the full cost of your medications (both generic and brand-name)
• While in the donut hole, what counts towards your True Out-of-Pocket cost includes the amount paid towards your deductible, any copays/coinsurance paid while in the initial coverage phase, the full cost of brand name drugs while in the coverage gap, and the amount paid for generic drugs while in this phase

Phase 4: Catastrophic Coverage Phase
• When your True Out-of-Pocket cost (TROOP) reaches a certain amount, you reach this phase
• While in this phase, your costs for medications usually go down
• In the catastrophic coverage phase, you only pay around 5% of the cost of your medication

Now that you understand the four phases of Part D, it's important to know that these plans change annually. So, during the annual enrollment period (from October 15 through December 7), you'll want to compare all the plans in your area to make sure you're saving the most money possible.

Thank you for watching this video! We hope you found it educational. Please subscribe to our YouTube channel and join our Medicare Community on Facebook.

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Whether you're enrolling in a Medicare Advantage plan for the first time, switching your current coverage, or renewing your current coverage, it's important to know what to review before choosing a plan. In this video, we're going to go over our pre-enrollment Medicare Advantage checklist so that you can feel more confident in your decision.

Your pre-enrollment Medicare Advantage checklist will include:
• Which doctors are in your plan's network
• Your plan's coverage area
• Cost-sharing
• Summary of benefits
• Drug formulary (if the plan includes prescription drug coverage)

The first item on the checklist is doctor networks:
• Most Advantage plans are HMOs or PPOs with limited networks so it's important to make sure that all of your physicians are within the plan's network
• If you have multiple doctors, make sure each one accepts the plan you're choosing
• Also, consider that you'll need a referral from your primary care physician to see a specialist

The next item on the checklist is the coverage area:
• Advantage plans do not travel with you – thus, if you travel a lot, an Advantage plan might not be the best option for you because some restrict you to the doctors within your county

Next up is cost-sharing/out-of-pocket costs:
• Cost-sharing varies from plan to plan
• It includes deductibles, coinsurance, and copays
• Check how much copays are to see primary care physicians and specialists
• If you see doctors often, these amounts can add up quickly
• Check what the maximum out-of-pocket limit is, as these vary from plan to plan; plans with lower monthly premiums tend to have higher maximum out-of-pocket amounts

Next, check for extra benefits:
• Not all Advantage plans include dental, vision, and hearing, so make sure your plan includes the extra benefits you want
• Ask your agent if there is a Part B reduction plan available to you – this is when the plan reimburses some or all of your Part B premium (not available in all areas)

Finally, you'll want to go over all the important documents:
• Summary of Benefits – Check the benefits (including exclusions), deductible amounts, coinsurance and copay amounts, out-of-pocket limit, direct links to preferred provider directory and drug formulary, as well as any referral requirements
• Annual Notice of Coverage & Evidence of Coverage – What you'll receive if you're already enrolled in an Advantage plan; These notify you of any changes that will take effect in the plan in the following year
• Drug Formulary – If the plan includes prescription drug coverage, this will include all the medications your plan covers; check that all of your medications are included on the formulary – also, check the deductible for prescription drugs, which varies from $0 to $445

The enrollment periods you can use to make changes to your Advantage plan are:
• Initial Coverage Election Period
• Annual Enrollment Period
• Medicare Advantage Open Enrollment Period

Thank you for watching this video! We hope you found it educational. If you have any questions, feel free to leave them in the comments below. Please subscribe to our YouTube channel and join our Medicare Community on Facebook.

YouTube Channel: https://www.youtube.com/MedicareFAQ/
Facebook Community: https://www.facebook.com/groups/MedicareFAQ/

Resources:
- https://www.medicarefaq.com/faqs/pre-enrollment-medicare-advantage-checklist/
- https://www.medicarefaq.com/faqs/medicare-advantage-open-enrollment-period/
- https://www.medicarefaq.com/faqs/medicare-annual-enrollment-period/
- https://www.medicarefaq.com/faqs/medicare-advantage-vs-medicare-supplement/
- https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-c/
- https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-c/medicare-advantage-prescription-d

While there are many similarities between Original Medicare and Medicare Advantage, they're actually quite different. With Original Medicare, your benefits are administered by the federal government and include Part A and Part B. Part A is your hospital coverage and Part B is your medical coverage. You pay into both of these parts during your working career through Medicare taxes.

With Medicare Advantage, your benefits are managed through a private insurance company. Medicare pays the Medicare Advantage carrier to administer your benefits for both Part A and Part B. When Medicare Advantage is administering your benefits, it's known as Part C. These private insurance companies must follow the guidelines that the federal government sets in place.

Now that we've gone over the basic difference between the two, let's go over the pros and cons.

Original Medicare Pros:

• Benefits are identical from person to person
• There are no copays, no waiting periods, and no pre-existing condition limitations
• There are no networks, meaning you can see any doctor that accepts Medicare
• Any out-of-pocket costs will be the same regardless of the provider you choose
•Your coverage will also travel with you across the United States

Original Medicare Cons:

• Both Part A and Part B come with a deductible and coinsurance
• No maximum out-of-pocket
• No coverage for prescription drugs

Medicare Advantage Pros:
• Some areas have plans with $0 premiums
• Some plans have a Part B give-back option
• Plans have an out-of-pocket maximum limit
• Can come with additional perks like dental, vision, and hearing benefits, gym memberships, and long-term care
• Many plans include coverage for prescription medications

Medicare Advantage Cons:

• Benefits are different from plan to plan
• You still need to pay your Part B premium
• Limited doctor networks and need for a referral to see a specialist
• High cost per service
• Plans do not travel with you
• Maximum out-of-pocket limit could still break the bank

Now that we've discussed the pros and cons of both, let's go over how doctor visits, covered services, and costs work.

Doctor Visits on Original Medicare:

• When you have Original Medicare, you can see any doctor or specialist that accepts Medicare without needing a referral
• Plans don't change annually, so you don't have to worry about your doctor leaving the plan's network

Doctor Visits on Medicare Advantage:

• Most plans are HMOs or PPOs and you'll have a primary care physician to direct all your care – therefore, you'll need a referral to see a specialist
• Physicians can leave the plan's network at any time

Covered Services on Original Medicare:

• A wide range of services are covered
• Does not include coverage for routine dental, vision, or hearing care

Covered Services on Medicare Advantage:

• Includes coverage for the same services Original Medicare covers plus possible coverage for dental, vision, and hearing

Costs on Original Medicare:

• Part A and Part B both come with a deductible and coinsurance
• You will pay a monthly premium for Part B
• No maximum out-of-pocket limit
• The Part A deductible is per benefit period

Costs on Medicare Advantage:

• You still need to pay your Part B premium in order to be eligible for a Medicare Advantage Plan

So, which is better –Original Medicare or Medicare Advantage? This answer depends on your specific situation and your health care coverage goals. If you're looking to cover the gaps in Original Medicare, then the best option for you might be a Medigap plan in combination with a Part D prescription drug plan. If you can't enroll in a Medigap plan, then having Medicare Advantage is better than just having Original Medicare

Medicare changes every year. In this video, we go over what changes you can expect to see in 2021.

Part A is your inpatient coverage. Most beneficiaries don't need to pay a premium for Part A because they've paid in for at least 40 quarters. Yet, if you didn't pay in at all, your Part A premium is $471. If you paid in for at least 30 quarters, your Part A premium in 2021 will be $259.

Part A also comes with a deductible. For 2021, the Part A deductible is $1,484.

If you end up in the hospital for an extended period of time, Part A will pay 100% of the cost of your stay for the first 60 days. After the first 60 days, your daily coinsurance will be $371 and for days 91 through 150, it will be $742 per day.

Skilled nursing facility coverage also falls under Part A. For the first 20 days, Part A will cover 100% of the skilled nursing facility's cost. For days 21 through 100, you pay a daily coinsurance of $185.50. After 100 days, you're responsible for 100% of the cost.

Next, Part B is your outpatient coverage. This comes with a standard deductible of $148.50 for 2021. Higher-income earners are subject to higher premiums. The Part B annual deductible for 2021 is $203.

Medicare Advantage also comes with cost-sharing. The average monthly premium for an Advantage plan in 2021 is $21, which is the lowest it's been since 2007.

Advantage plans come with a maximum out-of-pocket limit. This limit for 2021 is $7,550 for in-network and $11,300 for out-of-network.

Another change for 2021 is Advantage plans now accepting patients with End-Stage Renal Disease (ESRD). Additionally, some Advantage carriers will start including long-term care benefits, such as personal care, transportation, meal delivery, and adult day care services. Yet, benefits will still not cover room and board or help with daily living activities.

For Part D, the average monthly premium for 2021 is $41. Premiums vary from state to state. The 2021 Part D deductible is $445.

The last thing we'll go over today is Medigap changes for 2021. Medigap includes two high-deductible plans. The high deductible for both High Deductible Plan G and High Deductible Plan F is $2,370 for 2021.

Medigap also includes two plans with maximum out-of-pocket limits. The maximum out-of-pocket for Plan L is $3,110, and the maximum out-of-pocket for Plan K is $6,220.

It's important to remember that most, if not all, of the cost-sharing for Parts A and B will be covered by a Medigap plan if you have one.

2021 Medicare Changes - https://www.medicarefaq.com/faqs/medicare-changes-in-2021/
Part A - https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-a/
Part B - https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-b/