SSI Blog
Many seniors want to know the difference between a Medicare Supplement and Medicare Advantage Plans. These two plans have different coverage and benefits to fit each individual’s needs and budget.
Medicare Supplement
Medicare Supplement Plans are offered through private insurance companies in IL. These plans help pay for costs not covered by Medicare, like deductibles, copayments, and coinsurance. There are no networks and you are free to use any doctor or healthcare provider you choose who accepts Medicare.
Medicare Advantage
Part C is offered through private insurance companies approved by Medicare. When you join a plan, you still have Medicare coverage. Part A and B benefits are provided through the insurance company. Many plans offer low or zero monthly premiums. Most plans have additional benefits not provided by Medicare including prescription coverage and dental and vision care.
References:
Medicare Advantage: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html
Medicare Supplement: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
Extra: https://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html
MUC44-2017-BCBS
SSI Blog
There are many reasons why you may want to change your Medicare Supplement. You could be paying for coverage you don’t need, or, want more. Maybe you need to change insurance companies or switch to a less expensive plan.
Requirements
To change plans you must be within your open enrollment period that provides you with a Guaranteed Issue Right. You can purchase any plan without being denied coverage, or being charged more due to a pre-existing condition. This period lasts for six months, starting when you first join Part B. If you are within your six-month period, you can change without any restrictions. As soon as this period ends, your guaranteed issue right ends. If you have health conditions, plans could cost more, and companies can deny coverage after your open enrollment period.
Exceptions
There are exceptions to the rule, and times when you have a guaranteed issue right to enroll or change plans outside of open enrollment. If your current coverage misleads you or isn’t compliant with the law, you can change plans with no restriction. If the insurance company providing your coverage declares bankruptcy, you can change. If you drop a plan to enroll in Medicare Part C but don’t like it, you have up to a year to switch back to a Medicare Supplement with a guaranteed issue.
Free Look
You have 30 days to decide if you want to keep the coverage. This Free Look period starts when you first get a new plan and ends 30 days later. Do not cancel your old policy until you are certain you want to keep the new plan. You will be responsible for paying both premiums for one month if you choose to use this right.
Older Plans
Plans sold before January 1, 2006, included prescription drug coverage. New plans do not. Many are no longer offered. If you have an older policy and want to change, understand you may not be able to carry these benefits over to the new plan.
References:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-scenarios.html
MUC67-2017-BCBS
SSI Blog
If you rely on medications, it’s important to review each Part D plan’s formulary, to confirm the prescriptions you need are listed.
Formulary
Each plan has its list of covered prescription drugs, called a formulary. Medications are classified into tiers, the lowest costing less than those in higher tiers. Be sure to check that your medications are listed. If you don’t see yours listed, search for another plan. These lists often change yearly, meaning your medications may no longer be available next year. Prescription drugs change tiers or move between classifications. Even if you are happy with your coverage, you must review the Annual Notice of Change for the upcoming year to avoid being surprised at the pharmacy.
Tier 1 – Generic, lowest copayment
Tier 2 – Preferred, brand-name, medium copayment
Tier 3 – Non-preferred brand name, higher copayment
Tier 4 – Specialty, highest copayment
Over-the-Counter
It’s important to know which medications will be covered under the plan, and which are not. Part D does not provide coverage for over-the-counter medications, including cough and cold medicine, and vitamins. Medicare covers some medications that Part D does not. For instance, vaccines, cancer drugs, and certain injectable drugs are covered under Part B if you receive them in an outpatient setting, like your doctor’s office.
Not Covered
In the event your medications are not covered under the plan, there are things you can do.
Substitutes
In many cases, formularies do not cover brand-name drugs but do offer coverage for generic, or low-cost alternatives. Ask your doctor if there is a substitute for the medication that’s not covered under your plan.
Exception
Medicare is open to listening to your doctor if he or she believes that a specific drug is the only medication that will help your condition. An exception may be granted if your doctor and Medicare agree that it is medically necessary. You also have the right to file an appeal should Medicare deny your request.
Change Coverage
Each plan is different, and your prescriptions may be covered under a different plan’s formulary. If your current coverage no longer covers your medication, and you find a new plan that does, you can change during Annual Enrollment (October 15 – December 7) each year.
References:
https://www.medicare.gov/part-d/coverage/part-d-coverage.html
https://www.medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html
MUC67-2017-BCBS
SSI Blog
GeoBlue Travel insurance from Blue Cross and Blue Shield of Illinois offers a new kind of coverage. While many Illinois seniors take to the open road after retiring, many travel internationally for work.
Plan Flexibility
Whether you’re planning a one-time trip, multiple, or planning to live outside of the country for an extended amount of time, you choose the coverage that fits your situation. GeoBlue online enrollment process is easy and reliable to obtain quality protection from home.
International Options
Single, Multi-trip, and Expatriate Plans
With three different categories, you can travel abroad with the peace of mind that you’re covered. Choose limits from $50,000 to a full $1,000,000 and deductible amounts from $0 to $500. Prescription reimbursement is available with all plans, ensuring you can get your medication conveniently.
Choice in coverage limits
Emergency evacuation
Accidental death coverage
Repatriation coverage
Dental care for the relief of pain (multi-trip and expatriate plans only)
Prescription medication reimbursement
Emergency and non-emergency care
Choice of deductibles
24/7 global assistance
Global health and safety resources
Expatriate plans are available worldwide (with or without coverage in the U.S.). Expatriate plans also include additional benefits:
Preventive and primary care
Professional services
Inpatient hospital services
Ambulatory and therapeutic services
Rehabilitation and therapy
Home health and skilled nursing
Hospice care
References:
https://www.geobluetravelinsurance.com/product_overview.cfm?link_id=148117&personalized=y&header=y
MUC50-2017-BCBS
SSI Blog
We created a checklist to help you be prepared for the Medicare enrollment process.
9 to 12 months before you turn 65
Confirm that you are eligible to receive Medicare by calling the Social Security Administration at 800.772.1213.
Review your current health insurance policy to find out what happens with that coverage when you turn 65.
Research options for coverage to help protect yourself from costs not covered by Medicare.
4 to 8 months before you turn 65
Become familiar with Medicare and its various parts: A, B, C, and Part D.
Ask your doctor if they accept Medicare or participate in other Medicare plans.
Sign up for coverage to help protect yourself from out-of-pocket expenses with Medicare.
1 to 3 months before you turn 65
Enroll in Medicare – if you do not receive your automatic enrollment information in the mail, contact the Social Security Administration at 800.772.1213.
Sign up for Social Security if you have decided to take early Social Security benefits (Note: it usually takes three months after you sign up before you begin receiving benefits).
If your spouse and/or dependent are covered under your employer’s plan, make arrangements for him or her to have coverage after you have Medicare.
Happy 65th Birthday!
If you have not received your Medicare card in the mail, call the Social Security Administration at 800.772.1213.
Make sure your physician’s office has a copy of your Medicare Card and any supplement plan you may have signed up for.
References:
https://www.medicare.gov
MUC25-2016-BCBS
