With Open Enrollment for Medicare and Medicare Supplement Plans running from October 15 to December 7, you’ve likely seen the advertisements on TV.
With promises of member discounts, benefit plans, and very attractive propositions for many, I wanted to interview the insurance specialists at Valley Insurance on Adams Ave. in La Grande to understand how these plans work, what you are actually entitled to, and what the “member discounts” truly are.
I sat down to interview Co-Owner Matthew Pidcock, CIC to learn more.
Sherry: Hey Matthew, thank you for joining me. My first question is, what is open enrollment and how long does it last?
Matthew: Medicare AEP (Annual Election Period) is from October 15 – December 7 each year. This is the “open enrollment” that gets advertised every fall on TV, etc.
It is for Medicare Part D (Drug Plans) and Medicare Part C (Medicare Advantage Plans)
Individual Health insurance open enrollment. From November 1– January 15 (usually December 15, but the government can change this from year to year).
It’s for people under the age of 65 on individual plans or plans through healthcare.gov.
Sherry: So, what is the difference between traditional Medicare and Medicare supplement plans?
Matthew: Traditional Medicare is in two parts.
- Part A is the hospital benefit.
- Part B is the medical benefit (outpatient visits, lab work, diagnostic imaging, etc.).
Medicare is an 80/20 plan.
Generally, it covers 80% of covered claims and passes along the 20% to the consumer, with no out of pocket maximum with base Medicare.
For example, if you had a $500,000 bill in the hospital and you only had base Medicare, then 20% can be passed on to them ($100,000).
This is why some people choose to buy supplement plans.
Medicare supplement, or Medigap plans, are federally standardized plans that “supplement” Medicare to cover the costs of covered Medicare claims that pass through to the consumer.
They are known by plan “Letters” – Plan F, Plan G, Plan N, Plan K, Plan L.
For example, the best supplement plan a person can buy now is Plan G.
It covers all approved Medicare costs that get passed through from Medicare except for the Part B deductible, which is currently $233.
So that same example above, with a $500,000 Medicare approved hospital bill, the person who had Medicare A & B and a Supplement Plan G would only be responsible for a total of $233.
Sherry: How much do they actually cover as paid benefits?
Matthew: They follow the same rules as Medicare. Since Medicare sets the rates of payments for all procedures/billing codes, the supplements simply pay the 20% that passes through to the consumer.
For example, a person gets an MRI and the hospital bills $3500. Medicare will only approve $2000.
Medicare pays 80% of the $2000 (or $1600). The $400 that’s left gets sent to the supplement to be paid to the hospital.
This is assuming a person is on a Plan G supplement and has already met their Part B deductible of $233 for the year.
Sherry: What is the deal with third party vendors offering “benefits” within a Medicare supplement plan?
Matthew: Some Medicare supplement plans offer features such as “Silver and Fit” gym memberships and similar programs. They typically cost more than the supplements that do not provide them.
Medicare Advantage is what is referred to as Medicare Part C.
These are the plans that can add A LOT of extra benefits, such as Dental Coverage, Hearing Coverage, Vision Coverage, Chiropractic and Alternative Care, and Prescription plans.
Many are advertised on TV at this time of year and say that the cost is “Zero Premium” – however, these plans are all ZIP code specific, and a person must reside in the coverage area.
There is only one Medicare Advantage plan available in our zip code. That is the Summit Health Advantage plan.
We offer this plan and well over one hundred clients are on it. The plan varies in premium at $59, $89, or $139 per month depending on the coverage level selected. They do not change the rate based on age.
Medicare Advantage plans are not right for everyone, as there are doctor networks and lots of co-pays/co-insurance that a person needs to consider. However, they do work quite well for the consumers that understand them and how to use them.
We are a general agent for Summit Health and can meet with people who are interested in Medicare Advantage.
Sherry: What Medicare supplement plans do you offer, and how does somebody sign up?
Matthew: We offer all the available Medicare Supplement plans that our companies write.
These days, it’s usually Plan G or Plan N. They are affordable and offer great protection for consumers on Medicare.
When a person first becomes eligible for Medicare, they have an “Open Enrollment” window of six months from the Medicare start date to get a supplement plan with NO underwriting, also referred to as “ Issue.”
If they miss that window, then they must be able to pass underwriting to get a Medicare supplement plan. If they can’t pass underwriting, then we turn to a Medicare Advantage plan during AEP.
Sherry: How much do Medicare supplement premiums cost?
Matthew: Here’s an example of the rates (as of 10/18/2022) with one particular company that we write with.
- Male 65-year-old Plan G = $133.50 per month, Plan N = $107.41
- Female 65-year-old Plan G = $121.41 per month, Plan N = $97.67
Medicare Supplement plans are based on age. They are more expensive the older we get.
Sherry: How can someone learn more about their health insurance options to make the right decisions for them?
Matthew: Schedule an appointment with me at Valley Insurance!
How to Contact Valley Insurance
You can contact Valley Insurance directly or request a quote through their website with insurance options for auto, homes, renters, condos, landlord, classic cars, business, commercial, life, health, and farm products.
Call: 541-963-3121
Web: https://www.valleyinsurance.com/
Address: 1215 Adams Ave., La Grande, OR 97850
