Medicare is a national health insurance plan provided by the government. When you purchase a Medicare Supplement plan (Medigap plan) from a private insurance company, the plans are strictly regulated by the federal and state government. Many people confuse a Medicare Supplement plan ( Medigap plan) with a Medicare Advantage plan. Often people use the term "supplement plan" when they are referring to an "advantage plan". There are major differences between the coverages. If you do not understand those differences, you should really work with an agent who does. There is no cost to using an agent, they get paid by the carrier if you decide to purchase a plan.
MACRA has many components, one of which is a limit on first dollar coverage in certain Medicare supplement insurance plans for individuals considered "newly eligible" and a transition away from using Social Security numbers as identifiers. It also includes a change to the way Medicare pays healthcare professionals. Currently, healthcare professionals are paid based on the number of services they perform. MACRA allows for healthcare professionals to be compensated on quality of care as opposed to the number of services they perform.
"Newly eligible" is defined as anyone who is turning 65 on or after January 1, 2020 or anyone who is eligible for Medicare benefits due to age or disability as defined by the Centers for Medicare and Medicaid Services (CMS) on or after January 1, 2020.
As of January 1, 2020 MACRA does the following:
Prohibits first dollar Part B deductible coverage on Medicare Supplement so Plans C and F cannot be sold to those "newly eligible" for Medicare.
Makes Plans D and G the new guaranteed issue plans for those who are "newly eligible" within the guaranteed acceptance rules for Medicare Supplement plans.
Mandates that a Social Security Number can no longer be used as an identifier.
Plans C and F can still be sold after January 1, 2020 BUT only to Medicare beneficiaries who were age 65 PRIOR to 1/1/2020 or first became eligible for Medicare PRIOR to 1/1/2020 regardless of what plan they had previously.
Plans C and F are NOT going away. Current policyholders can continue with their Plan C or Plan F and may continue to buy Plans C and F beyond January 1, 2020. Example: A customer who bought Plan F (or any other plan) in 2018 can purchase any plan, including C and F, prior to January 1, 2020 or thereafter.
MACRA mandates the removal of Social Security Number (SSN) based Health Insurance Claim Number (HICN) from Medicare Cards to address the risk of beneficiary medical identity theft and fraud.
New numbers are unique and randomly assigned
The new number will be referred to as the Medicare Beneficiary Identifier Number (MBI)
Beginning April 2018 new cards will be issued and will continue through April 2019.
Every year you can choose a different prescription plan during the Annual Enrollment Period (Oct 15 - Dec 7th). During that time you should go online and input your prescriptions into the government website to help determine the best coverage for the upcoming calendar year. There are no medical questions to be answered during this time. It's important to do this exercise since your current prescription plan may change it's formulary and no longer cover your medicine under their new formulary. It's easy to enroll in a new plan, all you have to do is click "enroll" once you make your decision. By enrolling into a new plan, your current plan will be automatically terminated Jan1st.
Here are the instructions:
On the front page is a green box that says “Find health and drug plans” click on it.
On the next page input your zip code then click “find plans” underneath of that.
On the next page check the circle that says “Original Medicare” and “I dont get any extra help”
Then click “Continue to plan results”.
Then input the name of one of your prescriptions. A box will pop up asking which dosage and frequency you take, complete that info and click “Add drug and dosage”.
Continue adding your drugs until your list is complete.
Then click “My list is complete”.
The next page will ask which pharmacy you prefer to use, click “Add pharmacy” when you find a pharmacy you would use.
On the next page at the top, click “Continue to plan results”.
On this page check the box that says “Prescription Drug plans (with Original Medicare)” then click “Continue to plan results”.
The next page will list Medicare as your medical insurance and underneath that it will list all the prescription plans available in the state in order of “Lowest remainder of the year retail costs ”.
Medicare Supplement plans are also called Medigap plans. They are offered by private insurers to assist in paying for many coverage gaps in Medicare.
The cost varies from insurance carrier to insurance carrier, even if they are offering the same plan (Ex, plan F, plan G, plan N).
You cannot be turned down for coverage for health reasons if you sign up when you first sign up for part B.
Medicare supplement plans are standardized. Every Medicare Supplement/ Medigap plan must follow federal and state laws designed to protect you.There are 10 different Medicare supplement plans to pick from: A, B, C, D, F, G, K, L, M &N each offering a different level of benefits and coverage. The overwhelming majority of people choose plan F, G or N because they offer the most comprehensive benefits.
When shopping fo a Medicare supplement plan, be sure your agent understands the nuances of each carrier. for example, some carriers will extend a household discount of 7% if each enrollee joins one of their plans. That is a nice savings just for living with your spouse :)
Approximately 70% of Medicare Beneficiaries will pay $109/mth for their part B premium. The remaining 30% will pay $134/mth. This does not include anyone that pays the high income adjustment premiums. also, the part B deductible will increase to $183/ year (compared to $166 in 2016) starting Jan. 2017.
Are you seeing a lot of commercials stating "its open enrollment"? Please notice they never say "it's open enrollment for Medicare Supplement plans". This is open enrollment season for Medicare Advantage plans. Do you know the difference? If not, please speak with a professional before making any changes that could cause you unwanted aggravation.
This article is a little confusing but I'm happy to see this topic being addressed; prescription costs are increasing and Medicare beneficiaries cannot budget for the donut hole.