Medicare supplement plans, also known as Medigap, are plans that work directly with Medicare to help alleviate some of the uncovered costs associated with Medicare. When using a Medigap plan, Medicare first covers their portion of your medical bills, and then your Medicare Supplement plan will cover the remaining out-of-pocket costs. Medicare supplement plans can help to significantly lower your costs and increase your medical benefits.  Medigap plans are designed to help cover the “gaps'' in original Medicare coverage such as :
- Deductibles
- Copayments
- Coinsurances 

Because they are standardized, Medigap plans offer the same basic benefits regardless of which private insurance company you decide to purchase from. The cost of each plan can vary depending on the policy you choose and your location. Medigap plans are recognized in most states by a series of letters. 

The chart below helps to break up the information and give a side-by-side visualization of the benefits that Medigap plans can cover.

It is important to assess your personal needs before deciding on a Medigap plan. The best plan for you will depend on which parts of Medicare that have the most “gaps” and the cost of the plans to fill them. The best Medigap policy should cover the areas that you expect to spend the most on healthcare. There should be a balance between your coverages and costs.

In the past, two of the most commonly purchased Medigap policies were plans C and F. Unfortunately, new regulations don’t allow these plans to be purchased by new enrollees any longer.

While each plan can offer a set of benefits that might be better for your personal coverage needs, we have narrowed it down to the 3 best Medigap plans available in 2021 related to the most common benefits needed - Plan G, Plan K, and Plan N.


Medicare supplement Plan G provides the most coverage for seniors. Plan G covers almost everything except the Medicare Part B deductible.  This means that you would be responsible for your Part B premium ($203 for the year 2021) before your Medigap benefits begin to pay for anything. 

Although plan G provides the most comprehensive coverage, it also comes with appropriately higher premiums . Plan G actually has the highest premium price of all of the Medigap plans, costing up to $473 each month.  You should compare this monthly premium with your expected medical costs for the year to be sure that you are choosing the most beneficial plan.

Medigap supplement Plan K may be a great option for you if you are looking for an inexpensive option that still provides some coverages. It is vital to assess your health care needs before choosing this option as it only provides 50% coverage for several commonly needed coverages such as skilled nursing, Part A hospice and deductible, Part B coinsurance, and blood.  This can lead to some expensive out-of-pocket costs. 

However, if you choose Medigap Plan K, you can expect a much lower monthly premium, costing only between $62 and $135 each month.

Supplement Plan N is a good choice if you are looking for a plan that offers many of the comprehensive benefits that Plan G offers but at a lower cost. Unfortunately, Plan N does not provide coverage for Medicare Part B excess charges, which can quickly add up during routine medical care.

On the other hand, Plan N costs significantly less than Plan G, averaging between $146-$289 each month.

Medicare Supplement plans can help you avoid unexpected out-of-pocket costs related to your health care. For more help finding the best Medigap plan for all your healthcare needs, fill out this simple online form and one of our highly-trained SAO Medicare staff will reach out to assist you with all your touch Medigap questions.

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Medicare Supplement Plans Parts G, K, N and More

As Medicare plans change each year and almost always is an expansion of the programs and benefits that are available to you.  Other changes each year maybe in costs such as premiums, deductibles, copayments, and coinsurances.  

It's common for the premiums for Medicare Part A and Part B to increase, but usually only by a few dollars each year. But from time to time, premiums may be reduced.  You may also see changes to the services within your Medicare Advantage Plan and the drugs that are covered in your prescription plan.

### Medicare Advantage Plan Changes
Because Medicare Advantage plans are offered by private insurance companies, there can be a variety of changes in your plan each yearm typically to offer you better choices. Some of the most recent, positive changes that have occurred for Medicare Advantage Plans include:
- Home-safety modifications
- Increased telehealth services
- Adult daycare
- In-home services
- Transportation

Other changes in your Medicare Advantage Plan will be related to costs such as premiums, deductibles, and copayments. 

### Medicare Prescription Plan Coverage Changes
With the continuous research in the pharmaceutical field, there is often more current information that can lead to changes in your prescription drug coverage each year.

Changes to your prescription formulary or list of covered drugs, can happen annually, but only during a certain period of time.  Fortunately, the government does not allow drug companies to make sudden, negative changes to your plan. This means that they can not just decide to take medications out of your plan’s formulary at any time unless they are deemed unsafe by the FDA.

More commonly, drug plans often make beneficial changes to their current formularies.  These changes include more prescription choices and lower copayments.


Remember these vital times and dates each year to make sure you are getting the most out of your coverage:
- You should begin reviewing your Medicare plan during the months of **September and October** of each year and compare it with any changes you have been notified about.  There is also a great tool at [medicare.gov](https://www.medicare.gov/plan-compare/#/?lang=en&year=2021) that can assist you with finding the best plan for all of your healthcare needs. 
- After you finish your coverage reviews, you will have to wait for Open Enrollment to begin to make any changes. Open enrollment begins on **October 15th** each year.  During this time you will have the chance to make any of your preferred changes to your current health and drug plan. 
- **December 7th** is the last day of Open enrollment and is the last time to make changes to your current plan.
- Your new coverage will begin on **January 1st**.

Even if annual Medicare changes are minor, it's crucial to review your plan yearly to make sure you are receiving the most benefit for the best price. For help exploring the changes to your plan, please fill out the simple online form and one of our highly-trained local experts will reach out to provide complementary help in answering your questions.


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From time to time, it's important to review insurance policies that cover your life, home, and other assets to ensure you're coverage is keeping up with rising prices. The same is true for your healthcare coverage.  Are you reviewing your Medicare plan to take full advantage of the benefits available to you? Medicare strives to provide higher quality care and more options each year and providers adjust their coverage amounts across a wide variety of costs.  Review your plan yearly to make sure it is still the right choice for you!

Medicare Changes Annually

If your next birthday is your 65th, then it's an exciting time. You become eligible for Medicare - the federally-sponsored health insurance program for U.S. citizens.  

Although it's a happy time, it can be stressful, too. Not only do you have to select the plans that make up your individual Medicare plan, but you also have to know when you're eligible and when to enroll. Read on to learn about eligibility and enrollment requirements. 

Meeting eligibility requirements can be a significant point in your life.  Most US citizens become eligible for Medicare the month of their 65th birthday.  Eligibility may occur sooner if you have certain disabilities or end-stage renal disease. There are 4 key facts to remember when beginning your Medicare process.
1. Some people may be automatically enrolled, while others will have to physically sign up for Medicare.
2. You have the freedom to choose the type of coverage you will receive, how you will receive it, and the costs associated with your coverage.
3. There are certain times of the year when you can sign up; signing up during this period can help to avoid financial penalties. 
4. There are programs available to help cover the financial burdens associated with Medicare for low-income individuals. 


The timeframe when you are allowed to enroll in a Medicare plan is called an enrollment period.  These dates are vital to receive timely coverage and to avoid costly penalties.  There are several types of enrollment periods available including:
- Initial Enrollment Period
- Open Enrollment Period
- General Enrollment Period
- Annual Enrollment Period
- Special Enrollment Period

### Initial Enrollment Period
The initial enrollment period gives you a 7-month time frame to enroll.  This time frame consists of the 3 months prior to your birth month, your birth month, and the 3 months after your birth month. During this time you will have the opportunity to enroll in Original Medicare, a Medicare Part D prescription plan, or Medicare Part C (Medicare Advantage Plans).

If you fail to sign up during your initial enrollment period, you could face consequences in the form of higher annual premiums.  In addition, you may not be permitted to enroll in Medicare Part B until the general enrollment period. This leaves you with several months of no Part B coverage at all.

### General Enrollment Period
You can also enroll in Original Medicare (Part A and Part B) during the general enrollment period. This occurs between January 1st and March 31st as long as you meet certain criteria.  This includes:
- Failure to enroll during the initial enrollment period
- If you are not eligible to sign up during a special enrollment period

### Annual Enrollment Period
During the annual enrollment period, everyone has the opportunity to enroll in a Medicare plan. You can also make changes to an existing plan during this time. The annual enrollment period begins on October 15th and continues until December 7th. 

### Open Enrollment Period
There are two different types of open enrollment periods-Medicare Supplement Open Enrollment and Medicare Advantage Open Enrollment.

#### Medicare Supplement
Medicare supplement plans piggyback off of your Medicare insurance and offer coverage to help with additional medical costs. The best time to purchase a Medicare Supplement plan is during the initial enrollment period that allows coverage to begin on the first day of the month you turn 65. 

It is important to note that you will not be able to sign up for a Medicare Supplement Plan unless you have already enrolled in Medicare Plan B. In addition, if you choose not to sign up for a Medicare Supplement during the Open Enrollment Period, you may not be able to sign up for one at all.
 
#### Medicare Advantage
Medicare Advantage Plans are bundled, all-in-one plans that can offer more medical coverage and often include prescription drug coverage.  They are provided by private insurers like Aetna, Humana, and many others. 

The Medicare Advantage Open Enrollment Period takes place each year between January 1st and March 31st.  During this timeframe, individuals have the option of switching to a Medicare Advantage Plan.  If you are already receiving benefits through a Medicare Advantage Plan, you may want to switch back to Original Medicare. That can also be done during this period. 

The new coverage that you choose will begin on the first day of the following month.

### Special Enrollment Period
There are some special circumstances that will allow you to enroll, change, or end benefits through a Medicare Advantage Plan.  These circumstances include moving to a new area that is no longer in your plan’s service area or losing coverage due to a change in employment. 

Your situation is unique.  For more help understanding your Medicare eligibility requirements and choosing the best enrollment period, reach out to one of our highly trained professionals by filling out this simple online form.

Medicare Enrollment Eligibility Turning Age 65

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Medicare Eligibility and Enrollment

It's not unusual for insurance plans to be confusing - Medicare is no exception. There are two main options available when deciding which coverage is best - Medicare Advantage Plans and Medicare Supplement Plans.  Both of these policies are provided by private insurers and designed to help cover the unexpected costs in Medicare coverage. Though they serve a similar purpose, they are designed very differently.

Before we look deeper, let's look at a quick overview, 

**Medicare Advantage Plans** are *completely separate* from Original Medicare.  When you enroll in a Medicare Advantage Plan, you will receive all of your coverages from that private insurer, not from Medicare. You will use this plan’s network of providers for all care. This means you may have to switch providers for certain health services.

On the other hand,  **Medicare Supplement Plans** work *directly with Medicare* to help pay certain uncovered costs. This is **not***italic text* stand-alone insurance like a Medicare Advantage Plan.  This means that Medicare first pays its portion of the medical bills, and then your Medicare Supplement Plan covers the remainder of the payment.

Like any type of insurance plan, both options will have significant differences when it comes to cost, coverage, and how they work in general. Therefore, it is vital to research all the differences and decide on the best coverage options for your personal situation

While both plans are meant to help reduce your out-of-pocket spending, we encourage you to take a more in-depth look at the features and benefits of each option.

A Medicare Advantage policy, referred to as Medicare Part C, is an alternative way to receive Medicare coverage. This bundled, all-in-one coverage not only includes all the services in Original Medicare but also offers a variety of additional benefits.  A Medicare Advantage Plan can expand coverage, help make your healthcare more affordable, and provide all of your healthcare related services under a single plan.  Other benefits can include:

- Vision coverage
- Dental coverage
- Hearing coverage
- Prescription drug coverage
- Transportation to doctor’s appointments
- Health and wellness services
- Customized benefits plans for certain chronic illnesses

It’s important to note that when you are enrolled in a Medicare Advantage Plan, you still have Medicare. In fact, you **must** be enrolled in Medicare Parts A and B to even be eligible for a Medicare Advantage Plan. Though you are technically enrolled in Medicare Parts A and B, *you will receive all your benefits through the advantage plan*.

The cost of a Medicare Advantage policy can vary greatly depending on the features and benefits in the package you choose. The cost will be **in addition** to the Part B premium you have to pay each month.

### The Zero-Dollar Premium Trade-Off
Some Medicare Advantage plans offer $0 premium plans. When an offer sounds too good to be true, it likely is. While the Zero-Dollar Premium may be the right choice for you it’s important to note that the no-premium option comes with a trade-off of sorts. 

Almost every zero-dollar premium plan will require you to agree to receive all of your care through that plan’s network providers. For some participants, the zero-dollar premium is worth the change in providers. But for participants with long-standing relationships with their medical providers, it may be a deal breaker to have to switch doctors or specialists who understand their complicated medical situations. Read the fine print and weigh your options carefully.

The parent company of the Medicare Advantage plan you choose will be responsible for paying your health care bills in place of Medicare paying them. You will be responsible for paying copayments, but they are typically considered affordable. Other costs associated with Medicare Advantage may include an annual deductible and coinsurance. Assistance may be available to qualify low-income participants.

There are 5 different types of Medicare Advantage Policies available:

1. **Preferred Provider Organizations (PPOs)** - These recommend the use of healthcare providers within an established network. The amount of medical cost coverage you receive will be higher when you stay within that network. 
2. **Health Maintenance Organizations (HMOs)** - These will require you to use medical providers within your designated network.
3. **Private Fee For Service (PFFS)** - These plans determine how much a health care provider will have to pay vs how much you, the beneficiary, will have to pay. 
4. **Medical Savings Account (MSA)** - These plans deposit money into a checking account used only for health care needs. This is used to pay for health care costs before your deductible is met.
5. **Special Needs Plan (SNP)** - These customized plans were designed to meet the needs of beneficiaries with certain health conditions.

It is very important to look at all the costs and coverage details of a Medicare Advantage plan before deciding if it is the right choice for you. These details can alternate greatly between different plans. As with any kind of insurance enrollment, it’s advised that you read through all the fine print, ask questions, and inquire about any features that aren’t clear to you.

Although Medicare Advantage plans can offer many benefits, there are also some disadvantages associated with their policies. Those drawbacks are something participants will want to be aware of before they become an unexpected problem. 

### Drawbacks of Medicare Advantage
Since most Medicare Advantage plans require you to see health care providers within their network of providers, you will have fewer options and less flexibility when it comes to the providers you see. This may mean parting ways with a doctor you have used for years who knows your health history.

While some Medicare Advantage plans will allow you to see doctors outside of their network, they will typically come with higher costs. This limitation may be a sticking point for those who are attached to their primary care physician.

Medicare Advantage premiums are greatly influenced by personal health factors.  This means that as you age and have changing healthcare needs, your costs have the potential to rise significantly.

### Is a Medicare Advantage Plan Right for you?
A Medicare Advantage plan may be a better option for you if you are in good overall health and if you do not expect a significant amount of healthcare-related expenses. This can help provide you with low monthly premiums and fewer unexpected costs. Medicare Advantage plans may also be better for you if you want additional coverage for things such as prescription, dental, and vision coverage.

Medicare Advantage plans are constantly being reevaluated to add coverages that are not usually addressed under Original Medicare.  Many of these benefits include transportation, in-home care, and adult daycare.  It is worth exploring your options in Original Medicare vs Medicare Advantage plans each year to make sure you are getting optimal access to all your health care needs.


Medicare Supplement plans, also known as Medigap, were designed to help cover the “gaps” in your Medicare Policy.  Medigap is supplemental insurance to your Original Medicare and helps cover the following costs:
- Copayments
- Deductibles
- Coinsurance
- Some emergency medical care when traveling outside of the United States

It is important to understand that to receive the benefits of a Medigap policy, you must also be enrolled in Original Medicare. Medigap **does not replace***italic text* Original Medicare but instead **works with***italic text* it to help cover your out-of-pocket expenses. For example, Medicare primarily pays your healthcare bills, while Medigap simply covers some of the costs that the original plan does not. 

The benefits of Medigap are standardized, meaning that you will receive the same quality and basic benefits of coverage no matter what private insurance you decide to purchase from. 

Although the benefits of Medigap are standardized, the cost is not. The cost will vary depending on the location and policy you choose. That cost is paid as a monthly premium.  This Medigap appointment is **in addition** to the Medicare Part B premium you pay. 

As with all insurance policies and plans, there are both advantages and disadvantages. Reading all the fine print ensures that you are aware of these benefits and drawbacks **before** they become an issue.

### Medigap Benefits
- You can purchase a Medigap policy from any insurance company that is licensed in your state.
- Any Medigap policy is guaranteed renewable no matter your current health problems. This means that no insurance company can drop you due to health conditions as long as you pay your premium.
- If you’re using Medigap, you won’t need referrals to see a specialist. 
- Medigap covers copayments, deductibles, and coinsurances.
- Medigap offers the freedom to choose your own doctors and hospitals. 
- Your plan may cover some care outside of the country.
- Medigap offers standardized benefits no matter what policy is chosen. 
- Medigap helps you avoid unexpected out-of-pocket costs. 

### Medigap Disadvantages
The main disadvantage of Medigap is the lack of coverage for certain, specific health care needs.  Medigap **does not cover**:
- Vision care
- Dental care
- Hearing-aid costs
- Private-duty nursing costs
- Long-term care costs

### Is a Medigap Supplement Plan best for you?
A Medigap supplement policy may be the best choice for you if you travel frequently or if you spend a significant part of the year living in a different location. This is because Medigap insurance plans provide coverage for you at any hospital or with any doctor that accepts Medicare.  The vast majority of hospitals and doctors do accept Medicare coverage, meaning you’ll be covered no matter where you are at the time services are provided. 

Medigap may also be extra appealing to those of you who prefer to continue existing relationships with your primary care physician, specialists, or hospitals, as you do not have to stay in a specific network to see providers.

If you're unsure whether to choose Medicare Advantage vs. Medicare Supplement, you're not alone. Many individuals consult a local Medicare expert to help determine which plan will work best for them. And, even if you believe you know which plan suits you best, it's wise to talk with experts who will share the information for you at no cost. 

Speak with a trusted local adviser today. 

If you're like many people, you may need assistance to sort out the best plan for you. Speak to a state-licensed Medicare specialist in your area for free. You'll get your questions answered and feel confident that you are signing up for the best plan for you. 

Medicare Advantage vs. Medicare Supplement

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The inconvenient truth is Medicare alone won’t cover all expenses.  Many Medicare participants buy added insurance to help cover unexpected costs. Which should you choose? 

Medicare Part D is a collection of plans that cover prescription drugs.  Although these plans are set forth by the Federal government, they are issued by private insurance companies. Each Medicare Part D plan will have different premiums, copayments, and medication coverages. 

When choosing your Medicare Part D drug coverage, it is important to try not to focus on only finding the lowest monthly premium.  Consider whether Part D plan covers your essential prescriptions.   It’s also important to determine what copayments apply. 

### Who Should Enroll in Medicare Part D?
As with Original Medicare, you become eligible for Medicare Part D if you are 
- age 65 or older, 
- are younger than age 65 with a qualifying disability, or 
- have been diagnosed with end-stage renal disease. 

As long as you do not have other drug coverage, we encourage you to enroll in a Medicare Prescription Drug Plan when you are eligible.  If you do not have creditable prescription drug coverage and you fail to enroll during your initial enrollment period, you may have to pay a Part D Late Enrollment Penalty.  This penalty will be added to your monthly Part D premium. 

There are two ways to receive a Medicare drug plan.  It can take the form of an individual plan that is added to your Original Medicare, or you can choose to receive your coverage through a bundled, Medicare Advantage Plan. 

### Medicare Part D Costs 
Medicare Part D costs will depend on a variety of factors including:
- Which plan is chosen
- Which prescriptions you take
- Which pharmacy you use
- Where you live (county and zip code)

When deciding on a Medicare D plan, one of the first aspects you will look at is your monthly premium.  Most premiums will cost between $17 and $76.

You will also have a yearly deductible.  This deductible is limited by Medicare to the amount of $435, meaning that you will have to pay $435 out of pocket before your plan will cover anything. 

In addition to these premiums and deductibles, you will also be responsible for copayments for each and every prescription.  Most people agree that these copayments on each prescription amount to their largest out-of-pocket expenses related to a Medicare Drug plan. 

### Will Your Prescriptions Be Covered?
There is no single plan that will cover all, or even most, prescription drugs. In addition, there are laws set that prevent certain drugs from being covered at all, including:
- Some sedatives
- Tranquilizers
- Sleeping pills
- Weight loss/gain drugs
- Over-the-counter medications

Each Medicare drug plan has a list of covered drugs called a “formulary”. Each formulary includes both brand-name and generic drug coverage. They also include at least two drugs in the most commonly prescribed categories, helping to ensure that people with different medical conditions can get access to the prescription drugs they need.  While a formulary may not cover your specific drug, there should be a similar drug available. 

Under each of these formularies, covered drugs are then divided into different levels that are called “tiers”.  These tiers were designed to help lower costs. For example, the lower the tier, the lower the cost of your copayments.  The higher the tier, the higher the cost of your copayment.

### Coverage Restrictions
In addition to formulary and tiered drug lists, there may be other restrictions on your regular medications.
#### Generic Only
Some plans only provide coverage for generic drugs, not brand-name prescriptions.
#### Substituted Drug
Some plans will be allowed to substitute a different, similar drug in place of the prescribed drug at a higher cost. 
#### Prior Authorization
This means that you or your prescriber must contact your plan with proof that the drug is medically necessary to receive coverage.
#### Step Therapy
Step therapy is another type of prior authorization that will require you to try certain, less expensive drugs on your plan’s formulary that have previously shown proven effectiveness before moving you up to a more costly medication.
#### Coverage Gaps-The Donut Hole
Unfortunately, the majority of Medicare drug plans have a coverage gap that puts a temporary limit on the amount the plan will pay and in turn, increases your out-of-pocket spending. This coverage gap is also known as the “donut hole”.

 Not everyone will reach the donut hole.  The coverage gap only begins once you reach your plan's initial coverage limit, set at $4,130 for the year 2021.  Being on the Extra Help program that assists with premiums, deductibles, and copayments also prevents you from entering the donut hole.

When you enter the coverage gap, you will be responsible for paying no more than 25% of the costs for your plans covered brand-name prescription drugs.  To assist you in getting out of the “donut-hole”, almost the full price of the drug will be counted as out-of-pocket costs, not just the percent that you pay.  

To get out of the coverage gap, you must spend $6,550 out-of-pocket.  You will then be automatically enrolled in “Catastrophic Coverage”, assuring you only pay a small amount of coinsurance or copayments for the remainder of the year. 

### Choosing the Best Medicare Part D Plan
There are a few steps you can take to help make this decision as easy as possible.  

Research what plans are currently available to you. Begin by visiting the official Medicare website and entering some personal information.  The website will then be able to provide you with a comprehensive list of all the Medicare Drug plans located near you. By consulting this list, you can also sort through to match your personal prescription drugs with the prescriptions that those plans cover. 

Deciding on the best Medicare Part D plan for you is not an easy choice to make.  If you feel uncomfortable making this complex decision on your own, please reach out to one of our highly trained staff here at SAO by entering your information here. We have all the information you need to help you make an informed decision. 

As with Original Medicare, you become eligible for Medicare Part D if you are 
- age 65 or older, 
- are younger than age 65 with a qualifying disability, or 
- have been diagnosed with end-stage renal disease. 

As long as you do not have other drug coverage, we encourage you to enroll in a Medicare Prescription Drug Plan as soon as you are eligible.  If you do not have creditable prescription drug coverage and you fail to enroll during your initial enrollment period, you may have to pay a Part D Late Enrollment Penalty.  This penalty will be added to your monthly Part D premium. 

There are two ways to receive a Medicare drug plan.  It can take the form of an individual plan that is added to your Original Medicare, or you can choose to receive your coverage through a bundled, Medicare Advantage Plan. 

Medicare Part D Prescription Drug Coverage

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Like all parts of Medicare, Medicare Part D can seem complicated and confusing to those of you who are unfamiliar with it.  By educating yourself on the basics of Medicare Part D such as coverages, how it works, and exclusions, you will be able to find the right plan to meet all of your needs.  

Medicare Part D

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