Medicare Supplements Plans - Tips For Coverage

Why A Medsupp Plan May Be a Better Choice

Boise Health & Life Insurance Agency & Chris Antrim Insurance Brokers can help with all your Medicare Advantage and Medigap needs and questions. Call or text today for a review of your current plan. Idaho now has the new birthday rule, meaning Supplement policyholders can now switch plans every year on your birthday. Save money and get the best plan.

9727 W Cory Ln

Boise, ID 83704

208-409-3382

If you're researching your health care options in general and your Medicare supplement options then this article is for you. Even if you already looked at different plans locally or online, this article hopefully will provide you new information that will help you make an informed decision. and avoid taking on unneeded risk. 

My hope is that I am going to help you understand your Medicare supplement plans and their role in your healthcare. I'm going to reveal to you how to determine what the possible best plan is and what they may or may not cover. 

Hello, I’m Chris your Boise Medicare Supplement specialist. My agency is an independent insurance broker specializing in Health Coverage, Life Insurance, Long Term Care and retirement needs. We help our customers with their insurance decisions throughout the entire state of Idaho. 

My and my agency's philosophy when helping or clients with their health care choices is to first review and understand your choices. You should first shop in the local marketplace, you can do this online or with the help of a local broker or agent like our staff. This is your insurance plan, it is important to review everything especially if you have a health issue. If you cannot find a policy that meets your needs, either with coverage or budget. You may consider a Medicare advantage plan. 

Medsupps Vs. Medicare Advantage Plans

The first thing to understand about Med supplement plans is this; if you chose a Medigap plan, it means you've also chosen to get original Medicare as your primary insurance. That red, white and blue card; that is your primary coverage. Because original Medicare is your primary coverage the benefits of that coverage pass on to your supplement, which is your secondary insurer. Your insurance plan you purchase picks up the other 20% not covered. This is true no matter which plan you have, or which insurance company that you choose. 

This is very important and it is often misunderstood. What are the benefits of original Medicare that pass on to your supplement plan? First, with the original plan you can see any doctor, go to any hospital in the US or it's territories as long as they accept Medicare. Because this is a feature of Original Medicare, it's a feature of any supplement plan you have, from any insurance company. Second is that the intent of your original plan is to cover everything that's medically necessary.

Your supplement will cover the copays and deductibles of all of your Health Care approved by Medicare and it will cover what is medically necessary. Just think of it like this, if your doctor tells you to have something performed it probably is medically necessary. If you are electing to have a procedure is done that doesn’t affect your health in any fashion, it most likely is not necessary and not covered. Our agents can explain this in more detail when we visit for your review. 

To determine medically necessary they really lean on your doctor. It depends on your doctor's diagnosis and your doctor's opinion. With original Medicare as your primary Health Care, any supplement you have will follow the direction of Medicare to determine what is or is not covered and Medicare depends on your doctor's diagnosis and opinion. The bottom line is your supplement will cover the copays and deductibles of all of your healthcare approved by and will cover what is medically necessary. 

Which brings me to my favorite benefit of having original Medicare. With original Medicare, the for-profit insurance companies are taken entirely out of the decision-making process. They have absolutely no say in what is covered, who is paid or how much. All they do is what Medicare tells them to do. This means that because you have original Medicare no matter which supplement plan or which insurance company you choose you to retain the right to see any doctor or go to any hospital. Plus, neither you nor your doctor ever has to ask an insurance company for permission to have a procedure. 

Please call the office with any questions! 208-409-3382

Idaho Birthday Rule for Medicare Supplement plans information

Idaho’s laws and rules for Medicare Supplement policies have changed. The Idaho legislature approved legislation to provide additional options and consumer protections for Idaho seniors. The Idaho Department of Insurance (“the Department”) published a temporary rule on November 3 related to Medicare Supplement policies in accordance with Senate Bill 1143, signed by Governor Little on April 22, 2021. The rule proposed went through negotiated rulemaking as required. 

The rule, IDAPA 18.04.10, was published November 3 in the Administrative Bulletin Volume 21-11, and includes two major changes effective after February 28, 2022:

1. Medicare Supplement policyholders may change their insurance company and/or plan annually regardless of health conditions during a 63-day enrollment period beginning on the policyholder’s birthday; and 
2. Premium rates for new Medicare Supplement policies (including when changing insurance companies) will no longer be based on the age of the applicant. This is referred to as “community rating.”

The proposed rule also prohibits charging application fees, higher premium rates based on the method of payment, and other unfair trade practices.

It is important to know that current Medicare Supplement plans are guaranteed renewable, and current policies will continue unless a change is requested by the policyholder. These rule changes provide flexibility to current Medicare Supplement policyholders who wish to change their policy, but no change is required. After February 28, 2022, existing Medicare Supplement policyholders may choose to shop for comparable community-rated coverage starting the day of their birthday.

The Department hosted public webinars on this topic on November 18, 2021 and February 15, 2022. The presentation slides from the February 15, 2022 event are available by clicking the following link  Changes to Idaho’s Medicare Supplement Rules 2022 Update

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