Frequently Asked Questions

Medicare is the federal health insurance program for:

• Most people age 65 and over
• Certain people younger than 65 with disabilities
• People with amyotrophic lateral sclerosis (ALS) , also known as Lou Gehrig’s disease
• People with end-stage renal disease (ESRD) , also known as permanent kidney failure

Medicare covers health care services and items that are medically necessary and reasonable as follows:

• Medicare Part A covers inpatient hospital stays, inpatient skilled nursing facility stays, home health care and hospice care.
• Medicare Part B covers outpatient medical services such as doctor visits, diagnostic lab tests and preventive care.
• Medicare Part D covers most prescription drugs

 Most people supplement Medicare with some other form of coverage, such as a Medigap plan, retiree plan, or Veterans Affairs (VA) benefits (if they qualify). Others receive Medicare through private health plans called Medicare Advantage (MA) plans. To learn about the different ways to supplement Medicare, please give us a call today! 314-306-9217

There really is no "better" option. It all comes down to personal preference and what you are looking for in a health insurance plan.

Medicare Advantage plans are popular for their low (or no) cost monthly premium and added benefits such as dental, hearing, and vision coverage (among other benefits). With Medicare Advantage plans, you are responsible for paying copayments and coinsurance as you use medical services. We refer to this as the "pay-as-you-go" option. Most Medicare Advantage plans are network-based meaning you can only see doctors within the plan's network and often need a referral from your primary care physician in order to see a specialist.  Outside of emergency care, seeing a provider outside of your network will typically result in higher costs or may not be covered by insurance at all.

Medicare Supplement plans are popular for their flexibility and predictable costs. They do come with a higher monthly premium, however, you will pay little to no out pocket costs beyond your premium. It also comes with additional flexibility as you can see any doctor in the country who accepts Original Medicare whenever you want or need to. You can also see specialists without the need for a referral. Medicare Supplement plans typically do not come with additional benefits like dental, vision and hearing coverage, though additional coverage can be purchased. Supplements are popular among our clients who spend long periods of time in different parts of the county and those looking for very consistent and predictable out-of-pocket costs. 

 Medicare Supplement policies serve as your secondary source of insurance after Medicare pays. Supplements fills in the “gaps” between what Medicare pays for covered services and what you are charged. Some plans offer extended coverage for Part B excess charges and foreign travel emergency costs.

There are ten standardized Medicare Supplement plans that are regulated by federal and state governments. Two of the ten plans (F and G) are the most comprehensive plans and also offer high-deductible versions. All plans are not available in all states.

Medicare Supplement policies may include the following benefits:

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
• Part B coinsurance or copayment
• The first three pints of blood
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible (only certain plans for people eligible for Medicare before January 1, 2020)
• Part B excess charges
• Foreign travel emergency services
• Out-of-pocket limits

Roughly 2 in 10 Medicare beneficiaries have a Medicare Supplement policy. There are a number of reasons for choosing this type of policy including:

• Rely on Original Medicare for your health care coverage. There is no cap on what you may pay for Part A and Part B services, so if you need much healthcare, your out-of-pocket costs for deductibles, copays, and coinsurances may be high and unpredictable. A Medigap plan offsets your portion of costs.
• Want freedom of choice of providers because you can see any Medicare provider in the U.S.
• Travel abroad and want coverage for emergency care.
• Anticipate the need for frequent healthcare now or in the future.
• Are in your initial open enrollment period and are guaranteed the opportunity to join a plan regardless of your health condition.
• Can afford the monthly premiums
• Don’t want a Medicare Advantage Plan