What is the best Medicare Supplement Plan in PA? This article discusses why enrolling in a Medicare Supplement Plan is important, when to enroll, how to select a plan, and how to maintain coverage throughout your retirement.
Why should I enroll in a Medicare Supplemental Plan?
Medicare Part A and Part B, also known as Traditional Medicare or Original Medicare, do not provide all of the coverage you’ll need to protect yourself from major medical expenses during your retirement.
Medicare Part A provides hospital coverage. In most cases, there is no premium due for Medicare Part A (as long as you or a spouse has 40 quarters of qualifying employment).
While many services are partially covered, significant gaps exist. For example, as of 2020, there’s a deductible of $1,408 for each “benefit period”. Regarding co-insurance payments for hospital stays, Medicare Part A covers:
Day 1 to Day 60 with $0 co-insurance required from the insured.
However, from Day 61 to Day 90, the co-insurance amount the insured must pay is $352 per day.
Beyond Day 91, 60 “lifetime reserve days” are covered at a co-insurance cost to the insured of $704 per day. Once these 60 “lifetime reserve days” are used up, you are on the hook for all costs.
Medicare Part B provides coverage for doctors’ services and preventive care. As of 2020, the standard premium for Medicare Part B is $144 per month.
However, the Medicare Part B premium varies based on income (see 2021 Part B Premium Table below). The Part B premium is as high as $505 per month for those in the top tax bracket. Remember that in retirement, Required Minimum Distributions from pre-tax IRA accounts can bump up your tax bracket. This not only increases your tax liability, but may also increase the cost of your Medicare Part B and Medicare Part D premiums.
In 2020, there’s also a yearly Part B deductible of $198. After the deductible is met, the insured is responsible for a 20% co-insurance payment for any covered service. 20% of a doctor’s bill can be a lot of money. Depending on how often medical services are used, the 20% co-insurance payment can be enough to inflict real damage to your long-term retirement security.
Among other things, Medicare Supplement Plans pay for the unpredictable and often very large co-insurance payments that you would otherwise be on the hook to pay for yourself with Part A and Part B only.
How do I choose a Medicare Supplement Plan?
Medicare Supplement Plan G is the most comprehensive plan currently available to those who are not already enrolled in a Medicare Supplement Plan.
Medicare Supplement Plan G covers all co-insurance and co-payments due under Medicare Part A & Medicare Part B. With Plan G, you still pay the Medicare Part B annual deductible, which is $198 per year.
After the deductible is met, you no longer have to pay the 20% co-insurance for services covered by Part B. Plan G also covers “excess charges”, which occur when the healthcare provider bills for more than the Medicare-approved amount.
The other type of Medicare Supplement Plan that covers “excess charges” is Plan F, which is scheduled to be phased out in 2020 for those not already enrolled in it.
Coverage through Plan F and Plan G are the same other than the $198 per year annual Medicare Part B deductible. Plan F covers this $198 annual deductible and Plan G does not.
However, you pay a higher premium for Plan F, and it doesn’t always make financial sense to pay a higher monthly premium for Plan F for the sole benefit of having the $198 per year Part B deductible covered.
Most importantly, both Plan G and Plan F pay the potentially very significant co-insurance costs and co-payments that you would otherwise have to pay yourself if you were only enrolled in Part A and Part B coverage.
For those not already enrolled in Plan F, Plan G is the most comprehensive Medicare Supplement Plan currently available.
Medicare Supplement Plans are heavily regulated by federal and state law. Plans in Pennsylvania are standardized. Online tools such as ehealthmedicare.com provide quotes from different insurance companies in your area.
On the website, you can see for yourself how much each insurer charges for Plan G, and you can also see all of the other Medicare Supplement Plans available in your area as well.
How much does Medicare Supplement Plan G cost in Pennsylvania?
Cost varies based on zip code, age, sex, and tobacco use. We ran quotes as of 2020 on the website ehealthmedicareplans.com for Philadelphia, Villanova, Berwyn, Malvern, Newtown, Yardley, and Langhorne, all in Pennsylvania. All locations had the same rates.
For 65-year old male non-smoker, Plan G options were available at $154 per month. Plan G was $134 per month for a 65-year old female non-smoker.
For 75-year old male non-smoker, Plan G options were available at $193 per month. Plan G was $168 per month for a 75-year old female non-smoker.
For 85-year old male non-smoker, Plan G options were available at $265 per month. Plan G was $230 per month for an 85-year old female non-smoker.
For 95-year old male non-smoker, Plan G options were available at $269 per month. Plan G was $238 per month for a 95-year old female non-smoker.
Note that relocating during retirement may impact your Medicare Supplement Plan premiums. For example, clients who have retired to the Carolinas will usually pay less for Medicare Supplement Plans compared to clients in the Greater Philadelphia Area.
When do I enroll in a Medicare Supplement Plan?
Your “Initial Enrollment Period” starts three months before your 65th birthday and lasts until three months after your 65th birthday. However, if you receive group health insurance through either your employer or your spouse’s employer, then in most cases you aren’t required to enroll in Medicare at age 65. Instead, you’ll be eligible to enroll during a “Special Enrollment Period” after your employer-provided health insurance coverage ends.
If you fail to enroll in Medicare when you are required to, you can face a lifetime penalty on your Part B premiums (a 10% penalty for each 12-month period you should have been enrolled, but weren’t).
Possibly even worse, you can also be excluded from coverage by a Medicare Supplement Plan, such as Plan G, if you do not enroll when you are initially required to enroll in Medicare.
Medicare Supplement Plans cannot deny coverage due to pre-existing conditions the first time an insured becomes eligible to enroll, but they can deny coverage due to pre-existing conditions if the insured doesn’t enroll the first time they are eligible.
How do I enroll in a Medicare Supplement Plan?
A fiduciary financial advisor who specializes in retirement planning will often have a Medicare Planning specialist on-call who can help clients with Medicare Supplement Plan selection and enrollment, as well as Medicare Part D prescription drug plan selection and enrollment.
We've had good past experience referring clients to this Medicare Planning company to help with selecting and enrolling in coverage: HTA Financial
For a self-directed approach, ehealthmedicare.com and many other online shopping tools are also available.
Can I change my Medicare Supplement Plan after I’m enrolled?
You may decide to switch Medicare Supplement Plans at some point. For example, you may find that another credible insurer is charging less for the same coverage, or you may want to upgrade to better coverage.
You can shop for a new Medicare Supplement Plan at any time. However, in most cases you will be required to undergo medical underwriting when changing plans. Also, it's possible that you can be denied coverage for pre-existing conditions when changing plans.
As long as you continue paying your premiums, Medicare Supplement Plan coverage automatically renews each year. You cannot be removed from a plan as long as you continue paying your premiums on time.
Enrolling in a good Medicare Supplement Plan, especially Plan G, is a simple yet important step towards protecting your long-term financial security throughout your retirement.
Healthcare planning is well within our scope of work as a fiduciary financial advisor who specializes in retirement planning.
Would you like a 1-on-1 retirement planning consultation? Fill out the “Request Consultation” form, call us at 267-427-5667, or email kyle.rolek@rolekretirement.com