It’s Your Last Chance..

The Medicare Access and CHIP Reauthorization Act of 2015 eliminates all Medigap Plans that cover the Medicare Part B deductible.

A deductible is an amount of money you must pay out of pocket before your plan will begin covering services. The Part B deductible in 2019 was $185 and is projected to be $197. Medicare Part B covers most of your outpatient services. Things such as Doctor visits, labs and tests, durable medical equipment, and some medications. That means, unless a preventative care visit, you would have to pay out of pocket $197 before your plan would cover you.

Why would Congress decide to pass a law that prevents an out-of-pocket expense like this? Some members of Congress believing Medicare beneficiaries are over-using healthcare services. 

 When someone doesn’t have to pay for Medical services, it is thought that they would overuse the system. By making everyone meet the Medicare Part B deductible, Congress believes Medicare Claims will be reduced.


 There are many Critics who believe the deductible will stop people from getting the care they need. When people put off some issues, they end up with not only more serious but more costly conditions later on. Besides that, there is issues of costs for all seniors in every income bracket. The low-income Seniors will be hit with high out-of-pocket expenses they aren’t  used to and any Senior who makes over $85,000/yr will pay 30-80% more than the standard premium. The Standard Part B Premium for 2020 will be $144.30/month. This is in addition to the yearly Part B Deductible.

So, how can you prevent yourself from having to have that Part B Deductible? Well, you have two choices; The first is that you can choose a Medicare Advantage Plan (MA/MAPD). A Medicare Advantage Plan is also called “Medicare Part C” and is a policy from a Private Insurer that is contracted through Medicare. These policies “replace” your Medicare Part A and Part B and some of them have Medicare Part D included to cover your Prescription Drugs.

An MA/MAPD policy is a good option, however, you still usually have high out-of-pocket costs through co-pays, co-insurance and you may have to get a policy that requires referrals to see your Specialists. MA/MAPDS by law, must offer the same or better coverage as Original Medicare A & B, so there are many different coverage options and the premiums differ from area to area. Here at Total Benefit Solutions, Inc we specialize in all Medicare policies, including MA/MAPDs, so if you wanted to discuss these types of policies, give us a call at 215-355-2121.

The Second option is to sign up on a Medigap Policy, and not just any Medigap Policy, but Plan C or Plan F because these policies cover your deductible as well as much more with $0 out-of-pocket costs to you.

Here is a look at the Medigap Structure (Note not all plans avaliable in all areas or at all after 12/31/19)

As you can see, Plan F gives you the MOST coverage. Plan C also covers most of your services as well. In addition to these plans, there will be two high-deductible policies to replace Plan F and Plan C starting Jan 1st, 2020. So how can you lock in one of these plans, forever?? It’s simple. If you became eligible for Medicare prior to January 1st, 2020, you are allowed to sign up for these two policies, which grandfathers you in. If you are Medicare-eligible after Jan 1st, 2020, unfortunately you will not be able to sign up for the current Plan C or Plan F.

Now the big question is how does a Medigap Policy work. A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare (Part A and Part B). With a Medicare Advantage Plan, the Plan “Replaces” your Original Medicare coverage, while with a Medigap policy, Medicare and your Medigap policy each pay its share of covered health care costs. Like Medicare Advantage Plans, these policies may offer extras not included in Original Medicare. Unlike most Medicare Advantage Plans, you have more access to Doctors and services since you do not need a referral.

Not sure if you should get a Medigap or a Medicare Advantage Plan? Here are some prime differences between the two products:

Cost: Medigap coverage usually has a higher monthly premium, but could result in lower out-of-pocket expenses than some Medicare Advantage plans. Medicare Advantage plans, on the other hand, generally cost less and cover more services, which can be the better option for your budget. 

Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.

Lifestyle: Medicare Advantage plans often only operate within a certain region. If you’re a snowbird living in more than one state throughout the year, traditional Medicare plus Medigap is probably a better choice than an Advantage plan. This may also be true if you travel frequently: Some Medigap plans provide coverage when traveling outside of the United States and cover you in all 50 states; Advantage plans generally do not.

Choosing the right Medicare Policy is a hard and difficult choice. You have to look at your different choices, find out which plans will cover the services, Rx and Doctors you want to see and you have to determine if a Medigap or a Medicare Advantage Plan is your best bet. Due to this, here at Total Benefit Solutions, we have Account Reps who specialize in only Medicare and look at your individual situation to help you determine your best fit that gives you the best coverage for you at the lowest price. Give us a call today at 215-355-2121.