If you are new to Medicare, or simply want to review your options, you might wonder if you should purchase a Medicare SELECT plan. This type of coverage helps to cover the gaps in original Medicare, while offering a low-cost alternative to other types of Medigap plans. But what is Medicare SELECT, and is it right for you?
Decoding the ABCs of Medicare
Medicare is a bit of an alphabet soup, with many different available parts. Before you can decide what type of coverage you need, it’s important to understand the various parts and how they work together.
Medicare Part A is hospitalization insurance. If you need a hospital stay, or another covered service such as hospice, this part will pay the bill. It is free for everyone who worked and paid Medicare taxes starting at age 65 (or earlier, if you have a qualifying disability).
Medicare Part B covers general medical services, such as doctor visits and screenings. You will become eligible at the same time as Part A, but you will need to actively enroll and pay a small monthly premium. You will also have a low deductible.
Medicare Parts A and B, when taken together, comprise original Medicare. It’s a good program, but there are some limitations. Original Medicare does not cover all services that may be required. It doesn’t cover prescription drugs. And you will need to pay coinsurance for each claim (typically 20% of the bill), with no limit on out-of-pocket costs.
Medicare Part C, also known as Medicare Advantage, is one solution to plugging the gaps in original Medicare. This is a type of health insurance offered by private companies such as BCBS of Kansas. It offers the same benefits as original Medicare, along with additional coverages and annual out-of-pocket limits. Some Part C policies also include Part D, which is prescription drug coverage. This is a good option, but it’s not the only one.
While Medicare Advantage can be seen as a sort of Medicare replacement, Medigap plans, also known as Medicare Supplement plans, work in tandem with original Medicare. Parts A and B pay first, and then the Medigap plan pays its share of the remaining costs. There are a lot of different Medigap plans, each with its own letter, but they are all standardized across states and insurance companies. Each plan letter offers certain specific benefits beyond original Medicare, such as additional coverage and/or out-of-pocket limits.
What is a Medicare SELECT policy?
Medicare SELECT is a lower-cost alternative to Medigap. While Medigap allows you to visit any doctor that accepts Medicare, Medicare SELECT plans require you to use providers, including both doctors and hospitals, within a local network. Otherwise, the plans are exactly the same as their Medigap counterparts. For example, Plan G SELECT is identical to Plan G, as long as you stay within your network.
When can I enroll in Medicare SELECT or change my plan?
It’s best to enroll in Medicare SELECT during your Initial Enrollment period because there is no medical underwriting required. This is a seven-month window that starts three months before you become eligible for Medicare. If you miss this window, you can enroll at any time. But if you don’t sign up initially, you will need to undergo a medical underwriting. If you have a preexisting condition, you may be denied coverage or need to pay a higher premium.
You cannot have both a Medicare Advantage (Part C) plan and a Medigap plan (including Medicare SELECT). If you want to switch from Medicare Advantage, you’ll need to do so during the Annual Enrollment period, which runs from October 15th through December 7th each year. If you want to switch from one Medigap plan to another, you can do this at any time, subject to medical underwriting.
What happens if I need health care while traveling?
Medicare SELECT plans only pay for standard health care when you are in the network. But if you have a medical emergency while traveling, you can get coverage at any facility that accepts Medicare. If you are on a Medicare SELECT plan, be sure to get your routine medical care while you are in your home area.
What if I use an out-of-network hospital for a pre-planned inpatient procedure?
A pre-planned procedure, such as a knee replacement, is not considered a medical emergency. If you have a Medicare SELECT plan and decide not to use a network hospital for your pre-planned inpatient procedure, Medicare will still pay its share of the approved charges. But the Medicare SELECT policy will not pay. You will be responsible for your portion of all charges under original Medicare rules, such as 20% coinsurance with no out-of-pocket limit.
How do I know if Medicare SELECT is right for me?
When selecting a Medicare Supplement plan, consider what your own personal needs are. Let’s look at two examples.
First up is Sara. She has Blue Cross Medicare SELECT Plan G to help cover costs not covered by her original Medicare. For her planned knee replacement, her doctor referred her to a hospital that is part of the SELECT network. This ensured that Sara would get the full benefits of her particular plan.
Next up, let’s look at Bob. Bob was diagnosed with cancer when he was 60 years old but is now in remission. When he turned 65, he decided not to go with a SELECT plan, because he wanted to be able to return to his preferred hospital in Texas if his cancer recurred. Instead, he signed up for a Blue Cross Medicare Supplement Plan G.
Both Sara and Bob enjoy exactly the same benefits from their Plan G Medigap policies. But their needs are different. Sara is saving money by choosing a SELECT plan, while Bob is keeping his options open with a traditional Medicare Supplement plan.
The alphabet soup of Medicare can be confusing. But Blue Cross Blue Shield of Kansas is here to help you every step of the way. To learn more about Medicare SELECT plans or any other type of Medicare Supplement, call BCBSKS today at 866-627-6705.