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Medical News Today
02-06-2025
- Business
- Medical News Today
Medicare and preexisting condition waiting periods
Original Medicare and Part C plans cannot deny coverage based on preexisting conditions. However, a waiting period for enrolling in Medicare due to preexisting conditions can apply to a Medigap plan. Due to the Affordable Care Act (ACA), Original Medicare (parts A and B), Medicare Advantage (Part C), and Part D drug plans cannot impose waiting periods for preexisting conditions or deny coverage based on such conditions. However, Medicare supplement (Medigap) plans are not subject to the ACA. For this reason, people who wish to sign up for a Medigap plan should be aware of enrollment and waiting periods where preexisting conditions might be applicable. Medigap initial enrollment period Private companies approved by Medicare offer Medigap plans, which are also called Medicare supplement plans. These plans cover costs that Original Medicare does not cover, such as deductibles, coinsurance, and copayments. Since Medigap plans do not provide direct medical coverage and do not meet the ACA's minimum essential coverage requirements, insurers can deny coverage due to preexisting conditions. However, other federal laws impose certain restrictions, one of which applies during the initial enrollment period. When a person turns 65 and enrolls in Medicare Part B, they enter a six-month Medigap open enrollment period. During this time, they can choose any Medigap policy without undergoing medical underwriting. Insurers cannot deny them coverage based on preexisting conditions, allowing the person to select the plan that best fits their needs. If a person misses this enrollment period, they may face higher costs or experience coverage denial. Additionally, those under 65 who qualify for Medicare due to a disability might have to wait until they reach 65 before Medigap insurers must legally offer them coverage. » Learn moreDoes Medicare cover preexisting conditions? Insurance companies can refuse to enroll a person in a Medigap plan based on preexisting conditions if the person applies outside the initial 6-month enrollment window. However, exceptions exist in which a person can get protection from coverage denial even after this period ends. These exceptions, called 'guaranteed issue rights,' apply in the following specific circumstances: A Medicare Advantage Plan either changes, becomes unavailable in the person's area, or the person moves outside its service zone. A person with Original Medicare and an employer or union plan that offers coverage after Medicare, including the Consolidated Omnibus Budget Reconciliation Act (COBRA), loses that coverage. A person with Original Medicare and a Medicare SELECT policy moves out of the policy's service area. A person who initially joined a Medicare Advantage Plan or Programs of All-Inclusive Care for the Elderly (PACE) when they first became eligible for Medicare decides to switch to Original Medicare within the first year. A person who switched to a Medicare Advantage Plan (or Medicare SELECT) within the past year now wants to switch again. A person's Medigap insurance provider goes bankrupt or cancels a person's policy through no fault. A person changes or cancels their Medicare Advantage plan or Medigap policy due to a violation or misleading information from the provider. Additionally, some states may have additional 'guaranteed rights' beyond what federal regulations require. » Learn more:What to know about Guaranteed Issue in Medicare Ten Medigap plans offer different levels of coverage. A person who has held their current Medigap policy for more than 6 months and wants to switch to the same Medigap plan offered by another insurance plan cannot experience coverage denial based on preexisting conditions, nor do they have to wait for coverage. But if a person wants to switch between different Medigap plans, they may have to wait 6 months for coverage. This is known as the preexisting condition waiting period. However, their new insurer should account for the period when the person has had coverage from their existing Medigap plan. For example, if a person has had 2 months of coverage before switching, their new policy should only impose an additional 4-month wait. Medicare Advantage trial period Medicare Advantage (Part C) plans must offer coverage equivalent to Original Medicare (parts A and B). According to the ACA, insurers providing Part C plans cannot deny coverage based on preexisting conditions. However, since a person can only have Medigap for Original Medicare expenses, they must discontinue their Medigap plan if they choose a Part C plan. For this reason, Medicare grants a 12-month trial period to allow a person to test a Part C plan without losing their Medigap coverage. The person may leave the Part C plan and return to Original Medicare within this period. In that case, they can rejoin their previous Medigap plan or select a new one without medical underwriting. Original Medicare (parts A and B), Medicare Advantage (Part C), and Part D prescription plans have no preexisting conditions waiting periods. This means these plans cannot deny coverage because of preexisting conditions. However, specific enrollment and waiting periods for preexisting conditions might apply to a Medicare supplement (Medigap) plan. These include a 6-month initial enrollment period, guaranteed issue rights, and a 12-month trial period to test a Part C plan. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Medical News Today
02-06-2025
- Business
- Medical News Today
Medicare plans in North Dakota
Medicare offers various plans and coverage options, from Original Medicare to Part D drug coverage and Medicare Advantage (Part C). In North Dakota, the best options depend on a person's finances and healthcare needs. Medicare is a health insurance program that the government funds. It is accessible in North Dakota for individuals ages 65 and older or for those with specific health conditions or disabilities. This article examines all the Medicare plan options available to North Dakota residents and factors to consider when selecting a plan, including costs and eligibility criteria. Does North Dakota have Medicare? Original Medicare, consisting of parts A and B, is accessible throughout the United States. Part A covers inpatient hospital stays, skilled nursing facilities, and hospice care, while Part B covers outpatient medical services and certain medications. Whereas the government offers Original Medicare, private insurers offer other Medicare plans. These are: Medicare Part D: This covers prescription medications. This covers prescription medications. Medicare Advantage (Part C): This is an alternative to parts A and B and offers the same benefits, along with additional ones such as dental and vision coverage in some instances. This is an alternative to parts A and B and offers the same benefits, along with additional ones such as dental and vision coverage in some instances. Medigap: This helps cover out-of-pocket expenses associated with Original Medicare, such as deductibles, premiums, and coinsurance. Residents of North Dakota can access these plans, although the specific options and associated costs depend on the insurer, the particular plan, and the individual's code. These ratings, which reflect the plan's performance from the past year, provide an understanding of its overall quality. Plans rated 3 stars or less may not deliver adequate coverage and service, so choosing plans with 4 stars or more might be advantageous. In North Dakota, NextBlue of North Dakota, which the Blue Cross Blue Shield Association offers, received a rating of 4 for its Part C plans, 4.5 for its Part D plans, and an overall rating of 4. Who qualifies for Medicare in North Dakota? In North Dakota, Medicare eligibility criteria are identical to those across the United States. Individuals qualify for Original Medicare if they are 65 or older, younger individuals receiving disability benefits, or those with a diagnosis of specific diseases. The chart below outlines these Medicare eligibility criteria: A person who qualifies for Original Medicare in North Dakota can also enroll in Medicare Advantage (Part C), Part D, or Medigap. However, it is important to note that Medigap is only usable in conjunction with Original Medicare. How much does Original Medicare cost in North Dakota? A person does not pay a premium for Medicare Part A if they have worked and paid Medicare taxes for at least 40 quarters, roughly 10 years. However, someone who has worked between 30 and 49 quarters must pay a Part A premium of $285. For those who have worked less than 30 quarters, the premium is $518. Other costs for Medicare Part A include: Annual deductible: This is $1,676. This is $1,676. Copayments: These include: $0 for the first 60 days of a hospital stay. $419 per day from days 61 to 90. $838 per day from days 91 to 150. After this, the individual covers all expenses. These include: Coinsurance: A 20% coinsurance fee applies to durable medical equipment (DME) needed at home, such as wheelchairs or walkers, needed during a hospital stay. For Medicare Part B, the typical premium is $185, and the deductible is $257. After meeting the deductible, individuals are responsible for a 20% coinsurance on eligible services. Income limits Eligibility criteria include total income and resource limits based on family size. Generally, in North Dakota, the Medicare Savings Program (MSP) income limits are $1,781 for an individual and $2,400 per couple. Still, depending on the type of MSP and a number of people in a household, these figures can vary as follows: The asset limits are generally $9,660 per individual and $14,470 per couple, plus an additional $1,500 for burial funds. How much do private Medicare plans cost in North Dakota? For privately managed Medicare plans such as Part C, Part D, and Medigap, a person's coinsurance, copayments, and annual deductibles will differ depending on the plan type and insurer. In 2025, the average monthly premium for Part C plans across the nation will be approximately $17, and the national base beneficiary premium for Part D will be $36.78 . Like in other states, some North Dakota Part C and D plans offer $0 premiums. Additionally, the most recent estimate for the average Medigap premium, from 2023, is $217. In addition, a person may wish to be aware that if they qualify for Extra Help, they can save money on their Part D prescription drug costs. The following table includes the annual income and resource limits to be eligible as an individual or couple. A person eligible for Medicare can choose between Original Medicare (parts A and B) or a Medicare Advantage plan (Part C). They also have the option to add Medicare Part D for drug coverage and Medigap. Several private insurers offer Part C, D, and Medigap plans in North Dakota. However, Medigap is only usable with Original Medicare. Comparing the Medicare plans in North Dakota is crucial to find the one that best meets a person's healthcare needs and budget. For guidance on plans or to initiate the enrollment process after making a decision, a person can contact Medicare, the plan provider, or their local State Health Insurance Assistance Program (SHIP) counselor. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
23-05-2025
- Business
- Health Line
Why Are Some Medicare Advantage Plans Free?
Medicare Advantage plans aren't free. Sometimes called Medicare Part C, private insurers administer these plans, and they may offer $0 premium options. However, plans may have other out-of-pocket costs. Private insurance companies administer Medicare Advantage plans. They're available to anyone eligible for Medicare. Plans include all of the benefits of Original Medicare but typically also include prescription drug coverage and additional benefits, such as: dental vision hearing fitness How can a Medicare Advantage plan be free? If you shop around for a Medicare Advantage plan, you may notice that private insurers advertise some plans as 'free.' Some insurers may refer to Medicare Advantage plans as free because the plans offer a $0 monthly enrollment premium. This offer makes them attractive for people looking to save money on monthly Medicare costs, but other costs exist. A free Medicare Advantage plan means the insurer offers a $0 monthly premium. However, there may be other costs, such as deductibles, coinsurances, and copayments, and you must still pay the Medicare Part B premium to Medicare, which in 2025 is $185. When a private insurance company contracts with Medicare, it receives a set amount of money to cover parts A and B insurance. The company could save money elsewhere by using in-network doctors and facilities. In that case, it could pass those extra savings to members, resulting in a 'free' monthly premium. These 'free' Medicare Advantage plans are also great for companies to advertise attractive savings to potential beneficiaries. Are $0 premium Medicare Advantage plans really free? Even though private insurers advertise $0 premium Medicare Advantage plans as free, you still have to pay some out-of-pocket costs for coverage, such as: Medicare Advantage plan monthly premium: If a Medicare Advantage plan is truly free, you don't have to pay a monthly premium to enroll. Part B monthly premium: You still need to pay the Part B premium to Medicare. In 2025, the Part B premium is $185 per month for most people, although it may be higher depending on your income. Deductibles: Most Medicare Advantage plans have two types of annual deductibles. One is for the bundles of inpatient and outpatient coverage for Part A and Part B, and the other is for prescription drug coverage if the plan includes it. Coinsurance/copayments: Most Medicare Advantage plans charge copayments. A copayment is the out-of-pocket fee you pay every time you receive medical services. Some plans may also charge coinsurance, which is a percentage cost toward billed services. Medicare Advantage plan costs can also differ based on their structure. For example, Preferred Provider Organization (PPO) plans charge different out-of-pocket costs based on whether you use a provider that's in or out of your network. Do you qualify for $0 premium Medicare Advantage plans? There are no qualifications for free Medicare Advantage plans. When searching for a Medicare Advantage plan online, you can usually sort the search results page by 'lowest monthly premium' to see $0 premium Medicare Advantage plans in your area. Another way to keep track of your Medicare Advantage costs is to pay attention to the Evidence of Coverage (EOC) form and annual notice of change (ANOC). Your plan sends them each year, and they can help you stay on top of any price changes or fee increases. Resources to help cover Medicare costs One of the most important ways to manage your Medicare costs is to use the resources available to help cover or lower your costs. These resources include: Medicare savings programs: These programs can help low income beneficiaries pay Medicare Advantage premiums, deductibles, copayments, and coinsurance. Supplemental Social Security: This benefit offers a monthly payment to people who are disabled, blind, or above 65 years old. This payment can help cover Medicare costs. Extra Help: This program can help with prescription drug costs and is available to people with low income and limited resources. Programs of All-Inclusive Care for the Elderly (PACE): This program can help you manage your healthcare needs from within your community. The takeaway Free Medicare Advantage plans mean private insurance companies don't charge a monthly premium. While private insurers advertise these plans as free, you still have to pay the standard out-of-pocket costs, including premiums, deductibles, and copayments. You also still need to pay the Part B premium directly to Medicare. If you qualify for Medicare and are a part A and B enrollee, you can search for $0 premium Medicare Advantage plans in your area. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
