WHY IS PLAN F GOING AWAY?

On Jan. 1, 2020, MACRA officially takes effect. The Medicare Access and CHIP Reauthorization Act (MACRA) is the Federal Law that will be impacting Medicare Supplement plans in all states. Only beneficiaries with existing Plan F coverage will be able to keep Plan F. Plan G will be the new “go-to” plan for those newly eligible for coverage after Jan. 1, 2020.

WHAT IS PLAN G?

Medicare Parts A and B provide insurance coverage for health-related expenses, but they don’t cover all of the health care costs you may have. While all Medicare Supplement plans help offset those costs, Plan G will now offer the most comprehensive coverage for those becoming newly eligible to Medicare.

WHAT’S THE DIFFERENCE BETWEEN PLAN F AND PLAN G?

The key difference between Plan F and Plan G is that Plan G does not cover the Part B deductible. This is because the federal government wanted to have each beneficiary have a vested interest in their care. The good news: premiums for Plan G are generally less expensive by more than the $250 deductible amount. Meaning although you’ll be responsible for the $250 deductible, you could save more than $350 in total premium. (Premium savings will vary by carrier.)

WHAT DOES PLAN G COVER?

If you choose Medicare Supplement Plan G from Erie Family Life, you won’t incur any out-of-pocket costs for expenses such as:

• Part A deductible
• Part A hospital copayments
• Part B copayments
• Part B excess physician charges
• Skilled nursing facility coinsurance
• Foreign emergency care

Medicare Supplement Plan G will still be a great option for those becoming newly eligible for Medicare. Plan G continues to allow you to choose any physician for your care, including specialists, while eliminating many out-of-pocket expenses associated with that care. Instead of paying copays and deductibles, you’ll pay a monthly premium for your Medicare Supplement plan.

AM I ELIGIBLE FOR A MEDICARE SUPPLEMENT PLAN?

If you are age 65 or over and enrolled in Medicare Parts A and B, you can apply for a Medicare Supplement plan policy.

You can apply for a Medicare Supplement plan policy if you are age 65 or over and enrolled in Medicare Parts A and B. The one-time Open Enrollment period, which begins on the first day of the month an individual is 65, or older, and enrolled in Part B provides for guaranteed issue. Individuals under age 65 eligible for and enrolled in Part B; are not eligible for guaranteed issue unless they have lost or are losing creditable coverage. In some states, Medicare Supplement insurance policies are available to people with disabilities who are under the age 65.

Medicare doesn’t cover most routine dental care or supplies, including oral exams, cleanings, fillings, extractions, and dental appliances, including dentures.

In some situations, you may be covered for extractions or oral exams when they’re related to a covered procedure. For example, Medicare covers oral exams if they’re part of a pre-op exam prior to getting kidney transplant surgery or a heart valve replacement. You’ll also be covered for teeth extractions when they’re needed to prepare your mouth for radiation (for example, to treat oral cancer). However, Medicare won’t cover dentures or fittings for dentures you may need after the tooth extractions.

You’ll typically have to pay the full cost out of pocket for dental care and dentures unless you have other insurance.

Medicare Part C coverage of dentures

Some Medicare Advantage plans may cover additional benefits that Original Medicare doesn’t cover. Also known as Medicare Part C, the Medicare Advantage program offers an alternative way to get your Original Mdedicare benefits. Medicare Advantage plans are available through private insurance companies that are approved by Medicare and are required to offer at least the same level of coverage as the federal program. However, many Medicare Advantage plans offer coverage beyond Original Medicare, which may include routine dental services and dentures. Since coverage can vary from plan to plan, always double-check with the Medicare Advantage plan you’re considering to see if a specific benefit is included.

PACE programs and coverage of dentures

Program of All-inclusive Care for the Elderly (PACE) may be another way to cover some of the cost if you need dentures. PACE is a program jointly run by Medicare and Medicaid that provides health-care services for individuals in their homes and communities. The program is focused on helping older adults remain independent and prolong nursing-home care for as long as possible.

PACE provides all services that are covered by Medicare or Medicaid, and dental services may be covered under your state’s Medicaid program. If you are interested in learning more about PACE,  

Alternative ways to pay for dentures

If you don’t have a Medicare Advantage plan and aren’t eligible for PACE, you may have other ways to pay for the costs. Keep in mind that the options below are separate from the Medicare program.

• Medicaid: Dental services and dentures may be covered by Medicaid in your state. Medicaid programs are state-run, and individual states are free to expand their programs beyond federal guidelines. Dental care and dentures are optional benefits, so not every state covers them. If you have limited income and qualify for Medicaid,  to learn if dentures are covered.
• Dental insurance: Many major medical health plans include dental coverage, but stand-alone dental plans may also be available in your state. These plans typically cover oral exams, cleanings, X-rays, fillings, and other preventive dental care. Plans may also help with some of the costs for oral surgery, implants, and dentures. Benefits will vary by plan, so check with the specific plan for more details. 
• Dental schools: Some dental schools may run low-cost clinics as a way to give back to the community and train dentists. Find dental schools near you to see if programs are available in your location.
• Community health clinics: Local community centers may provide dental services for low-income individuals. The National Council on Aging and Eldercare Locator can help you find resources for seniors in your area.
• Dental Lifeline Network: This program provides free dental services to vulnerable groups who can’t afford care, including seniors and disabled individuals. Find out if you’re eligible and look up the program for your state by visiting the Dental Lifeline Network website.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.