Joanne: When it comes to Medicare coverage, it can be easy to get lost in the endless debate of Medicare Advantage versus Medicare Supplement coverage, but today, we're here to discuss the overlooked plan options that can help you with cancer, hospitalization, travel, and more.

Cameron: But before we start, my name is Cameron Giardini. Together with my co-host, Joanne Giardini Russell, I operate Giardini Medicare, an independent insurance agency based in Southeast Michigan.

Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states find the right Medicare coverage for them. If we do not work in your state, we will connect you with another trusted independent agent who can help you find the coverage you want.

We also now offer a free online course that you can register for to learn about many Medicare topics. You can do this by going to gmedcourse.com, or you can access a full list of our educational material at our new website, doineedmedicare.com. So, with that out of the way, we will briefly talk about Original Medicare, Medicare Advantage, and Medigap in an overview of today's episode.

Again, that is very brief; it is just a reminder as we discuss these coverages. We will discuss cancer insurance and how it works with Medicare Advantage and Medicare supplement plans. We will also talk about hospital indemnity insurance. Again, we will discuss how that works with Medicare Advantage and/or Medigap plans. Then, we'll round things out by talking about short-term care or home healthcare options and travel insurance.

So first, we have to talk about the basic coverage for most Medicare consumers, which are Medicare Advantage and Medigap plans. Original Medicare is provided by the federal government, and as you've probably heard in other episodes, it consists of Part A and Part B coverage. Now, Part A is often called hospital insurance, and it provides coverage for essential services like inpatient hospital stays, skilled nursing facility care, hospice care, home health care services, and more.

Part B, on the other hand, is medical insurance, and it provides coverage for outpatient care, such as doctor visits, preventive services, medical supplies, and more. Now, the vast majority of you listening to this podcast will not stop with just having original Medicare coverage; instead, you will either enroll in a Medicare Advantage plan or a Medicare Supplement plan, often called Medigap.

Medicare Advantage plans are private alternatives to Original Medicare, provided by insurance companies that receive funding directly from the federal government. These bundled plans provide Part A, Part B, and usually Part D coverage all in one plan, which is often why they are commonly referred to as Part C.

They're not part of Original Medicare, but they combine many of these services. Now, on the other hand, you have Medicare supplements, again, often called Medigap policies. These are health insurance plans sold by private insurance companies to fill the gaps in original Medicare coverage.

Medigap policies help pay for some or all of the out-of-pocket healthcare costs that Original Medicare leaves behind. These plans provide secondary coverage to Original Medicare, which still remains your primary coverage if you go with a Medigap. We do have other episodes devoted to these coverages in much more detail, which we will link to in the description of this episode. Still, now we are going to move on and discuss the additional, less talked-about insurance options to go with these different plans.

Joanne: First, we have cancer insurance. Many different types of cancer insurance exist, but we often provide clients with what we will call a lump-sum cancer insurance policy. This policy essentially functions just like it sounds: It provides a lump sum tax-free cash benefit that an insurance company pays you in the event of an internal cancer diagnosis.

These are usually paid out in the amount of your choosing, and they can range from about $5,000 to $75,000. That's the lump sum payout that you would receive based on what you chose for your policy. The monthly premiums for this coverage will, of course, vary based on your age, where you live, and what company you're going to purchase this coverage from.

However, here's a quick example using a cancer insurance policy quote provided by Aetna so you can get a better feel for the cost. Using Michigan as our example, a 65-year-old would pay roughly $27/month for a $10,000 lump sum benefit, or they would pay $54/month for a $20,000 benefit. A 70-year-old might pay roughly $30/month for a $10,000 benefit and $60/month for a $20,000 benefit.

So that'll give you just a good guideline, you know, cost-wise. It's important to understand, though, that when you apply for cancer insurance, you will have to qualify for the coverage by answering a few medical health questions. For example, With the Aetna coverage that we just mentioned, they essentially ask you if you've been diagnosed or treated for cancer within the last five years. This coverage also has a waiting period of 30 days, so if you're diagnosed in the first 30 days of it being effective, understand that the benefits will not be payable.

Now, this is important here: statistically speaking, 87 percent of cancers are diagnosed in people age 50 or older, and roughly one-third of people everywhere will be diagnosed with cancer in their lifetime. The stats are pretty high. So, how can cancer insurance help you pay for expenses with Medigap or Medicare Advantage plans? Cameron will get into that next.

Cameron: Yeah, now that you understand the pricing, how does this coverage work with Medigap or Medicare Advantage coverage? First, we'll talk about how cancer insurance can work with Medigap and Part D coverage. So, with the most popular Medigap Plan G, you're really only responsible for the yearly Part B deductible, which is pretty low this year in 2024.

It is $240 for the year. That applies to all Medicare Part B-covered services. The Medicare Part A side of things is fully covered by Plan G as well. So, with Plan G, if you have Medicare-covered services like surgeries, doctor visits, and chemotherapy due to a cancer diagnosis, you would only be responsible for that $240 Part B deductible for this year for anything that, again, is approved by Medicare.

However, you may still have expenses due to prescriptions that are covered by Part D coverage. Some oral medications used for chemotherapy treatment can fall under Part D coverage instead of Part B, so they would not be covered by your Medigap policy. This used to result in several thousands of dollars out of pocket.

However, due to recent changes from the Inflation Reduction Act covering Medicare Part D medications, they are capped this year, or roughly capped, around the mid $3,000 range. And then next year, they will actually have a set cap of $2,000 for the year. And that begins in 2025. So we really aren't going to sit here and say that you have to have cancer insurance if you have a Medigap policy and Part D coverage, but it doesn't mean it can't be helpful.

You can use the lump sum cancer benefit for anything you would like. Again, you're getting the cash, and you can use it for anything you see fit. It might help with expensive Part D medications, or it might be helpful for many less obvious benefits like paying for travel to and from doctor's appointments.

Time off of work for you or even for family members. It could help with caregiver support. It can help with even just a nice vacation. Also, no matter how your coverage changes, this is really important because if your Medigap policies go up in price and you have to change to a Medicare Advantage plan in the future, you can keep your cancer coverage.

Your other coverages. So, if you go to a different Medigap plan or Medicare Advantage, you can keep your cancer insurance with you regardless of your plan changes. And this can come into play because we will talk about cancer coverage with a Medicare Advantage plan. So, with a Medicare Advantage plan, on the other hand, compared to Medigap plans, they will generally require that you pay about 20 percent co-insurance for chemotherapy and other cancer services or treatments.

This can quickly add up and cause you to reach your Medicare Advantage maximum out-of-pocket limit; in 2024, this maximum out-of-pocket limit for in-network services can be all the way up to $8,850, and it usually increases a little bit every year. However, according to a report by Milliman in 2024, the actual average Medicare Advantage plan has a max out-of-pocket of $4,750, so it's not quite as high as $8,850, but it's still up there in price.

Keep in mind that this is a per calendar year limit. So if your treatment goes from one year to the next, for example, if you're getting treatment in November and it goes through maybe February of the next year, you could end up paying your max out of pocket twice. So we always recommend that you get a cancer insurance benefit to cover this max out of pocket twice.

If you have a Medicare Advantage plan, which, in this case, is the $10,000 benefit from cancer insurance, which is the pricing that Joanne already talked about, overall, with either coverage option, whether it is Medigap or Medicare Advantage coverage, cancer insurance is designed to help with potentially large, unexpected costs.

Many people overlook these. They think, "Hey, I got my Medigap, or I have my Medicare Advantage; I'm good to go." But again, there are often out-of-pocket expenses that will catch you off guard, and that is exactly what cancer insurance is here to help with.

Joanne: You can expand on that for just a second, Cameron, too.

A lot of times, you travel to different facilities or doctors if you're out of network or going out of network. Other things are, you know, just you're exhausted, right? Housekeeping, right? Or just eating out, you know, family. We've had people, you know, purchase these plans where they can fly their kids or somebody in to help them for a couple of weeks, you know, pay for their airfare.

So there are a lot of things that go beyond just even the out-of-pocket costs. Exactly. Whatever you want. Vacation. You can do whatever you want. So that's where we want you to start thinking about those products.

Cameron: Then, moving away from cancer insurance, Joanne can talk about hospital indemnity insurance and what it can look like.

Joanne: Okay. Hospital indemnity insurance is easier to understand if you think of it as sort of like hospital copay insurance, but essentially, these insurance plans are designed to reimburse you for unexpected medical costs that result from being hospitalized. First, we're going to talk about hospital coverage and the costs with Medigap and how they would work under the Medicare Advantage plans because they are different, remember?

Your coverage includes a Medigap plan and a standalone prescription drug plan. As we discussed, Medigap plans have strong coverage for cancer diagnosis and treatments, and the same applies to hospitalization. Although Original Medicare currently has a Part A deductible for inpatient hospitalization of $1,632 per benefit period, your Medigap plans, like the popular ones of Plan N and Plan G, fully cover this out-of-pocket cost.

But it's a little different with the coverage under a Medicare Advantage plan. So, unlike Medigap, the Medicare Advantage plans do leave more out-of-pocket costs for hospitalizations and other services. We can't really get into the details of any specific Medicare Advantage plan.

However, as an overall example, it's not uncommon to have a Medicare Advantage plan that might require you to pay 300 a day for a co-pay for days one through six should you be in the hospital. For those many days. So this means that if you're hospitalized for three days, you might end up with a $900 out-of-pocket charge or $1,800 for the full six-day stay.

Okay, six days times the $300/day. It's important to know that these hospital costs with Medicare Advantage plans are not once per year; instead, they will occur each time you're hospitalized as an inpatient throughout the year. Thankfully, in the worst case, you do have that max out-of-pocket limit that Cameron just went over for your Medicare Advantage plan in the event of multiple hospitalizations. Still, really, this hospital copay or hospital indemnity insurance can come into play.

Cameron: Yeah, it's definitely going to be more on the Medicare Advantage side of things. And, you know, based on what we just discussed or what Joanne talked about, it is probably no surprise that hospital indemnity plans are really often specifically designed by insurance companies to help cover those out-of-pocket costs with Medicare Advantage plans.

So, as insurance agents, we would love to say, you know, insurance is the solution to everything. Still, generally, this coverage, it really doesn't make much sense to purchase with a Medigap plan unless you're enrolling in a high-deductible Medigap plan. Again, I'm not saying you can't do it, but you are going to have pretty strong coverage with a Medigap policy.

If you plan on changing to a Medicare Advantage plan soon, you might want to try to get a hospital indemnity plan in the meantime. That way, it can change with you as you change products. As always, these plans will vary based on the coverage you are looking for and the company providing it.

But we will go over a quick cost example using a company called Wellabe, which was formerly Medico. So, for a 65-year-old male in Michigan, a plan that reimburses you $300 per day for up to six days for covered hospital stays would cost approximately, as of now, about $20/month. The same coverage might cost about $23/month for a 70-year-old male, just as a comparison.

Now, in addition to the hospital copay coverage, these plans typically let you add extra coverage in the form of riders, which are additions to the plan. These can help reimburse you for costs due to ambulance rides.

So make sure to talk with a broker to cater the coverage to your specific Medicare Advantage plan and your budget. And just going back to what I talked about, when I say the plan reimburses you up to $300 per day for six days, again, Joanne mentioned you might pay $300 per day based on your copays for the Advantage plan.

This insurance policy gives you back those $300 per day. One you owe, and the other provides you with benefits to help cover those costs. And just like we talked about with cancer insurance, you will still likely have to qualify for hospital indemnity insurance based on your health conditions at the time.

However, in recent years, it has become more common for insurance companies offering these hospital indemnity plans to offer a guaranteed issue period for individuals within certain age ranges. So, in this case, you can actually still apply for coverage without being denied due to your health or even asked health questions in most cases.

So, well, for our example, they have one of the longest guaranteed issue windows, which, in many states, lasts from age 60 all the way to age 79. Just know that if you apply for coverage during this time frame, even though you can qualify for it, pre-existing conditions will likely still be excluded from the coverage for a set period of time, which might be about six months in most cases.

But shifting away from hospital indemnity coverage, what about coverage for things like short-term care or home health care when it comes to Medicare?

Joanne: Let's talk about Medicare coverage for skilled nursing facility stays. Part A of Original Medicare may provide some coverage for stays in a certified skilled nursing facility following a qualifying hospital stay.

Days 1 through 20 have a zero-dollar-per-day copay, while Days 21 through 100 will have a 204-dollar-per-day copay. You are responsible for all costs for days 101 and beyond. Medicare Advantage plans typically have similar out-of-pocket costs. Although most Medigap plans will cover the costs for you from days 21 through 100, even with a Medigap plan, you are still responsible for the full costs from day 101 and beyond.

Now, Medicare covers home health care. According to Medicare.gov, Medicare does cover eligible home health care ordered by your physician for services like intermittent skilled nursing care, physical therapy, speech therapy, occupational therapy, and some other services. However, Medicare does not provide coverage for 24/7 caregivers.

They do not cover homemaker services, custodial, or personal care. If that is the only care that you need and more. Medigap plans will mirror this coverage by Original Medicare. Although some Medicare Advantage plans may provide some helpful extra benefits, they'll still be far from the full coverage with caregivers that some people expect.

So be careful and look into the details of your Medicare Advantage plan. To help with some of the costs that we just mentioned, many of the insurance companies that offer cancer and hospital indemnity insurance also provide short-term care insurance with possible additional home health care coverage.

Now, these plans can vary, so we can't really discuss specific costs and coverages, but these plans can help. You can be reimbursed with set amounts for stays in a facility for up to just under a year, as well as benefits to help pay for home healthcare services that are not covered by Medicare. Just like before, you'll have to qualify for these plans based on your health, but they typically use a series of easy yes and no questions to have you qualify.

Now, it's really important, though, to understand that although we're not going to be discussing this today, Medicare does not cover traditional long-term care. This is really focused on short-term healthcare needs.

Cameron: Yeah, this is always a reminder that Medicare does not cover long-term care. I have never heard this said because people always think that it does at some point.

Last but not least, our less talked about insurance options when it comes to Medicare are travel insurance. So, being a U S government-run program, what happens when you're traveling outside of the U S and its territories? Well, we will link in the show notes as well, but Medicare.gov states that Medicare may only cover care in a foreign country in a few rare scenarios, which are the following.

Number one, you are in the U.S. when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. Number two, you're traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S. state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency. Number three, you live in the U. S. and the foreign hospital is closer to your home than the nearest U. S. hospital that can treat your medical condition, regardless of whether there's an emergency. Also, Medicare won't pay for services you receive while on a cruise ship that is more than six hours from a U.S. port.

Again, that is how Medicare works with foreign travel coverage. So, if you have a Medigap plan, then These do provide some foreign emergency coverage beyond original Medicare, which we just talked about, but it still should not be considered sufficient or full coverage in most cases because most Medigap plans provide foreign emergency coverage for care.

If it begins only within the first 60 days of your trip and this coverage, it still has a $250 deductible. It would only pay 80 percent of certain medically necessary emergency care outside of the United States. And perhaps most importantly, this coverage has a $50,000 lifetime limit. Now, for Medicare Advantage coverage, although some plans may provide strong foreign emergency coverage with the Medicare Advantage plan, this will greatly depend on the plan.

So, you'll have to look at your plan's evidence of coverage document for more details. But overall, if you're looking for travel health insurance, which we do typically recommend, in addition to everything we discussed, we would typically recommend looking for coverage from a company like GeoBlue. It is a Blue Cross Blue Shield affiliate, and you can find more information by going to GeoBluetravelinsurance.com. We will link to more information in the description. Overall, in this episode, we just want you to be aware again of some of these different gaps in coverage you may have with original Medicare or even with Medicare Advantage or Medigap policies. And again, travel insurance is one of them.

Although Medicare supplement and/or Medicare Advantage coverage is often very comprehensive and good coverage, there are still going to be holes in that coverage that we talked about. Luckily, we've covered most of these in these episodes, so you shouldn't have any problem getting the full coverage that you need while you're on Medicare.

As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us by going to YouTube and searching Giardini Medicare, or you can do the same thing on TikTok. Last but not least, if you have any feedback or questions, you can send us an email to info@gmedicareteam.com

Thanks for listening, and have a great day.