Medicare in General

Have you signed up for Medicare parts A and B? 

If NO – call 1-800-772-1213 (Social Security) – or – go to www.Medicare.gov to enroll in Medicare – it is not too early to start the process.

Like most, you will be shopping for a Medigap supplemental health insurance plan.

You are guaranteed enrollment in a Supplemental plan until six months have passed after your part B enrollment date.

You want to make sure that you take advantage of this window of opportunity. Once the 6 months has passed after signing up for part B, an insurance company has the right to decline coverage. But now they have no choice but to accept you for coverage. For those who have been on disability and are turning 65 you have the same open enrollment period.

So, with all the choices in coverage and all the companies offering coverage which one should you select?

There are two philosophies – both have different advantages.

All Supplemental plans (A thru N) are standardized by the Federal Government.

What does that mean? Each company will provide identical benefits for each plan. You cannot be singled out for cancellation – No matter how many claims you file.

Most people select plan F since it provides comprehensive coverage and it will cover excess charges doctors may charge their patients.  

Did you realize that a physician can legally charge 115% of the allowable charges outlined by Medicare? Plan F pays those excess charges.

Now that you understand that coverage is identical for Plan F from each company....

What company to choose? Why not select the company with the most reasonable premium?

Premiums for plan F range from Just over $100 per month to $200+ per month for the same coverage of a 65-year-old insured.  (Depending on Age, Sex, Zip Code and Household Residents - YES there are discounts just for living with someone else)

(You should read page 19 of the Shoppers Guide to Choosing a Medigap Policy) Click the blue link, or I can provide a copy of this guide for you.


Think of it this way - You are in the middle of making a cake and reach into the refrigerator to grab four eggs and find that there are just three in there - what do you do?  You go down to the store and buy the cheapest ones because they will all make the same cake.  The same holds true for Medicare Supplement Plans of the same type (F to F, G to G, N to N, etc.)

I can represent just about every company authorized to do business in your state. As a broker, I choose to represent just a few – those with the lowest premiums.

We Mostly make plan selection based upon the lowest overall premium for your lifetime. With most companies when you enter a plan your rates are locked in for twelve months with no increase. 

You can purchase directly from a company or you can go through an agent like myself for the same price and have a service oriented batter to step up to the plate if a problem ever occurs. 


The Other Philosophy is the Medicare Advantage Health Plan.  There are several Preferred Provider (PPO) and HMO plans out there. I recommend staying away from them. If you step out of the service area with some of these plans you could wind up paying much more than expected. While I certainly get paid more for selling those plans, Med Sup F is far superior coverage. Remember – Medicare Advantage plans do a change in benefits each year and you may need to change doctors occasionally.

I strongly recommend staying away from these plans since they are costing the taxpayer much more than those on Original Medicare and a Supplement; and passage of the healthcare reform bill in 2010 dramatically cuts funding for Medicare Advantage plans. Plan N Medicare Supplement to me is a very viable choice rather than a Medicare advantage Plan.  

To select the best choice for YOU – there are two key factors.

- Health now and family health history
- Ability to pay premiums


Plan F is superior coverage and if premiums are paid you have little to no out of pocket expenses – easy to budget your health care expenses. Plan F doesn’t change every year on you. 

Plan G is gaining poplularity as a Medicare Supplement Plan - it is just like a plan F, but it does not cover the part B of Medicare Deductible (2017 - $183). In some areas the spread in premiums from Plan F to Plan G make Plan G a better buy.
I prefer the Plan F as the deductuble is spread out over the course of a year and you don't have that front end charge each year. 

PFFS PPO & HMO could have lower premiums but you have co-pays every step along the way. If you like these types of plans I think you will be happier in a Plan N Medicare supplement.

I do many enrollments for Medicare Supplements and many feel the few minutes I spend with them valuable to help sort out Medicare questions they have.

What about Prescription Drug Coverage?  Most likely your largest expense in retirement.

With all the choices out there – Which one should you choose? You need to have one since Medicare penalizes you later on if you don’t get one now.

There are three factors that affect your choice. Premium of the plan – Schedule of Benefits – but the most important is the price you will pay for the prescriptions you take. This is where I really go to bat for my clients.

Employer plans used to offer retirees an advantage because of their Prescription benefits – but now that Medicare has Prescription Drug Plans, employer plans are not as attractive. Don’t be afraid to look around - leaving the employer umbrella might be a good thing.

NOTE: If you are on the government program, (Tri-Care) you will want to continue with their coverage. Everyone else will be shopping employer plans have lost their advantage with the addition of Medicare Prescription Drug Coverage.

Will your spouse need short-term coverage until their 65th birthday? I can help with that as well.


The secret to getting the best bang out of your dollar - is not to go out and buy the first plan you see or from the first agent that says they have what you need.

The preferred sequence of events is for you to send a list of prescriptions that you are taking so I can do the research in my office, then I bring the solutions to you. If you take none just write "None".  CLICK HERE for a form to send me your information.


Medicare Made Easy Video

Click here to watch my short video and get your personalized recommendation!


www.MedicareMadeEasyVideo.com 

course1.png

Click below to get answers to some common Medicare questions:

Answer

If you want to keep working and stay covered by your employer plan there are two possible answers.

1) If there are 20 or more emplyees there you will want to pick up part A of Medicare Only – it is free. Medicare will be secondary to your employer plan. If you know in advance call me about three months before you retire and I will walk you through how to add part B of Medicare with no penalty and help you get set up with a Medicare Health Plan. You DO NOT want part B of medicare because it will just lay there and do nothing and cost you money to have it. When you add part B of Medicare later it triggers a new open enrollment period and protects your insurability.

2) If there are fewer than 20 employees there – You MUST have both parts A and B of Medicare as under this scenario Medicare is Primary to employer coverage. NOTE – if this is you, I strongly suggest that you not stay on the employer plan and enroll in a Medicare plan right away since your open enrollment period ends six months after your Part B effective date and you would have to prove insurability to add a Medicare Supplement Plan after that open enrollment period ends.

Answer

When you are new to Medicare part B (first six months) a company has to take you and they have to pay for you. After that six month open enrollment window, they can ask the medical quesitons and turn you down. NOTE that if you have something that needs to be fixed - once it is fixed and you have the all clear from the doctor you become insurable once again. (for Cancer you must be cancer free for 2 years to be insurable once again)

Answer

For those who start Medicare after January 1st 2020 – they cannot purchase a Plan F.

For those who start Medicare before January 1st 2020 – they will be able to purchase a plan F after January 1, 2020.

Therefore, if you choose a Plan F now you can change carriers and get a new plan F later on as you would be grandfathered in.

Answer

No there is not – you pay the same premium if you have an agent as a go between to troubleshoot any problems that may arise as you would had your purchased directly from a company. Remember that purchasing directly from a company provides no service support like you get with an agent.

Answer

NO – you can see any doctor that takes Original Medicare. If you enroll in a Medicare Advantage plan you may be limited to a subset of providers that take that company’s plan.
NOTE – Medicare Select Plans have facility Resrictions such as which hospital you can use – I Strongly recommend that one stays away from Medicare Select plans and stick with Traditional Medicare Supplement plans to avoid this problem.

Answer

Absolutely NO referrals are required for ALL Medicare Supplement plans. You get to see who you want when you want to see them with NO Gatekeepers.

Answer

YES – but after six months pass from your Medicare Part B effective date the open enrollment window closes and you would have to prove insurability to move up in coverage. The Medical Underwriting is easier than one might think, but there are plenty of situations that would cause a company to decline such a move.

Answer

Once you are six months past your Medicare part B effective date you would have to pass underwriting to move to a Medicare Supplement Plan.

There are a few common exceptions:

If you enroll in a Medicare Advantage Plan for the first time when you are new to Medicare – this triggers a new 12 month open enrollment period to move to a Medicare Supplement plan. Medicare understands that the Medicare Advantage plans are lesser coverage and give you 12 months to give them a test drive and still be able to go back to Original Medicare and add a Medicare Supplement plan in the first 12 months. If a plan leaves the marketplace – it triggers a special enrollment period to move to a Medicare Supplement plan with no questions or preexisting conditions.

Answer

Just to be safe – I recommend that you ask your doctor to call the phone number for providers on the back of your prescription drug plan ID card before he prescribes a new med for you. By doing this 1- he makes sure he is prescribing a covered drug and 2- he takes care of all the prior authorizations ahead of time so there are no surprises at the pharmacy.

Answer

When you are new to Medicare (first 12 months) you are allowed a “Welcome to Medicare Physical” Be sure that you schedule it and tell the doctor when you are there that you are there for the “Welcome to Medicare Physical” YES this is covered.

After 12 months have passed you are allowed an annual preventative exam (No Touching, shake hands talk with doctor only) basically how are you doing – ok – great see you next year exam. If you schedule an annual Physical – Medicare Says NO EVERY time and tells your supplement to say no too. Important to schedule those exams when you call for the appointment as either the “Welcome to Medicare Physical or the annual Medicare wellness exam. If you schedule it as a physical it will be billed wrong EVERY time.

If you take any meds at all – call and schedule the exam to monitor whatever you take the meds for and it will be billed right every time.

Answer

YES we believe in good old fashioned service.

All of our clients will hear from us once per year talking about Medicare Supplement Rates and how their plan stacks up.

All of our clients get our annual newsletter in the fall telling of upcoming changes to Medicare and details about Prescription drug plan changes.

Answer

Most doctors take Medicare.

There are many doctors now who are not taking new patients on Medicare. To get around this look in your social circle and ask who they see – write a letter “PERSONAL AND CONFIDENTIAL” to the doctor and tell them you have heard great things about them and understand they are not taking new patients on Medicare – ask if they would make an exception since you have heard such great things about them and do not want to see another doctor. Most will grant an exception the trick is to get past the billing clerk – thus the letter directly to the doctor’s attention. For specialists if they are not taking new patients on Medicare – ask your doctor to refer you to them and you can usually get in.

Answer

YES! There are several plans that cover what are commonly known as the three holes in your head not covered by Original Medicare. You can get one of those plans to go along with Original Medicare and a Medicare supplement Plan or to go with a Medicare Advantage Plan. You will find those stand-alone plans to offer benefits that are better that those offered within the Medicare Advantage Plans.

Contact Info

Greg Giles, CLU LUTCF RHU

2613 SW Brooklane Dr

Corvallis, OR  97333

medsupguy@gmail.com 

Phone:  (800)809-1378

Fax:  (541)752-0588

Craig Blair

7958 Mykala St NE

Keizer, OR  97303

medicareguy@outlook.com 

Phone:  (844)393-2793

Derek Finken

PO Box 366

Missouri Valley, IA  51555

dmedsupguy@gmail.com

Phone:  (844)786-4865

Fax:  (844)786-4867

bbb-logo-A+rated.png
SFSP.png

www.GregGiles.net

Licensed in Oregon, Washington, California, Idaho, Arizona, Iowa and Nebraska