Medicare Supplement Plans (Medigap)
Medicare Supplement plans cover 14 million Medicare beneficiaries as of 2018. These plans are becoming more commonly known as Medigap plans and include a wide variety of plans depending on the level of insurance coverage you would like to have in place.
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Medigap plans are purchased separately in order to fill in the gaps of Original Medicare as these policies help pay for your share of Medicare expenses, such as deductibles and co-insurance.

Medicare supplement insurance plans are standardized by the US Government and are available for purchase nationwide. Because you are staying with Original Medicare with these plans you will have the broadest PPO style plan available on the market.

If you are seeking a plan option that provides you with open access to medical Doctor, outpatient facilities, top cancer centers, and hospitals with little to no copays, deductibles, and co-insurance this is our top recommendation.

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How do my Medical bills get paid with a MediGap plan?

We believe this is one of the best parts of how a Medicare supplement works. This is because they are nearly invisible in the overall process. What that means is they have no say in what is covered and what is not covered. They simply receive the bill from Medicare and they have to pay their portion of the remainder of the bill.

Frist, your Doctor will provide the medical services and bills Medicare for payment.

Second, Medicare pays their portion of the bill (equals 80% of total approved cost) and send the excess amount to your MediGap Insurance Company.

Lastly, Your MediGap plan pays up to 100% of the remaining cost (remaining 20%) depending on the Medicare Supplement plan you selected minus your annual Part B deductible if not covered by Plan F.

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What is Medicare Supplemental Insurance and how does it work?

Original Medicare was first introduced in 1966 and was made part of your Social Security benefit.  In the early 1980’s private insurance companies introduced Medicare supplement plans which were designed and approved by the US Government in order to fill in the gaps in coverage left behind by Original Medicare.  All Medigap plans are regulated by the US Government even though they are sold through private insurance companies.  This means that all insurance company that offer Medigap plans are required to provide specific guaranteed level of coverage based on the Plan you are obtaining. Insurance carriers are not allowed to deviate from each plan offered.

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Medigap Plans are Standardized Government Approved Plans

The chart below provides you with a list of all the Medicare supplemental plans available with some restrictions that will be discussed.  You can also find this chart in your Medicare and You Handbook located on page 72 of the 2021 handbook.  Each Medigap plan provides a different level of coverage depending on the letter plan you choose.

Medigap Plan F offers the riches benefit of all available plans, meaning you would have zero cost when you need to see the doctor or go to the hospital up to the coverage terms and conditions.  If you become eligible for Medicare after Jan 1, 2020 this plan is no longer an option for you but will continue to be offered for those individuals who were or are eligible for Medicare prior to Jan 1, 2020.

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What are the different Medicare Supplements Plans?

Medicare supplement plans are broken down by their individual letter plan.  Each plan letter provides a different level of benefits to you as the Medicare Beneficiary.  Like the individual health insurance market (Covered CA) is now broken down by Bronze, Silver, Gold, and Platinum, Medigap plans are broken down by a specific letter such as “Plan G”.

Medicare supplement plans are available across all 50 states. Each plan letter (such as Plan G) will provide a different level of benefits depending the medical services provided.  For instance the only difference between Plan F and Plan G is Plan F will cover your Part B deductible.  Other than the Part B deductible they both provide the exactly the same benefits.

Medicare supplement plans provide standardized coverage regardless of which insurance company you end up with. For example, Medicare supplement Plan N at Carrier A has the same benefits as Plan N from Carrier B, C, & D.  This means the only difference between the plans is your monthly premium.  It is important to mention that not all plans are available in each state.

Plan F was the most popular plan as it filled in all of the coverage gaps left behind by Original Medicare to include your Part B deductible.   Unfortunately this comes at an increased cost for the insurance carrier to manage this cost on your behalf.  Plan G is a plan we will typically recommend over Plan F.  This is because the savings in your monthly premiums far outweigh the cost difference between the two plans.

As a Medicare insurance agent / broker who specializes in Medicare supplemental insurance and Medicare Advantage plans for seniors we can help you determine which plan best suits you and your individual needs.  The advantage to you is we represent all of the major insurance carriers who offer these types of plans, which allow us to shop the lowest rate for you at no additional cost to you.

If you called Carrier A and they offers you a Plan G for $150 dollars directly, we can get the exact same plan for you at the exact same price.  However, as we are an independent insurance Agents we are able to shop all available insurance carriers which may enable us to find you the exact same plan with Carrier B for a lower monthly premium for the exact same coverage.  We would love the opportunity to represent and serve you, our clients in all of your Medicare needs.

How do I pick a Medicare Supplement plan?

When it comes to a Medigap policy, we have found that most Medicare beneficiaries choose to enroll into Medicare supplement plans F (if eligible for Medicare Prior to Jan 1, 2020), Plan G or Plan N.

While there are other plans available outside of these three plans, these other plans typically offer less coverage benefits. Plan F, G, & N offer the most comprehensive coverage which is why they are the most popular.

It is important for you to decide how you want your Medigap plan to pay out when you use it. Are you someone who doesn’t mind paying a copay or deductible, which in turn will provide you with a lower monthly premium. Or do you want to pay a little more in your monthly premium so you don’t have to worry about any cost or very little cost when you go to the Doctor or Hospital.

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Do Medicare Supplemental Plans have an Initial Open Enrollment Period?

While you can enroll into a Medigap plan today or even in the future, if you try to enroll into a Medicare supplement plan beyond your Initial Enrollment Period which provides you a period of time to obtain your policy on a guaranteed issue basis, you will need to go through medical underwriting.  Depending on your medical conditions you could be declined coverage for a Medigap plan. 

How do you enroll into a Medigap plan with guaranteed issue rights?  You are given a six month window that either begins on the first day of your 65 birth month, or the month you enroll into your Medicare Part B coverage. After either you pass the six month time period you will be required to go through full underwriting.  While this is not impossible for many individuals it can be difficult or impossible for others.  

Per your Medicare and You Handbook, they also confirm that the best time to buy a Medicare supplement policy is during your one-time open-enrollment window (See page 73 – When to buy of your 2021 handbook). 

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Medicare Supplement Plans – Guaranteed Issue

Medicare supplement policies only provide guaranteed issue rights within a small six month window.  Your six month window either begins on the first day of your 65 birth month, or the month you enroll into your Medicare Part B coverage.

Why do some Medicare beneficiaries delay their enrollment into Part B coverage?  If you continue to work and your employer provides with you creditable health insurance coverage, then you can delay your Part B enrollment.  Once you decide to retire or lose your group health coverage, you have the right to purchase certain Medigap policies and Part D prescription drug coverage. Each of these two coverages have specific time periods to enroll, so please make sure you plan ahead so you avoid penalties and/or delays in coverage.

During your guaranteed issue window, you will be given the opportunity to enroll into specific Medigap plans & Part D coverage that work best for you.  The insurance company you sign up with for your Medicare Supplement plan is not able to deny your application for any health related issues during your guaranteed issue period.

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