July 29, 2022

Learn What Medigap Plans Cover: Original Medicare And Medicare Supplement Plans

If you’re signing up for Medicare it is critical to know what the Medicare plan covers and why you need to consider buying a supplement healthcare plan.

Medigap is an insurance plan that covers the gaps left by Original Medicare. It can be used if your needs are much greater than what’s covered in Parts A and B of the original program—such as when you’re facing chronic illness or catastrophic medical bills from preexisting conditions like cancer treatment or heart surgery—or if someone on your family becomes eligible for Supplemental Security Income.

A Medicare supplement plan is a good idea for anyone who wants superior access to doctors and medical facilities with extra benefits. Here’s what Medigap covers:

Basics of What is Supplemental Insurance: Medigap Plans Cover

Medigap is a type of supplementary plan that helps cover the costs of Medicare Part A and Part B deductibles, copays, and coinsurance. Medigap plans are standardized by the federal government, which means that each standardized Medigap plan must offer the same basic benefits regardless of where you buy it.

Many Medicare Beneficiaries prefer Original Medicare with a Medicare supplement plan as they get to keep their doctors and are not locked into a medical group. They are also able to obtain care without the need for a referral to see a specialist or prior authorization to obtain a medically needed surgery.

However, there are some things that Medigap policies don’t cover, such as:

Long-term care
Dental care
Eyeglasses
Hearing aids
Prescription drug coverage

You’ll likely have to pay your premium for Medigap coverage in addition to your Medicare Part B & Part D premiums. The amount you pay will depend on factors like your age, gender, tobacco use, and the specific Medigap plan you choose.

It is vital when choosing a Medigap plan to not only think about your health today but also consider your future health care needs.

Once enrolled, your Medigap policy is guaranteed renewable no matter your future health condition.

What is Medigap Coverage Used For?

But what exactly is Medigap coverage? Medigap is short for Medicare Supplement Insurance. These policies are sold by private companies and help to cover some of the gaps in Medicare coverage. Medigap plans help pay for some of the coinsurance, copayments, and deductibles that Medicare does not cover.

The most popular Medigap plans include Plans G and N, which offer the most comprehensive coverage today.

How do you know if a Medigap policy is right for you? The best way to determine if you need a Medigap policy is to review your own health care needs and costs. Consider your current health, your anticipated health care needs, and your budget.

If you think a Medigap policy might be right for you, contact one of our licensed agents to obtain more information.

How do Medicare Supplement insurance plans work with Original Medicare?

When it comes to navigating the waters of Medicare, there are a lot of options to choose from and it can be confusing to understand how all of the different parts work together. If you’re new to Medicare and looking for some clarification on how Medicare Supplement insurance plans work with Original Medicare, you’ve come to the right place.

Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance). Together, these parts cover a wide range of medically-necessary care, from routine doctor’s visits to hospital stays.

While Part A and Part B provide a lot of coverage, there are still some out-of-pocket costs that you may be responsible for, like deductibles, coinsurance, and copayments.

This is where Medicare Supplement insurance plans come in. Also known as Medigap plans, these policies can help cover some of the costs that Original Medicare doesn’t, like deductibles, coinsurance, and copayments.

Medigap plans are offered by private insurance companies and they must follow certain guidelines set by the federal government.

There are 10 different Medicare Supplement insurance plans that are available in most states, and each plan is identified by a letter (Plan A, Plan B, Plan C, etc.). The plans all offer different levels of coverage, so you’ll want to compare the plans to see which one best meets your needs.

It’s important to remember that you can only have one Medicare Supplement insurance plan at a time. You also need to enroll in both Original Medicare (Part A and Part B) in order to be eligible for a Medigap policy.

Parts of Medicare

There are four parts to Medicare: Part A, Part B, Part C, and Part D.

– Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

– Part B covers outpatient services such as doctor’s visits, preventive screenings, and durable medical equipment.

– Part C is also known as Medicare Advantage. This part of Medicare is offered by private insurance companies and includes all Parts A and B benefits, usually with additional benefits such as prescription drug coverage.

– Part D is prescription drug coverage. You can enroll in this part of Medicare if you want, but if you have creditable prescription drug coverage through another source (such as an employer), you are generally allowed to keep it.

What does Medicare Part A cover?

Medicare Part A covers things like hospital stays, skilled nursing care, and hospice care. Medicare Part A does costs related to deductibles, coinsurance, or excess charges.

What this means is that if you have a hospital stay, for example, Medicare Part A will cover some of your coinsurance (the amount you have to pay after Medicare pays its share) and any copayments (a set amount you have to pay for a service) however, it does not cover all of your coinsurance costs once you exceed a specific number of days.

You will also incur a hefty deductible for each benefit period (the amount you have to pay before Medicare starts paying its share).

A Medicare supplement plan will pick up all of these costs associated with your hospital stay. For instance, if you are admitted into a hospital for 135 days, with a Medigap Plan G the cost of this stay will be zero.

What does Medicare Part B cover?

Medicare Part B covers your primary care, specialist visits, and outpatient surgeries. Without a Medigap plan, you will be responsible for copayments and coinsurance for all costs related to your services.

What does this mean for you?

Part B will cover:

– 80% of the cost of medically-necessary services after you’ve met your yearly deductible,

– 100% of the cost of preventive services,

– Clinical research trials, and

– Ambulance services.

Both Medicare Part A and Part B do not have a max out-of-pocket limit. This means your risk exposure is unlimited. With Medicare supplement coverage, these costs are covered at 100% with a Medigap Plan F. If you have the Medigap Plan G, your only cost would be your annual Part B deductible.

What does Medicare Part C cover?

Medicare Part C is optional coverage and is more commonly known as a Medicare Advantage plan.

When you sign up for a Medicare Advantage plan you are leaving your Original Medicare and transferring your Medicare rights over to a private insurance company. The Advantage plan you sign up for will take control of your medical services and decision-making.

Most Medicare Advantage plans are HMO plans, which means you will be locked into a medical network of doctors and facilities.

You must be enrolled in both Medicare Part A & B before you can join an Advantage plan.

What does Medicare Part D cover?

Medicare Part D is a prescription drug benefit that is available to all Medicare beneficiaries. Part D plans are offered by private insurance companies and cover a wide range of prescription drugs. There are some drugs that are not covered by Part D plans, including:

Drugs that are not FDA approved
Drugs that are not covered by the plan’s formulary
Drugs that are not used for a medically accepted indication
Drugs that are investigational

Most Part D plans have an annual deductible and a co-insurance payment, however, some private insurance companies may offer prescription drug plans without a deductible. The monthly premium for Part D plans varies depending on the plan chosen.

Part D premiums range from $7.50 to several hundred dollars per month depending on your prescription drug coverage needs.

How do I know if I am Eligible for Medicare Supplement Plan?

To be eligible for Medicare supplemental plan, you must be enrolled in Medicare Parts A and B.

If you’re already enrolled in a Medicare Advantage plan, you can’t buy a Medigap policy unless you’ve joined an MA plan for the first time and want to disenroll. In that case, you have a limited time (up to 12 months) to join original Medicare and buy a Medigap plan.

Only individuals can buy Medigap plans. Each spouse has to buy their own separate Medigap plan. However, if both spouses sign up for a Medigap plan with the same insurer they may qualify for a discount. The average household discount is 5%.

If you need help with Medigap questions, you can contact one of our Medicare insurance agents. We are here to answer any

What are the Different Types of Medigap Policies?

There are 10 medical gap insurance plans, each designated by a letter of the alphabet: A, B, C, D, F, G, K, L, M, and N.

Medigap plans differ in what they cover and the percentage of costs they cover. For example:

Plans A and B don’t cover skilled nursing coinsurance.
Plans C and D provide Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted.
Plans F and G also offer a high-deductible plan in some states.

Medicare supplement Plan G is the most desirable plan today followed by the less expensive Plan N.

Any standardized Medigap policy is guaranteed renewable even if you experience poor health problems.

How do I compare Medigap policies?

There are 10 standardized Medicare Supplement Insurance plans, each identified by a letter. The plans with the same letter offer the same basic benefits, no matter which insurance company sells them.

This means if you purchase a Plan G from United Healthcare or Aetna the plan is exactly the same. Some supplemental insurance companies may offer additional benefits at no cost. This would be the only difference between one insurance company and another.

When you compare Medigap policies, you’ll want to consider things like the monthly premium and whether the policy has any extra benefits that might be important to you. An independent Medicare Agent can help you find an insurance company that is the most cost-effective and plan that is right for you.

How do I Enroll in Medigap Policies?

You can enroll in a Medigap policy during your Medigap initial open enrollment period. This is the six-month period that begins on the first day of the month that you turn 65 years old or when you enroll in Part B after you turn age 65.

During your Medigap open enrollment period, you have what’s called guaranteed issue rights — which means you can’t be turned down for coverage. You can buy any Medigap policy offered in your state – even if you have health problems.

After your initial enrollment period ends, you may be subject to Medical underwriting (health testing), Denial of coverage, or a higher premium. There are exceptions to this arrangement, so it is always best to seek help from a Medicare insurance agency before you apply for a Medigap policy.

One of our certified Medicare insurance agents can sell you a Medigap policy. They will go over the different Medigap plans and verify your eligibility.

How do I pay for my Medigap policy?

There are several ways to pay the premium for your Medigap policy:

Directly through the insurance company
Auto deduction through your checking account
Auto deduction through a credit card

You can do so either in full, quarterly, or monthly installments. Integrity Now Insurance Brokers recommends auto deduction from your checking account as most Medicare beneficiaries keep their checking accounts in place. Credit cards expire which can cause a lapse in coverage.

Once a Medigap plan lapses you will be required to go through medical underwriting.

It is critical to note the insurance company can’t cancel your Medigap policy due to poor health conditions.

What are the Benefits of having Medigap Plans?

There are several benefits to having a Medigap policy, including:

You can’t be turned down for coverage during your Medigap initial open enrollment period.
Freedom to see any doctor who accepts Medicare
Can see a doctor out of state while traveling
No referral required
No prior authorizations
Your Doctor decides what is medically necessary NOT the insurance company
No surprise bills
Medical costs are easily budgeted through your monthly premiums
Freedom to pick any standalone Part D prescription drug coverage

One study found that most older adults are happy with their Medicare supplement policy.

What are the Drawbacks of having a Medigap Policy?

There are a few drawbacks to having a Medigap policy.

First, after your open enrollment period ends, you may be subject to medical underwriting (health testing). This means that the insurance company can deny you coverage or charge you a higher premium based on your health status.

Additionally, Medigap policies do not cover long-term care, dental care, or vision care.

Finally, Medigap policies are only available to people who have Medicare Part A and Part B. If you only have Part A, you will not be able to purchase a Medigap policy.

Should I Consider A Medicare Advantage Plan?

If you’re eligible for Medicare, you might be wondering if a Medicare Advantage plan is right for you. Medicare Advantage plans are offered by private insurance companies and can help you pay for your health care costs. Here are a few things to consider when making your decision:

Do you want a plan that covers everything?

Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) covers. This includes hospital stays, doctor’s visits, and preventive care. Many plans also offer extra benefits, like prescription drug coverage, vision, and dental.

How much does it cost?

When you sign up for a Medicare Advantage plan you will need to continue to pay your Part B premium. Some Medicare Advantage plans also have a monthly premium, however, in recent years many Advantage plans can be obtained at no additional monthly premium.

What is the network?

A Medicare Advantage plan will have a network of doctors, hospitals, and other health care providers that you can use. Make sure your doctor is in the plan’s network before enrolling.

What are the rules?

Medicare Advantage plans have rules about things like pre-authorization for certain services and referrals to see a specialist. Original Medicare has fewer rules.

How do you get prescription drugs?

If you need prescription drugs, you can get them through a Medicare Advantage plan. Most Advantage plans include prescription drug coverage as part of your program.

Medigap and Medicare Advantage plans are two different ways to obtain the needed health insurance coverages. While Advantage plans may offer additional coverage, it is vital to evaluate these added benefits to ensure you are not sacrificing the benefits that are included with Original Medicare with a Medigap plan.

Making the decision about whether or not to enroll in a Medicare Advantage plan is an important one. Take your time to weigh your options and talk to your doctor to see if a Medicare Advantage plan is right for you.

Request Our Expert Advise and Help

For most people, signing up for Medicare is a simple process. However, it is important to know what the Medicare plan covers and why you may need to consider buying a supplement healthcare plan.

A Medicare supplement plan is a good idea for anyone who wants superior access to doctors and medical facilities with extra benefits.

Integrity Now Insurance Brokers is here to help you sign up for a Medicare plan that is best suited for you. No matter if that is a Medicare supplement policy or a Medicare Advantage plan.

We look forward to talking with you and helping you sign up for a plan today.