Medicare Supplement (Medigap) Insurance
Find affordable Medicare Supplement Insurance plans
Speak to a Medicare Expert by calling (877) 419-2422
Do you have fairly frequent doctor or hospital visits? If so, you may already know that Medicare Part A and Part B come with out-of-pocket costs you have to pay. You might be able to save money with a Medicare Supplement plan. Medicare Supplement, or Medigap, plans fill in the “gaps” in coverage left behind by Original Medicare, Part A and Part B, such as deductibles, coinsurance, and copayments.
In 47 states, there are 10 standardized Medicare Supplement plans that are denoted by the letters A through N (plans E, H, I, and J are no longer sold). The private insurance companies offering these plans do not have to offer every Medicare Supplement plan, but they must offer at least Plan A. If an insurance company chooses to offer any Medicare Supplement plans in addition to Plan A, it must offer either Plan C or Plan F along with any other standardized Medicare Supplement plans it offers.
Please note that although the names may sound similar, the “parts” of Medicare, such as Part A and Part B, are not the same as Medigap Plan A, Plan B, etc.
Medicare Supplement plan coverage
Each Medicare Supplement plan offers a different level of coverage, but each lettered plan must include the same standardized benefits regardless of insurance company and location. For example, Medicare Supplement Plan G in Florida includes the same benefits as Plan G in North Dakota. Please note that if you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement insurance options are different than in the rest of the country. Medicare Supplement plans do not have to cover vision, dental, long-term care, or hearing aids, but all plans must cover at least a portion of the following basic benefits:
Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits are exhausted
Medicare Part A hospice care coinsurance or copayments
Medicare Part B coinsurance or copayments
First three pints of blood used in a medical procedure
Some plans include additional coverage. For example, Medicare Supplement Plan F, the most comprehensive standardized Medigap plan, carries the following additional benefits:
Medicare Part A deductible
Medicare Part B deductible
Part B excess charges
Part B preventive care coinsurance
Skilled Nursing Facility (SNF) care coinsurance
Foreign travel emergency care (80% of Medicare-approved costs, up to plan limits)
Some plans may include additional innovative benefits.
Medicare Supplement plan costs
Although private insurance companies are required to offer the same benefits for each lettered plan, they do have the ability to charge higher premiums for this coverage. You might want to shop around to find a Medicare Supplement plan that may fit your medical and financial needs. Insurance companies may price their plan premiums in any of the following ways:
Community no-age-rated: These Medicare Supplement plans charge premiums that are the same across the board, regardless of age.
Issue-age-rated: These plans base their premiums on your age when you first enrolled in the policy. Therefore, the younger you are when you enroll in this type of plan, the lower your premium will be.
Attained-age-rated: Like issue-age-rated, these plans base their premiums on the age you were when you first bought a policy, but unlike issue-age-rated, premiums increase as you get older.
Please note that no matter what rating method an insurance company uses, premiums may increase over time for reasons other than age, such as inflation.
Medicare Supplement plan enrollment and eligibility
To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. A good time to enroll in a plan is generally during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed-issue right to join any Medicare Supplement plan available where you live. You may not be denied coverage based on any pre-existing conditions during this enrollment period (although a waiting period may apply). If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage or charged a higher premium based on your medical history. In some states, you may be able to enroll in a Medigap plan before the age of 65.
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.
Medicare Health Plans
Medicare Advantage (Part C)
Medicare Part C is available through Medicare Advantage plans, and is an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans are health insurance plans offered by private health insurance companies approved by Medicare. Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.
One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan. Also known as Medicare Advantage Prescription Drug plans, these plans give you the convenience of having your Medicare Part A, Part B, and Part D coverage through a single plan. If you want prescription drug benefits, you should get it through a Medicare Advantage plan that includes this coverage; you shouldn’t enroll in a Medicare Prescription Drug Plan, which typically works with Original Medicare.
Medicare Advantage plan costs and coverage details can vary depending on the insurance company and county that you live in.
What are the types of Medicare Advantage plans?
As mentioned, Medicare Part C coverage details can vary depending on the insurance company, so it’s always a good idea to compare the Medicare Advantage plan options in your specific location. The following are types of Medicare Advantage plans that may be available in your location:
Health Maintenance Organization (HMO) plans: These plans offer a network of doctors and hospitals that members are generally required to use to be covered. Because of this, HMOs tend to have strict guidelines, meaning that any visits and prescriptions are subject to the plan approval. If you use providers outside of the plan network, you may need to pay the full cost out of pocket (with the exception of emergency or urgent care). You generally need to get a referral from your primary care doctor to see a specialist.
Preferred Provider Organization (PPO) plans: Medicare Advantage PPO plans offer a network of doctors and hospitals for beneficiaries to choose from. Unlike an HMO, you have the option to receive care from health-care providers outside of the plan’s network, but you’ll pay higher out-of-pocket costs. Medicare Advantage PPOs don’t require you to have a primary care doctor, and you don’t need referrals for specialist care.
Private Fee-for-Service (PFFS) plans: This type of plan allows visits to any Medicare-approved doctor or hospital, as long as the plan’s terms and conditions of payment are accepted by the provider. Keep in mind that you’ll need to find providers that contract with the plan each time you are receiving treatment.
Special Needs Plans (SNPs): These plans limit enrollment to beneficiaries who have certain chronic conditions, are institutionalized, or qualify for both Medicare and state Medicaid (also known as dual eligibles). Benefits, provider options, and prescription drugs are tailored to meet the needs of the plan’s enrollees.
Speak to a Medicare Expert by calling (877) 419-2422
Medicare Medical Savings Account (MSA) plans: These plans combine a high-deductible Medicare Advantage plan with a medical savings account. Every year, your MSA plan deposits money into a savings account that you can use to pay for medical expenses before you’ve reach the deductible. After your reach the deductible, your plan will begin to pay for Medicare-covered services. These plans don’t cover prescription drugs; if you want Medicare Part D coverage, you may enroll in a stand-alone Medicare Prescription Drug Plan.
What does it take to be eligible for a Medicare Advantage plan?
In order to be eligible for Medicare Part C, you must be enrolled in both parts of Original Medicare (Part A and Part B). Once you have Medicare Part A and Part B, you are generally able to enroll in a Medicare Advantage plan, provided you live in the plan’s service area and do not have end-stage renal disease (ESRD).
There are some exceptions where you may be able to enroll in a Medicare Advantage plan even if you have end-stage renal disease. For example, if you’re enrolling in a Special Needs Plan that targets beneficiaries with end-stage renal disease, you may be eligible to enroll in this type of Medicare Advantage plan. To learn more about other situations where you may be eligible for Medicare Part C if you have end-stage renal disease, you can contact Insurance Quote Central to speak with a licensed insurance agent and get your questions answered.
Those with other health insurance coverage (a union or employer-sponsored health plan, for example) should get more information about their existing coverage before enrolling in a Medicare Advantage plan. It is possible you could lose your existing coverage once you enroll in a Medicare Advantage plan. Furthermore, if you discontinue the other plan for Medicare Part C coverage, you may not be able to reinstate your original coverage if you change your mind It is generally a good idea to check with your current benefits administrator before you enroll in another health-care plan.
If you’d like to learn more about Medicare Advantage plan options or if you’d like help finding coverage that may fit your needs, contact insurance quote central's licensed insurance agents today.