A Medicare Supplemental Plan is private insurance that helps pay the “gap” between what’s covered by Original Medicare and what’s not. It covers things like deductibles, coinsurance, and co-pays.
Another name for Medicare Supplement is Medigap supplemental insurance or Medigap insurance.
You must have Original Medicare Part A (hospital) and Part B (medical) in order to purchase a Medigap plan. You cannot purchase a Medigap plan if you have Medicare Part C (Medicare Advantage).
Medigap plans do not cover gaps in Medicare Part D (prescription).
Open Enrollment for Medigap Plans
Your open enrollment period for Medigap coverage begins on the first day of the month you are 65 and enrolled in Medicare Part B. The enrollment period runs for 6 months.
If you purchase Medigap coverage during your initial enrollment period, there is no medical underwriting. This means you cannot be denied coverage or charged extra for health reasons.
However, after your initial enrollment period, you will be required to complete a medical questionnaire to buy or change plans.
Therefore, we recommend you:
- Purchase Medigap coverage as soon as you are first eligible.
- Select the best coverage you can afford.
- Choose a carrier you can trust.
After all, most people have the same Medigap coverage for life.
Types of Medigap Coverage
All Medigap policies must adhere to federal and state laws. They are standardized according to their benefits. This is true regardless of the issuing insurance company.
Standardized Medigap plans are identified by the letters A through N. Each policy with the same letter must offer the same basic benefits, no matter which insurance company sells it.
|Part A Co-Insurance & Hospital Costs (up to 365 additional days after Medicare benefits are used up)||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B Coinsurance or Copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled Nursing Facility Care Coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A Deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B Deductible||No||No||Yes||No||Yes||Yes||No||No||No||No|
|Part B Excess Charges (a doctor's charges above Medicare's approved amount)||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign Travel Exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out of pocket limit**||N/A||N/A||N/A||N/A||N/A||N/A||$4940||$2470||N/A||N/A|
* Plan F also offers a high deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,180 in 2016 before your Medigap pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
The only difference between Medigap plans with the same letter sold by different insurance companies is typically the cost.
So when choosing Medigap coverage, it is important to select a reliable insurance carrier and shop around for the best price.
We typically recommend Plan F, High Deductible F, or Plan G. We would be happy to help you choose a plan that makes sense for you.
Please give us a call at 703-707-8270!