Medicare Supplement Plan
& Medigap Plans
When you have Original Medicare, your insurance will cover approved healthcare costs but it will not cover everything, leaving you with several out-of-pocket expenses. You will be responsible for copays and deductibles. Also, you must consider things such as your 20% coinsurance payment as well as medical expenses that you might incur during foreign travel that are not Medicare-approved.
This is where Medigap policies comes into play—also known as Supplement Insurance Policies, as this is precisely what such plans are intended for: supplementing your Original Medicare insurance. You can get Medigap insurance through numerous insurance companies. Medigap premiums will vary depending on the provider and the type of Medigap plan you choose. For most of the country, Medigap policies are standardized policies; meaning, regardless of the insurer, policy holders will receive the same standard coverages. (Minnesota, Massachusetts and Wisconsin are the only states with different Medigap standards.)
Choosing a Medigap Plan That is Right For You
Medigap policies, for those who may not be familiar with them, are policies that are available to people currently enrolled in Medicare which help cover costs that Medicare does not. So, for instance, the expense of deductibles and copays can be defrayed with a Medigap policy in place. There are a few exceptions and circumstances under which a Medigap policy cannot be used for otherwise uncovered costs.
In order to qualify for a Medigap policy you must have Medicare Parts A and B. This means you will be paying two premiums: your income-determined Part B premium along with the premium for the Medigap policy. You cannot be enrolled in a Medicare Advantage Plan and enroll in a Medigap plan. Medigap plans available are identified as Plans A through N.
This guide will offer a brief overview of Medicare and Medigap and evaluate the various choices available to help you make a more informed decision regarding the type of Medigap policy that might work best for your specific situation.
Medicare: A Brief Overview
Medicare is insurance coverage available to those who are 65 and older and to those who may be under the age of 65 but have certain disabilities. Essentially, Medicare consists of three parts: Parts A, B and D, with Part A covering hospital related expenses; B pertaining manly to outpatient care, doctor visits and preventive care, and Part D is the prescription drug coverage. If you enroll in Original Medicare, you will receive Part A for free if you or your spouse have worked in the US for at least ten years. The current deductible for Part A is $1364.00. With Part B, the amount you pay is based upon income, so those reporting higher incomes will pay an adjusted premium from the base rate of $135.50. The deductible for Part B is currently $185.00. Now, Part D is sourced by private companies that adhere to the rules and regulations of Medicare. As such, premiums and deductibles can range widely, with the average premium hovering right around $33.00, and deductibles anywhere from $0 to $400. There is, incidentally, also a Part C; this is referred to as the Medicare Advantage Plan. With this, you get Parts A, B and D, so it is a bundled option that can potentially come with a lower premium. However, with Medicare Advantage, you are not eligible for a Medigap policy.
What About Medicare Advantage?
If you have Medicare Advantage it is illegal for a provider to sell you a Medigap policy. It’s important to know a little about the differences between having Original Medicare with Medigap supplemental coverage and having a Medicare Advantage Plan. Basically, with Medicare Advantage, instead of enrolling in Parts A, B and D, you would simply enroll in this bundled plan.
Medicare Advantage (or Part C) will likely cost less as far as the premium goes (you still do pay a Medicare Advantage premium along with your Part B premium); however, some of the out-of-pocket costs can be a bit higher.
This option does limit doctor choice as, most generally, patients are required to use providers within the HMO or PPO. Another consideration is that Medicare Advantage usually only works within a specified region. If you’re a frequent traveler or have multiple residences in various areas of the country, this may not be your best choice.
Unlike Medicare Advantage, Medicare with Medigap does let you choose essentially any doctor—you will want to double check as far as any specialists you may need to see. And Medigap also has more flexibility in terms of where you are located and consequently where you require medical/health services.
Enrolling in a Medigap Plan
Enrolling in a Medigap plan that fits your needs and lifestyle takes a little bit of homework. The good thing is that pretty much all Medigap policies are standardized (except, as previously noted, for Minnesota, Massachusetts and Wisconsin, which standardize their plans differently). This of course means that whatever benefit one insurer offers, you know that the same will be offered by competing companies.
Because of this across-the-board standardization it really will come down to pricing and your level of comfortability with a particular insurance company. Keep your budget in mind, and don’t be afraid to ask questions. Any potential insurer should be knowledgeable about Medicare and Medigap, and they should not hesitate to address your questions and concerns.
Your primary consideration will ultimately be which of the Medigap plans to choose. The links above should give you a clearer picture of what each plan covers. Also, you can visit Medicare.gov which provides more information regarding the nuts and bolts of the plans and Medigap coverage in general. Many opt for Plan F as that is the most comprehensive. Do remember that beginning in 2020, Plans F along with C will no longer be available to new Medicare subscribers.
Cost is probably going to be a huge deciding factor when it comes to which plan you choose. You want to spend some time thinking about and looking at your history as far as the deductibles and expenses you pay and those you might anticipate paying: lab test copays, doctor visit copays, hospital costs and deductibles not covered by Medicare, among other factors. The key is to weigh the pros and cons of each of the ten plans and their respective coverages and then make an informed decision based upon your personal medical/healthcare needs and budgetary concerns.
What Medigap Will Not Cover
As you can see, supplement insurance really does come in handy in terms of picking up many of those expenses that Medicare will not. There are though certain things that this supplemental plan will not cover.
The following are not covered with a Medigap policy:
- Long-term care
- Vision expenses/eyeglasses
- Dental care
- Hearing aids
- Private nurses
Also keep in mind, if a healthcare provider accepts Medicare, and the expense is an approved Medigap expense, then your coverage will be effective. If though, a provider does not take Medicare, you won’t be able to use any portion of your Medigap policy. Additionally, with Medigap there are no joint policy options, so both you and your spouse will require your own plan.
When Should You Enroll in a Medigap Plan?
Right after you turn 65 you have a period of seven months in which to enroll in Medicare. Most will want to make sure and enroll during this initial period, otherwise insurers can ask about health-related issues and past medical history. Whereas, if you enroll within that seven-month timeframe, they are not allowed to question you regarding pre-existing conditions—this will also be when you want to get your Medigap policy in place.
Some Final Thoughts on Medigap
Again, when choosing a plan, the help of the insurance provider is probably going to be pivotal. They should be well-versed on the nuances of each of the Medigap plans, and they should also take the time to understand your history, your expectations and your concerns moving forward.