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Medigap Explained

Medigap Explained

Perhaps the most versatile of optional Medicare choices, Medigap plans help defray health care costs not paid by Original Medicare Parts A and B. Also known as Medicare Supplement plans, Medigap plans typically cover out-of-pocket costs such as co-pays and co-insurance fees.

What is Medigap insurance? What Does Medigap Cover?

So, just what is a Medigap policy? Medigap or medicare supplement policies are sold by private insurance carriers. Seniors  choose the Medigap coverage they need and can afford from among ten Medicare Supplement Plans.   While not managed by the federal government,  there are some federally-mandated requirements regarding Medicare Medigap plans, For instance, the federal government requires that every insurance carrier that offers Medigap Policies must offer Medicare supplement Plan F. “What is a Medigap insurance policy?” is a multi-faceted answer.  Here are the highlights you’ll see as we compare Medigap insurance plans and what Medigap will cover.

  • Medicare Supplement Insurance (also referred to as a Medigap policy)
  • Purchased from private insurance companies
  • Supplements Original Medicare coverage
  • Covers some costs Original Medicare doesn’t pay, like coinsurance and deductibles
  • Plans are available with varying coverage options
  • Freedom to visit any doctor who accepts medicare patient.

While all ten medicare supplemental insurance plans pay co-insurance for up to 365 days in a hospital after Medicare Part A coverage runs out, as well as Part B preventive care co-insurance, other perks are available only with certain plans.

Medigap Plans Comparison Chart

 

PLAN Part A

Deductible 

 

Part B

Deductible

 

Part B

co-payment

Part B

Excess charges

1st 3 pints

of blood

Part A Hospice care co-pay Skilled nursing

co-insurance

Foreign-travel emergency care
A 100% 100% 100%
B 100% 100% 100% 100%
C 100% 100% 100% 100% 100% 100% 80% up to plan limits
D 100% 100% 100% 100% 100% 80% up to plan limits
F 100% 100% 100% 100% 100% 100% 100% 80% up to plan limits
G 100% 100% 100% 100% 100% 100% 80% up to plan limits
K 50% 50% 50% 50% 50%
L 75% 75% 75% 75% 75%
M 50% 100% 100% 100% 100% 80% up to plan limits
N 100% 100%, except for $50 emergency room visit

if not admitted, & $20 for some doctor visits

100% 100% 100% 80% up to plan limits

 

Clear from a look at the options above is there are many options to suit the needs of every person. Please contact a medicare supplement advisor at 866-936-3831 to help your navigate the options and to better understand coverages. We’ll take in your personal circumstance to help your make the right choice, because the wrong coverage could impact your healthcare and your pocketbook.

Let’s assume the senior likes the low monthly premium for a carrier’s Medigap plan N. It seems a good choice, because she’s planning overseas travel.  If, however, she is scheduled for a gall bladder operation, but her surgeon charges in excess of what Medicare pays, her out-of-pocket for the surgery might exceed the difference between the annual premium expense of Medigap Plan F or Medigap Plan G minus the annual premium expense of Plan N.  Medicare supplement Plan F or G pays all excess surgery charges.

Medigap vs Medicare Advantage

For seniors in good health, for whom monthly insurance premium costs is the primary consideration,  a Medicare Advantage plan (also known as MA) may be the best choice, compared with higher Medigap plans cost. Many MA plans, unlike Medigap cost, are zero premium – that is, charging no upfront monthly premium for the coverage.  Several of these plans offer one or two upgraded tiers as well, that allow the insured to increase his or her hospital coverage, decrease their doctor-visit copay, or add dental coverage to the mix, as a few examples.

Deciding on one of the Medicare supplemental insurance plans or opting for an MA should take into consideration the volume and cost of anticipated surgeries and doctor visits, budget for monthly upfront costs, travel plans, and the importance of retaining control over which medical caregivers and facilities provide care. While Medicare Supplement plans do not dictate which caregiver the insured must use, Medicare Advantage plans generally require that the senior choose physicians and medical facilities within its provider network.  Additionally, MA coverage, except for emergency and urgent care, is limited to the senior’s home state.

Choosing a Medigap policy

Choosing among MA or Medicare supplemental insurance plans is not as weighty a decision as one might think. The answer to the question “Can I switch from Medicare Advantage to Medigap?” is yes, annually. The medicare annual enrollment period (AEP) is October 15th to December 7th each year.

Medicare supplemental insurance plans, however do not have any enrollment period.  You may enroll anytime of the year. However some states such as California and others have a birthday rule caveat. The birthday rule allows you to switch to a like medicare supplement plan from a different carrier without having to go through medical underwriting. For example lets say you have a medicare supplement plan F with carrier A. However you learn through your medicare advisor/broker that carrier B offers the same exact medicare supplement plan F coverage for a lower monthly premium. Thus, the medigap plans vs medicare advantage decision can be an annual one.

To find out about low priced options available to you, please click here in addition you can speak with a licensed agent by calling  866-936-3831. Gary W Blackmon is licensed medicare insurance agent and helps customers from California to New York with their medicare options. If you have any questions, need assistance in  enrolling, or would like to obtain a quote specific to you, please contact me.