Medigap Explained

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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? 

So, just what is a Medigap policy? Medigap or medicare supplement policies are sold by private insurance carriers. These plans are supplemental insurance and fill the “gap” in Original Medicare coverage. 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.

As of 01/01/2020, no Medigap policy sold to a new Medicare beneficiary will pay for the Part B deductible. That means that Medigap plans C and F cannot be sold to someone new to medicare. However, there is a grandfather clause for people that were already on Medicare before January 1, 2020, they can still keep their Medigap plan C or F or purchase it new if they’re been enrolled in Medicare part A & B prior to January 1, 2020.

What is a Medigap insurance policy?

To answer this question you need to first understand Original pays alot of your health care costs but not all. A Medigap insurance policy or Medicare Supplement Insurance policy as it may be called can help pay the remaining health care costs that you would otherwise have to come out your own of pocket to cover. Medicare Supplement insurance plans can help pay for copayments, coinsurance and deductibles that are not covered by Original Medicare Part A & B. What is a Medigap insurance policy? Here is a review:

  • 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.

What Does Medigap Cover?

All Medicare Supplement insurance or Medigap insurance plans pay the Part A co-insurance and hospital costs up to an additional 365 days  after Medicare benefits are used up.  All Medigap plans will also pay the Part B preventive care co-insurance, however other coverages may be available only with certain plans.  Additionally, some Medigap insurance plans cover services that Original Medicare Part A & B does not.  Some plans provide coverage for health care costs when you travel outside of the U.S. See the chart below: 

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

 

Medigap insurance plan F and medigap insurance plan G both offer a high deductible plan option in some states. With Medigap insurance plan that has a high deductible, you must pay for all Medicare health care costs up to the limit of the deductible before the plan pays. 

In 2020 you must pay the first $2,340 if you have a high deductible Medigap insurance plan F or high deductible Medigap insurance plan G.  As we discussed earlier Medicare supplement plan C and Medicare supplement plan F are no longer available to someone new to medicare after January 1, 2020. 

For Medigap supplement plan K and Medigap supplement plan L, after you meet the out of pocket annual limit and your annual Part B deductible, your Medicare supplemental insurance plan pays 100% of all covered services for the rest of the year. In 2020 the annual Medicare Part B deductible is $198.00

Let’s assume you like the low monthly premium for a carrier’s Medigap plan N. It seems a good choice, because you’re planning overseas travel.  If, lets say you’re scheduled for a gall bladder operation, but your surgeon charges in excess of what Medicare pays, then your out-of-pocket for the surgery might exceed the difference between the annual premium expense of Medigap Insurance Plan F or Medigap Insurance Plan G minus the annual premium expense of Plan N.  Both Medicare supplement insurance Plan F and Medicare supplement insurance plan G would pay all excess surgery charges.

There are many Medigap insurance plan 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 consider your personal financial situation and help you get the most coverage for the best price.

As you can see, the wrong coverage could impact your healthcare and create alot of out of pocket cost at a time when you’re already dealing alot of stress.  Lets us help guide you. Call a Medigap insurance plan advisor today at 866-936-3831 or use our online quote engine to get started. 

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 to buy a Medicare Advantage over a Medicare supplemental insurance plan is as weighty a decision.  What happens if you buy a medicare advantage plan but then decide later that you would prefer a medigap insurance plan.  Can you switch to a medicare supplement plan? Absolutely. During the medicare annual enrollment period (AEP) between October 15th to December 7th each year you may drop a medicare supplement and enroll into a Original Medicare and buy a medigap insurance plan. There maybe other times that you may drop a medicare advantage plan during the year prior to the annual enrollment period if you have a qualifying enrollment period. Please contact an insurance advisor at 866-936-3831 to discuss all of your options. 

 

Buy a Medigap Insurance Plan

If you are only enrolled in Original Medicare Part A and Part B you have can buy a Medigap insurance plan year around. Medicare supplemental insurance plans do not have any enrollment period.  You may enroll anytime of the year.

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 an insurance company.  However you learn through your medicare advisor/broker that a different insurance carrier offers the same exact medicare supplement plan F coverage for a much lower monthly premium.   In California and Oregon there is a birthday rule that provides an annual open enrollment to accomplish this switch.

Please contact an insurance advisor at 866-936-3831 to discuss your options. Thus, choosing a medigap insurance plans vs medicare advantage decision can be an annual one.

Medigap Insurance – Contact Us

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.