Learn more about Medicare Supplemental Plans also known as Medigap.

Medicare Supplement Policies or Medigap Insurance Plans

Medicare Supplement Policies or Medigap insurance plans are sold by private insurance companies. There are 10 modernized plans labeled A through N that pay for part, or all, of Medicare’s co-payments and deductibles, with Plan F being the most comprehensive. Some may also cover other healthcare costs that Medicare does not pay for, such as foreign travel emergency medical care.

Medigap is designed to bridge the coverage gaps in Original Medicare Parts A and B. While Original Medicare covers a significant portion of healthcare expenses, it doesn’t cover everything, typically about 80% after deductibles. Medigap policies, sold by private insurers, provide additional coverage for costs not fully covered by Original Medicare. Note that Medigap is distinct from Medicare Advantage Plans, and you cannot be enrolled in both simultaneously.

Worried about uncovered expenses in Medicare coverage?

Many Medicare beneficiaries opt for a Medicare Supplemental Insurance (Medigap) plan to manage healthcare expenses not covered by Original Medicare. These plans are designed to bridge the financial gap, covering some or even all out-of-pocket costs like copayments, coinsurance, and deductibles. One significant advantage of Medigap plans is their flexibility; they don’t restrict beneficiaries to specific healthcare networks and don’t necessitate referrals for specialist visits. This aspect ensures greater freedom in healthcare choices and financial protection against unexpected medical expenses.

How do Medigap plans work?

While Original Medicare (Part A and B) covers a significant portion of healthcare expenses, it doesn’t fully cover all costs – typically covering around 80%. A Medicare Supplement plan, also known as Medigap, is a separate private insurance policy that works alongside Original Medicare. It helps to offset expenses not covered by Medicare, like copayments, coinsurance, and deductibles. As healthcare costs continue to rise, Medigap becomes essential in managing the remaining 20% of costs not covered by Medicare. Medigap plans are standardized and federally regulated, ensuring consistency in coverage across various insurance providers, although premiums may vary.

What are the most popular Medicare Supplement (Medigap) Plans?

Among Medicare Supplement Plans, Plan F, Plan G, and Plan N are the most highly favored. Plan F is often regarded as the premier choice since it fully covers all Medicare-approved services. However, it’s important to note that Plan F is not accessible to everyone. In contrast, Plan G and Plan N are well-liked for their balance of comprehensive coverage and more affordable premiums. For a detailed comparison of these plans and further insights, contact a My Senior Health Plan senior health consultant for guidance.

Need more research on Medigap Plans? Visit the cms.gov website.

How much do Medigap Plans cost?

The cost of Medicare Supplement plans varies based on several factors including:

  • Age
  • Location
  • Gender
  • Tobacco usage
  • The chosen plan

For example, premium rates for a 70-year-old male under Plan F could be significantly higher in Florida compared to North Carolina. To find the most suitable Medigap plan, contact a My Senior Health Plan senior health specialist for assistance at (877)255-6273. They can quickly compare plans from over 25 companies, helping you to efficiently find and apply for the right plan over the phone.

What cost and expenses does a Medigap Plan cover?

These plans stand out due to their flexibility and coverage scope. They don’t restrict you to specific networks, meaning you can visit any doctor, hospital, or healthcare facility that accepts Medicare nationwide, including all 50 states and U.S. territories. Additionally, these plans often offer some level of international coverage, depending on the specific plan chosen.

Seeing specialists doesn’t require referrals, offering greater autonomy in managing your healthcare. These plans also provide the assurance of lifelong coverage, contingent upon timely premium payments and the accuracy of information provided in the application.

Most Medigap plans cover:

  • Assists in paying expenses not covered by Original Medicare, with some plans potentially covering all costs.
  • Freedom to consult any Medicare-accepting doctor.
  • No need for specialist referral.
  • Nationwide travel coverage.
  • Overseas emergency care benefits: Available during the first 60 days of travel, covers 80% of necessary medical costs after a $250 deductible, with a $50,000 lifetime cap.
  • Lifelong guaranteed coverage provided premiums are paid on time and the application is free of significant misrepresentations.

What cost and expenses does a Medigap Plan NOT cover?

Medicare Supplement (Medigap) plans step in to cover costs after Medicare has paid its portion. Once Medicare approves and pays for a claim, the remaining expenses are forwarded to the Medigap insurance provider. However, it’s important to note that certain expenses are not covered by Medicare or Medigap plans, including:

  • Long-term or custodial care.
  • Routine dental, vision, and hearing check-ups.
  • Hearing aids, eyeglasses or contact lenses.
  • Prescription drugs under Part D.

Overview of the 12 Standard Medigap (Medicare Supplement) Plans

In most states, there are 12 distinct standardized Medigap plans available, labeled A, B, C, D, F, G, K, L, M, and N. Each of these plans offers varying levels of coverage, addressing different healthcare cost needs. Notably, Plans F and G also come in high-deductible options. However, the states of Massachusetts, Minnesota, and Wisconsin have unique standardization for their Medigap policies.

How do I determine if I am eligible to enroll in a Medicare Supplement Plan?

The ideal time to sign up for a Medigap plan is during your Open Enrollment Period, coinciding with your Medicare Initial Enrollment Period. This period begins three months before, includes the month of, and extends three months after your 65th birthday. In this window, you can select any Medigap plan and receive guaranteed coverage without denial based on your current or pre-existing health conditions.

10 Things you need to know about Medicare Supplement policies available nationwide:

You must have Medicare Part A and Part B.

If you are applying for a Medicare Supplement plan outside of the Open Enrollment period, you may be subject to the carrier’s underwriting policies.

If you have a Medicare Advantage Plan, you can apply for a Medigap plan, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement policy begins.

You pay the private insurance company a monthly premium for your Medicare Supplement policy in addition to the monthly Part B premium that you pay to Medicare.

A Medicare Supplement policy only covers one person. If you and your spouse both want Medicare Supplement coverage, you’ll each have to buy separate policies.

You can buy a Medigap plan from any insurance company that’s licensed in your state to sell one.

Any standardized Medicare Supplement insurance plan is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement policy as long as you pay the premium.

Medigap plans do not include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

The company cannot change the benefits covered by the plan, and cannot cancel the policy unless you fail to pay the monthly premium. The company can however, at its discretion, increase the premium you must pay.

Medicare Supplement policies nationwide generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

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