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Understanding Medicare Supplement Plans
Original Medicare, and policies sold by private companies, covers multiple health care costs and supplies. However, it is not comprehensive and may not cover costs like co-insurance, co-payments, and deductibles. Medigap is a Medicare Supplement Insurance that helps the consumers to pay for the remaining health care costs. Moreover, some Medigap policies offer a few services that are not covered by the Original Medicare policy. For instance, it may cover overseas health care costs. When combined, supplement Medicare insurance and Original Medicare can protect the consumer’s interests in times of need.
How to Use Medicare Supplement Plans to Get the Best Coverage?
You know what they say: The best defence is a good offence. This holds especially true for health insurance. With the right insurance, you can sleep soundly knowing that if you need medical attention, your expenses are covered.
The thing is, not all health insurance is created equal.
If you require more frequent doctor visits due to health conditions or age, you’ll pay more out-of-pocket if you have original Medicare without a supplemental plan. To ease the financial burden placed on customers, Medigap was created to either pay in full or cost-share medical expenses, like paying your Plan A deductible.
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Table of Contents
The Difference Between Original Medicare And Medicare Advantage
If you’re eligible for original Medicare through the federal government, you’re purchasing Plan A (hospital trips) and Plan B (medical coverage) healthcare insurance. Although both elements are crucial pieces of the healthcare puzzle, it isn’t enough to protect you from paying steep out-of-pocket medical bills.
Original Medicare is an affordable healthcare alternative that covers the basics (Plan A and Plan B), while with Medicare Advantage—also called Medicare Part C—you’ll receive:
- Plan A and Plan B coverage
- Plan D: Some Medicare Plans come with prescription drug coverage
Medicare Advantage plans can be more affordable or more costly than original Medicare, depending on the exact policy you receive.
What Is Medigap Coverage?
Medigap is supplemental coverage provided by insurers (not the federal government) to help pay for things original Medicare doesn’t. Original Medicare is a good start, but it won’t cover the entire medical cost, so investing in Medigap coverage means your insurer will help pay your deductibles, copay and coinsurance—so you pay less.
Medigap Policy Options
Here’s where you have the power to choose which Medigap policy is right for you as there are quite a few choices available.
You may also notice that Plan C and Plan F are intentionally left out as they’re being phased out to new customers.
| Medigap Benefit | Plan A | Plan B | Plan D | Plan G | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|
| Part A Medicare Coinsurance | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part A Hospice Coinsurance/Copay | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Blood (First 3 Pints) | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part B Copay Or Coinsurance | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled Nursing Coinsurance | No | No | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A Deductible | No | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B Deductible | No | No | No | No | No | No | No | No |
| Foreign Travel Exchange | No | No | 80% | 80% | No | No | 80% | 80% |
| Cost | $147- $784 | $202- $726 | $221- $515 | $199- $473 | $62- $135 | $119- $301 | $201- $430 | $146- $289 |
Choosing The Right Medigap Coverage
With so many choices, these are some of the best Medigap plans:
- Best Overall Coverage: If you’re looking for the most overall coverage, Plan G is a solid choice. However, since it offers the most dynamic coverage, you’ll also pay a higher premium, so make sure it’s within your budget before purchasing.
- Runner Up: If Plan G is too much money for you or you don’t need the highest level of coverage, then Plan N may be a better fit.
- Most Affordable: If you can’t afford to pay high premiums, the best policy is Medigap Plan L. Even though Plan K is cheaper, you go from 50% coverage in skilled nursing to 75% coverage for a little extra.
Additional Benefits of Medigap Plans
Aside from helping to ease the financial burden of medical costs and services, Medigap plans come with some other surprising benefits, like:
- Travel Insurance: Some insurers lump in travel insurance, so if you’re outside the US and require medical care, you’re entitled to both Medicare and Medigap.
- Guaranteed Renewal: No matter your current state of health, there is no risk to your Plan if you have medical conditions. So long as you pay your premium, you’re insured.
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Medigap Stipulations
You should know a few important facts that could affect your eligibility for Medigap Supplemental Plans or influence your decision on whether Medigap is right for you.
- Original Medicare: To be eligible for Medigap, you must have original Medicare coverage, meaning you’ve bought into Plan A and Plan B.
- Supplemental: Medigap is not a standalone healthcare plan; it is only used in conjunction with original Medicare to increase your coverage. Therefore, it is for use with original Medicare only, and can’t be used with other healthcare insurances, like Medicaid.
- Single Person Coverage: Medigap will cover only one person. If you need additional coverage for your spouse, your partner will have to take out their own Medigap plan.
- Drug Coverage: Before 2006, some Medigap coverage included prescription drugs; this is no longer an option. If you need a prescription drug plan, you can purchase one through your insurance provider or Medicare Part D or Part C, which includes prescription drugs.
How To Apply For Medigap?
Depending on the state you reside in, most insurance companies offer Medigap to persons 65 and older. If you would like to set up Medigap supplemental insurance, you can apply during Medigap Open Enrollment on the first day of the month when you’re both 65 (or older) and paying for Plan B insurance. You then have six months to apply for Medigap and are guaranteed acceptance, no matter your state of health.
If you miss the cut-off window, you may still qualify. However, you’ll pay higher premiums or get denied basic benefits. This said, if you’re placed on a waiting list during Open Enrollment, you won’t be penalized.
Who Benefits From Medigap Coverage?
Medigap was created to help seniors or those with serious health conditions in mind. These beneficiaries require more frequent medical attention; thus, they need supplemental coverage to help cover additional costs.
Medigap Plan Costs Aren’t Fixed
Qualifying insurance agencies that offer Medigap supplemental coverage aren’t required to sell it at the same rate nationwide. Since Medigap coverage isn’t fixed, you’ll have to shop around to find the coverage that both fits your budget and your needs.
Insurers arrive at a Medigap price using one of the following methods:
- Community No-Age-Rated: No matter your age, the premiums are universal to all Medigap beneficiaries.
- Issue-Age-Rated: Premiums are based on age; if you enroll at a younger age, your rates will be lower.
- Attained-Age-Rated: Premiums are based on how old you were when you bought Medigap. However, the premiums will increase as you age.
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How Do Medicare Supplement Plans Work With Other Insurance Plans?
With Medicare Supplement Plans, your medical expenses are mostly taken care of. However, it does not cover hearing aids and eyeglasses. Moreover, it also does not cover private-duty nursing or long-term nursing home care. You may want to consider other private company insurance plans to cover these.
However, a Medicare Supplement Plan should definitely be a feature of your financial planning because –
Medicare Supplement Plans
Whether you’re taking proactive measures or you currently need financial relief to cover your medical expenses due to age or health conditions, Medigap supplemental plans are here to offer you peace of mind. You shouldn’t have to worry about how you’ll cover necessary trips to the doctor, and with Medigap coverage, you won’t have to.
FAQ
Not necessarily. If you have employer healthcare insurance, for example, you would not qualify or need Medigap. Medigap coverage is intended for original Medicare beneficiaries that pay into Plan A and Plan B and are looking to pay less upfront medical costs (e.g., copay). Typically Medigap is an excellent choice for seniors as they require more medical care.
The easiest way to apply for Medigap coverage is by calling your current insurance provider and asking about your eligibility. At this time, they provide you with the details on when your Open Enrollment Period is, so should you decide to purchase a Medigap plan, you can make the deadline without penalty.
Good question. The answer depends on how much you can comfortably afford to spend on premiums and what your medical needs are. If you’re anticipating many doctor appointments, you may want comprehensive coverage with Plan K or Plan N. If finances are tight or if you’re taking out Medigap coverage as a precaution because you’re over 65, you may want low-mid level protection.
Medigap insurance supports Original Medicare insurance. It is private health insurance that is designed to lower out-of-pocket costs.
It is available for people who are at least 65 years of age. For ones below 65 years, consumers who have disabilities or are suffering from end-stage renal disease can apply for it.
It is available for people who are at least 65 years of age. For ones below 65 years, consumers who have disabilities or are suffering from end-stage renal disease can apply for it.
Due to its advantages, consumers should apply at the first opportunity when they are eligible to buy a Medigap Supplement Insurance policy. Also known as open enrollment, it begins on the first day of the month when you are at least 65 years. However, you should also possess part B to be eligible for the Medigap policy. This period lasts for six months, and your chances to invest in it start diminishing after it lapses. It is advisable to buy it during this period.
A Medicare Plan, in itself, is not comprehensive. There are gaps, and your out-of-pocket costs can be as high as 20 % of your medical costs. In the absence of a steady income, it can pinch you. The combination of Original Medicare and Medigap plans will protect your interests.