As you approach the age of 65, you become one of the most popular people in the world. It seems like overnight you start receiving mail from every insurance carrier and company under the sun, and then the phone calls start. There is truly a lot of information that you need to learn and understand.

What Medigap Coverage Is Used For

Medigap is another name for Medicare Supplement plans. These plans help cover your, coinsurance, deductibles, copayments, or any other out-of-pocket costs associated with Original Medicare. They are administered by private insurance companies such as Mutual of Omaha, Aetna, and United American.

Medicare Supplement plans are standardized by the federal government. This means that, for the most part, no matter where you are, or which carrier you choose the coverage is required to be the same.

There are a few states that have exceptions to the standardization. Those states include Minnesota, Wisconsin, and Massachusetts.

About Medicare Supplement Coverage

As mentioned above Medigap coverage assist with your Medicare costs. There are 10 Medicare Supplement insurance plans to choose from. Each plan has varying levels of coverage.

Since these plans are supplemental coverage to Medicare, you must continue to pay your Medicare Part B premium in addition to any Medigap insurance you choose.

These plans will cover anything that is covered by traditional Medicare. Some will even provide you with emergency coverage for foreign travel.

Essentially they’ll cover all benefits and services that are covered by Medicare. Some of those services are listed below.

  • Inpatient Hospital
  • Skilled Nursing Facility
  • Hospice care
  • Outpatient services and procedures
  • Doctor and specialist appointments
  • Drugs administered in the hospital, or Doctor’s office

What isn’t covered by Medicare Supplement Plans?

Since Medicare insurance policies are secondary to Medicare, they only cover what Medicare covers. Medicare coverage is defined as medically necessary health care services.

Items that aren’t covered by Medicare supplements include:

Costs covered by Medicare Supplemental Insurance

Medicare Supplements coverage some or all of your costs left over after Medicare pays.

Depending on the health coverage you choose they could pay all or part of the following costs.

  • Medicare Part A deductible – $1,556
    • Per occurrence deductible each time, you’re admitted into the Hospital
  • Medicare Part A Coinsurance
  • Medicare Part A Copayment
    • Daily copays begin
      • After you’ve spent 60 days in the hospital
      • After you’ve spent 20 days in a skilled nursing facility
  • Medicare Part B deductible – $233
    • Annual deductible
  • Medicare Part B co-insurance
    • 20% of the Medicare-approved amount
  • Medicare Part B Excess charges
    • Up to 15% above the Medicare-approved amount

Enrollment requirements for a Medigap Policy

Medicare beneficiaries can enroll in a Medicare Supplement at any time, as long as they can pass medical underwriting.

There are a few cases that allow you to enroll in a Medigap health insurance plan without underwriting. When you first turn 65, you’ll be in your open enrollment period.

The open enrollment period runs for six months. During this time beneficiaries can enroll in any Medigap plan of their choice without the need for underwriting.

Some states, such as New York and Connecticut, have special rules that allow you to enroll year-round, or at certain times without requiring underwriting.

There is also something called Guarantee Issue rights. There are 7 special situations that allow you to enroll in certain Medigap plans without underwriting. most of these revolve around losing creditable coverage at no fault of your own.

Medicare Supplement Plan Letter Coverages

As mentioned above they’re 10 plan options to choose from. Most Beneficiaries choose one of the top three plans. The most popular plans are Plans F, G, and N.

Plan F is the most comprehensive plan available. Essentially you simply pay your monthly premium, and the Plan F pays your Medicare health care costs.

Plan G is the most popular plan when it comes to beneficiaries that are new to Medicare. This health plan offers almost the same coverage as Plan F. The only difference is it doesn’t cover the Medicare Part B deductible.

Plan N is a very popular plan for healthy and cost-conscious individuals. This plan offers a great balance of monthly premium versus good benefits. The main difference between Plans N and G is that Plan N has copays for doctor visits and the emergency room.

Below is a breakdown of all the available plans and what they cover. Plan F and Plan G both have a high-deductible option as well.

What impacts the cost of Medigap Plans

With Medicare Supplement benefits being standardized, there are a few things you need to consider are you’re settled on your preferred plan. The monthly premium, and quality of the company.

Since the benefits are the same monthly premium is one of the first things we consider. After all, who wants to pay more for the same thing.

There are a few factors that can affect your premium. Two of the major contributors are your age, and if you have any underlying health problems.

Quality of company is important. If you do have an issue, would you prefer a company that has excellent customer service or one where you struggle to speak to someone that can help?

A higher-quality company is also less likely to have high rate increases when compared to a company that isn’t as strong.

What’s the difference between Medigap and Medicare Advantage?

Medicare Supplement plans are secondary coverage added to Original Medicare. A Medicare Advantage Plan is an insurance that takes over your Medicare benefits from the Medicare program. They’re offered by private companies like Humana, and UnitedHealthcare.

These plans are required to cover the same benefits as traditional Medicare. In many cases provide extra benefits that aren’t covered by Original Medicare. They’ll usually include your Part D prescription drug coverage as well.

Medigap plans usually have higher premiums than those of Medicare Advantage. Medicare Advantage is another name for Medicare Part C.

FAQs

Is Medigap the same as supplemental?

Yes! A Medicare Supplement and Medigap plan are 2 names for the same coverage.

What does Medigap cover and who provides it?

Medigap plans help fill the gaps in Medicare coverage. These plans cover part or all of your out-of-pocket costs after Medicare pays its portion. They are provided by private companies such as Mutual Of Omaha, Cigna, and Aetna.

What is the difference between Medicare and Medigap?

Medicare is your standard health insurance. Medicare Supplement picks up some of all of the costs left over by Medicare.

What are some of the advantages of Medigap?

Since you are supplementing your Medicare, you retain the right to choose any doctor nationwide that accepts Medicare. They travel with you and the coverage will always be the same.

What health care services are not covered by Medigap?

Medicare Supplements don’t cover dental, vision, hearing, and long-term care.

What does Medigap do for people?

Medigap insurance helps pay for your medical costs when using hospital and medical services.

What are the benefits of Medigap?

There are many benefits of enrolling in a Medicare Supplement plan. They give peace of mind and options for your health care. that’s easy to budget.

Getting Help with Choosing a Medigap Plan

Choosing a Medigap plan can be a daunting process. With 10 choices and 20 to 30 insurance carriers to choose from, many people look for help when comparing. That’s where we come in. Our licensed insurance agents are here for you.

Let us educate you on the differences and costs. We’ll help with providing comparisons and walk you through the enrollment process. For assistance give us a call, or fill out our online request form.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.