MEDIGAP PLANS
MEDICARE SUPPLEMENT PLANS
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What Are Medigap Plans
Medicare Supplement Insurance is a product offered by private insurance companies that helps make your Medicare benefits more comprehensive. Medicare Supplement Insurance can take your Medicare coverage from a “7” or “8” to a “9” or a “10.” In this guide, we’ll dive deep into the benefits and options available for Medicare Supplement Insurance. By the end, you’ll be able to make a wise choice for your Medicare coverage.
What Is Medicare Supplement Insurance?
Medicare Supplement Insurance is a secondary (supplementary) coverage that works in conjunction with Original Medicare, Parts A and B. Because Original Medicare isn’t designed to cover 100% of your medical expenses, there are a number gaps or holes that you’re responsible for. These gaps can expose you to high out of pocket spending, which many people would prefer to avoid. That’s where Medicare Supplement Insurance comes into play; this coverage closes some or all of these gaps. For this reason, Medicare Supplement is often called Medigap insurance.
Medigap Insurance has been around as long as the Medicare program has existed. It is the original private insurance option to help lower your out of pocket costs. It is much older than Medicare Advantage, which was created in the late 1990s.
Medigap plans are standardized; there are 12 “Plans:” A, B, C, D, F, G, K, L, M, N, and high deductible versions of Plans F and G. Each of these Plans is standardized across the United States (47 of the states use the standardized Medigap plans). This means that Plan D in Nevada has the exact same benefits as Plan D in Ohio. This standardization makes it very easy to choose a Medigap plan based on two easily determined criteria:
- Level of coverage needed (do you need very comprehensive coverage, or just back up coverage in case of emergency?)
- The price for coverage
To pick the right Medigap plan for you, you have to understand which options are available, so we’ll do that next.
Medigap Plan A
Medigap Plan A covers these gaps in Original Medicare:
- Part A co-insurance and up to 365 additional hospital stay days beyond what Original Medicare provides
- Part A hospice co-insurance
- First three pints of blood
- Part B co-insurance
Plan A leaves these gaps uncovered – you’ll still have to pay for them out of pocket:
- Part A skilled nursing facility co-insurance
- Part A deductible
- Part B deductible
- Part B excess charges
- Emergency coverage outside the United States
Medigap Plan B
Plan B is slightly more comprehensive than Plan A. Plan B covers everything that Plan A does, plus the Part B deductible. Plan B leaves these gaps uncovered:
- Part A skilled nursing co-insurance
- Part B deductible
- Part B excess charges
- Emergency coverage outside the US
Medigap Plan C
Standardized Medigap Plan C is very comprehensive. In fact, there is only one gap that Plan C leaves uncovered – Part B excess charges.
Plan C is only available to people who became eligible for Medicare before January 1, 2020.
Medigap Plan D
Plan D is another comprehensive plan, and it is still available to all Medicare Beneficiaries. Plan D covers everything that Plan B covers, plus:
- Part A skilled nursing care co-insurance
- Part A deductible
- Emergency coverage while traveling internationally
There are only two gaps left uncovered by Plan D:
- Part B deductible
- Part B excess charges
Medigap Plan F
Plan F is the most comprehensive Medigap Plan available. It will cover every single gap in your Original Medicare coverage. Many people with Plan F do not pay any costs out of pocket during the year. Like Plan C, Plan F is only available to people who became eligible for Medicare prior to January 1, 2020.
Medigap Plan G
Plan G is now the most comprehensive Medigap Plan available to people who become eligible for Medicare after December 31, 2019. Plan G only leaves one gap uncovered – the Part B deductible. Since this deductible is only a few hundred dollars, this is a pretty minor gap. In exchange for leaving this tiny gap open, the premiums for Plan G are usually quite a bit lower than for Plan F.
Medigap Plan K
Plan K has some unique features; it offers partial coverage of a variety of gaps:
- 100% Part A co-insurance and up to 365 additional hospital stay days
- 50% Part A hospice care co-insurance
- 50% Part A skilled nursing care co-insurance
- 50% Part A deductible
- 50% of the cost of your first three pints of blood
- 50% Part B co-insurance
Plan K leaves three gaps completely uncovered:
- Part B deductible
- Part B excess charges
- Emergency coverage outside the US
Even though you’re sharing a lot of the cost for your care, Plan K gives you a cap on your annual out of pocket costs. For 2022, you’ll pay no more than $6,620.
Medigap Plan L
Plan L is very similar to Plan K, but it covers a greater percentage of your costs:
- 100% Part A co-insurance and up to 365 additional hospital stay days
- 75% Part A hospice care co-insurance
- 75% Part A skilled nursing care co-insurance
- 75% Part A deductible
- 75% of the cost of your first three pints of blood
- 75% Part B co-insurance
Plan L also leaves three gaps completely uncovered:
- Part B deductible
- Part B excess charges
- Emergency coverage outside the US
Plan L’s out of pocket maximum for 2022 is $3,310.
Medigap Plan M
Plan M is very similar to Plan D, except that Plan M only covers 50% of your Part A deductible. Plan M leaves these gaps uncovered:
- 50% of the Part A deductible
- Part B deductible
- Part B excess charges
Medigap Plan N
Plan N is also very comprehensive, but it adds a unique twist in the form of small co-payments. With Plan N, the only gaps that are not covered are:
- Part B deductible
- Part B excess charges
All the other gaps are closed by Plan N, including emergency coverage outside the United States. However, when you use Part B services, you are subject to the following co-payments:
- $50 for emergency room visits (this is waived if you’re admitted to the hospital)
- $20 for some office visits
TALK TO YOUR ORLANDO MEDICARE ADVISOR NOW!
Who Is Eligible For Medigap Plans?
Of all the private Medicare Insurance plans, Medigap has some of the most restrictive rules. For starters, you must be enrolled in Part B of Medicare, and you must continue to make your premium payment. You must also be enrolled in Part A. Besides this, you must also be age 65 or older in most states. There are some states will allow you to enroll in Medigap before age 65, but these are somewhat rare.
When Is The Best Time To Enroll In Medigap Plans?
Medicare Supplement Insurance provides great flexibility in terms of an opportunity to enroll, but there is definitely one period of time that is best for you. If possible, you want to enroll in a Medigap Plan during your Open Enrollment Period. This enrollment window lasts for six months, and it only begins when you meet both of these requirements:
- You are at least 65 years old
- You are actively enrolled in Part B
You’ll notice that there’s no way for this enrollment period to start before your 65th birthday, even if you enter Medicare early due to disability or health. Also, your Open Enrollment Period won’t start before you actually start taking Part B benefits. So, if you work past 65 and delay taking Part B, you won’t be missing out on your Medigap Open Enrollment Period.
What’s so great about this enrollment window? During this period you have the guaranteed right to enroll in any Medigap plan available to you in your state. You can’t be turned down or charged a higher rate based on your health history or current health status.
This is important, because if you choose not to enroll in Medigap during this time (say you enroll in Medicare Advantage), but you decide you want Medigap coverage years later, you may not be able to do so. When you apply for coverage outside of your open enrollment period, you have to answer health questions, the insurance company will conduct an investigation into your health, and you may be declined or charged higher premiums based on your health status.
There are a few times when you can get a second right to purchase Medigap coverage with a Guaranteed Issue right, but they are somewhat restrictive; you can’t count on being able to take advantage of them. Get Medigap coverage during your Open Enrollment Period if you have any interest in it; if you wait, you might not be able to get it later.
These underwriting rules generally also apply for switching from one Medigap plan to another. You may not be able to switch from one plan to another, or from one insurance company to another if your health doesn’t meet the underwriting guidelines. Make sure you enroll in the Medigap plan that best suits you when you have the chance.
Review Medigap Plans With Orlando Medicare Advisors
There are dozens of insurance companies out there, and 12 different Medigap plans to choose from. It can be difficult to choose the plan that will work the best for you. Orlando Medicare Advisors can do the heavy lifting for you. We can help you review and compare quotes for all the plans available. You can get started with a free, no-obligation consultation. Give us a call today to get started.
TALK TO YOUR ORLANDO MEDICARE ADVISOR NOW!