A Medicare Supplement Insurance (Medigap) plan is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare plan coverage. Medigap plans help pay some of the health care costs that the Original Medicare plan doesn’t cover. Some plans will even cover deductibles. A Medicare Supplement plan will also allow you to choose any doctor who accepts Medicare patients, as it travels with you nationwide. Going to spend time with grandchildren in Dallas, Texas? No, problem. How about Helena, Montana? Perfectly cool.
What Do I Need To Have To Get On A Medicare Supplement Plan?
First, you must have Medicare Part A and Part B. You must also select a plan that is available in your area. You will continue to pay your Medicare Part B premium, in addition to your Medicare Supplement premium.
When Can I Apply For A Medicare Supplement Plan?
In general, the best time to sign up for a Medicare Supplement plan is during your six-month open enrollment period that starts the first month in which you are age 65 or older, and enrolled in Part B (except in the states of Connecticut, Massachusetts, and New York, where guaranteed acceptance is ongoing and Medicare supplement plans are guaranteed available). Some states have additional open enrollment periods, including those for people under age 65. There may be other situations in which your acceptance may be guaranteed. During this period, Medicare Supplement companies cannot do any of the following, even if you have a disability or health problem:
Refuse to sell you any Medigap plan it offers
Charge you a higher premium than they charge others who are 65 and older
Delay the start of your coverage
It is important to buy a Medicare Supplement plan during your Open-Enrollment Period because otherwise, Medicare Supplement companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge for the policy.
What If I Have A Pre-Existing Condition, Is There A Waiting Period?
Although an insurance company can’t delay the start of your overall coverage during Open Enrollment, in some cases it may be able to make you wait for coverage related to a pre-existing condition. If your Medicare Supplement company has a pre-existing condition waiting period, it can refuse to cover your out-of-pocket costs for any services related to this condition for up to six months. After six months, the plan will cover the out-of-pocket costs for the pre-existing condition.
Is It Possible To Avoid Or Shorten The Pre-Existing Condition Waiting Period?
Yes, you can avoid or shorten waiting periods for pre-existing conditions if you meet all of the following criteria:
You buy a Medicare Supplement plan during your Open-Enrollment Period
You are replacing creditable coverage
You have had at least 6 months of continuous prior creditable coverage
You did not have a break in coverage for more than 63 days
What If I Waited To Enroll In Medicare Part B?
In most cases, it is best to enroll in Medicare Part B when you’re first eligible so you avoid paying a Part B late enrollment penalty. However, if you and your spouse are working and have group health insurance though an employer or union, you could decide to delay Part B, even after you turn 65. If and when your employer coverage ends, you may be able to enroll in Part B without a penalty. Your Medicare Supplement six month Open-Enrollment Period will begin at that time.
However, if you enroll in Part B while you still have employer-sponsored coverage, the Medicare Supplement Open Enrollment clock will start ticking. Unless you buy a Medicare Supplement plan before you need it-other words, while you still have coverage through your employer, you will lose your Open Enrollment Period.
What Are The Different Types Of Medicare Supplement Plans?
Currently, there are 10 standardized Medicare Supplement (Medigap) plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N). There is also a high deductible-version of Plan F. These plans are available in most states; Massachusetts, Minnesota, and Wisconsin each have their own different set of standardized Medicare Supplement plans.
Coverage levels and premiums vary, but the benefits of each plan within a lettered category remain the same despite the insurance company or location. For example, Plan A benefits are the same in New Jersey as they are in Texas, if a Medicare Supplement plan includes a certain benefit, this benefit is covered 100% unless otherwise specified.
What Do Medicare Supplement Plans Cover?
In a nutshell, all Medicare Supplement plans cover the following benefits:
Medicare Part A co-insurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B co-insurance or co-payment
Blood (first 3 pints)
Part A hospice care co-insurance or co-payment
Some Medicare Supplement plans may also cover :
Skilled nursing facility care co-insurance
Medicare Part A deductible
Medicare Part B deductible
Medicare Part B excess charges (the amount that a non-participating provider may charge above the Medicare-approved cost for a service)
Foreign travel emergency (up to plan limits)
Keep in mind, Medicare Supplement plans will not cover prescription drugs, so you will need to go on a stand-alone Part D plan for coverage. Long-term care is also not included, along with vision, dental, hearing aids, or private-duty nursing. We can help you get this outside coverage to go along with your Medicare Supplement plan, no matter if you are in Texas, California, or Florida.
For more information on the different Medicare Supplement plans, click here.
Q&A- My wife and I here in Texas are now Medicare eligible and wondering what’s the big hoopla on these Medicare Supplement (Medigap) Plans?
Good question. Well for starters…
30 Days Free Look-
Return any policy for any reason within 30 days after receipt for a full refund of all premiums paid.
12-Month Rate Guarantee-
No rate increase for the first 12 months, as long as the premiums are paid on time.
No worries of reduced benefits or cancelled coverage for the life of the policy, as long as the premiums are paid on time.
Freedom To Choose Your Doctors-
You control and choose the physicians who you trust for your care.
Go Direct To Your Doctors-
You can go directly to the physicians and specialists you choose without pre-certifications and pre-approvals.
Benefits Stay The Same-
You always know what your benefits are with this standardized plan, meaning no surprises or re-evaluations year after year.
You are not restricted to use a network of health care providers. If you move, your coverage goes with you.
If you feel a Medicare Supplement plan might suit your health care needs, reach out to us today and we can go over all the plan options, and find something in your budget. We can also take care of your Part D plan, at the same time! Talk about a win-win.
Did You Know?: As you will hear in the short video below, if you will be traveling to a foreign country, Original Medicare will not usually cover your medical care except in very limited circumstances. Medicare Supplement (Medigap) plans might be a viable option for you if this is a concern, as many have coverage built in for travel outside the United States. This is a big question we get here locally in San Antonio, Texas.
The Harrin Group offers free, comparative quotes on Medicare Supplements from multiple insurance carriers so you can get the best possible rate.
Want to see how much we can save you? Just request a quote to find out.
Source: Medicare.gov, Centers for Medicare and Medicaid Services (CMS)