MEDIGAP PLANS
MEDICARE SUPPLEMENT PLANS
What can make your Original Medicare coverage even better? Medicare Supplement Insurance. Find out what Medicare Supplement is, how it works, and how to choose the right plan for you, in this power-packed guide.
What Are Medigap Plans?
Medicare Supplement is also known as Medigap. They have this nickname because of the job they were designed to do. Simply put, Medigap plans are designed to help protect you from some of the gaps in your Original Medicare coverage. Don’t misunderstand: Original Medicare provides excellent coverage on its own. However, there are a number of costs that you’re expected to pay out of pocket, and the way these costs are structured can cause financial hardship.
There are two main areas of cost when it comes to Original Medicare:
- Costs to have the coverage (premiums and taxes)
- Costs for using your coverage (co-payments, deductibles, and co-insurance)
You’ll have to pay payroll taxes and premiums for your basic coverage one way or the other. When it comes to the costs for using your coverage, Medigap plans can make a big difference. These plans are designed to help cover some, or all, of your share of costs when you use your Medicare benefits. The costs that you’re normally responsible for include:
- Part A deductible
- Part B deductible
- Part B co-insurance
- Part B excess charges
- Part A daily hospital or skilled nursing co-payments
These are the costs that Medicare Supplement Insurance is designed to help with. There are twelve standardized Medigap plans available in 47 of the states. Michigan, Wisconsin, and Massachusetts have their own standardized plans. Each one of the standardized Medigap plans covers a slightly different mixture of the gaps in Original Medicare.
When you enroll in a Medigap plan, you’ll actually have two Medicare coverages that work together. Your primary health insurance coverage will continue to be Original Medicare, Parts A and B. Medicare is the first payer, and they pay the majority of the cost for your care. You’ll also present your Medicare Supplement Insurance card; you’re Medigap plan is the secondary payer. They will pay some of, much of, or all of, the amounts you’d normally have to pay, depending on which level of coverage you chose.
Who Is Eligible For Medigap Plans?
The rules for Medigap eligibility roughly match those for Original Medicare, but there is one major difference. For Original Medicare – Part A and Part B – you can become eligible before you turn 65 if you meet certain disability or chronic illness diagnoses. However, you may not be able to enroll in Medigap plans if you are younger than 65. Federal law allows each state to set their own rules for people younger than 65. Some states will allow you to enroll in Medigap plans before age 65, but many won’t. You’ll have to check the rules in your state, or ask Tampa Medicare Advisors to see if you’re eligible.
The other rule for eligibility is that you have to be actively enrolled in both Parts A and B in order to enroll in a Medigap plan. Also, you have to keep paying your Part B premium. If you fail to pay your Part B premium, you can eventually lose your Part B coverage, and then you’d also lose your Medigap coverage.
TALK TO YOUR TAMPA MEDICARE ADVISOR NOW!
What Are The Most Popular Medigap Plans?
While there are a total of 12 standardized Medigap plans, there are three that stand out from the crowd in terms of popularity. The three most-chosen Medigap plans are Plans F, G, and N. These are three of the most comprehensive plans available, which explains their popularity.
Medigap Plan F Details
Plan F is the most comprehensive Medicare Supplement plan available today. This plan will cover 100% of every gap in Original Medicare, and also provides some bonus coverage. Plan F provides coverage for:
- Part A Deductible
- Part A daily co-insurance and 365 additional hospital stay days
- First three pints of blood needed
- Part A skilled nursing facility co-insurance
- Part A hospice care costs
- Part B deductible
- Part B co-insurance
- Part B excess charges
- Emergency coverage outside the United States
As you might expect for the most comprehensive plan, it is also the most expensive in terms of premiums. Plan F is only available to people who became eligible for Medicare before January 1, 2020. For those Americans who gain Medicare eligibility on or after January 1, 2020, Plan G is the most comprehensive plan available.
Medigap Plan G
Plan G covers everything that Plan F does, except for the Part B deductible. With Plan G, you’ll have to satisfy the Part B deductible. Once you’ve hit this limit, Plan G will cover 100% of the rest of your Medicare-covered costs for the rest of the year. Because you have to pay a little bit out of pocket, Plan G is more affordable than Plan F.
Medigap Plan N
Plan N is the most interesting of the Big 3 Medigap plans. It turns out to be very similar to Plan G, but it has a few quirks.
First of all, Plan N does not cover Part B excess charges. These are additional costs imposed by providers who don’t accept Medicare’s prices as full payment. They have declined to accept “Medicare Assignment” which is Medicare’s standard prices for every Medicare-approved service or procedure. Most doctors and facilities accept Assignment. Those that don’t can add up to 15% of the Medicare-approved amount onto your bill. This is pretty rare, which is why Plan N turns out to be pretty similar to Plan G.
The other big difference with Plan N is that you’ll have to pay some small co-payments. You’ll pay no more than $20 when you visit the doctor, and you’ll pay up to $50 for emergency room visits. If you end up being admitted to the hospital, Plan N waives the co-payment.
In exchange for you paying the Part B deductible, any excess charges, and the small co-payments, the Premiums for Plan N noticeably lower than for Plan G and much less than for Plan F.
When Can You Sign Up For Medigap Plans?
Everyone who is Medicare-eligible has the right to enroll in a Medigap plan during their Medigap Open Enrollment Period. This period is a six month window that begins when you are at least 65 years old and enrolled in Medicare Part B. You can enroll in any of the Medigap plans available in your state during this timeframe. In some states you may be able to get Medigap prior to age 65; if that is the case in your state, it does NOT use up your Open Enrollment Period.
Since this enrollment window requires that you be enrolled in Part B, you’ll be able to take advantage of it in one of two circumstances:
- When you turn 65 and enter Medicare, or
- When you retire and lose employer coverage if you delay taking Part B past age 65 because you’re still working
You can’t miss out or lose your Open Enrollment Period if you delay taking Part B; it just won’t start until you actually enter Part B, even if it’s years or decades past your 65th birthday.
Once your Open Enrollment Period is over, you still have the ability to enroll in a Medigap Plan, but it may be more difficult. In most of these cases, you’ll be subject to medical underwriting. You’ll have to answer health history questions, and the insurance company will run a background check on your health. However, the requirements for passing underwriting are not overly strict; many people are able to enroll in a Medigap plan after their Open Enrollment Period.
Can You Change Medigap Plans?
It is possible to change your Medicare Supplement coverage. This could happen in one of two ways:
- Stay with the same insurance company, but move from one standardized Plan to another (say from Plan N to Plan G)
- Move from one insurance company to another (using either the same standardized Plan, or changing that, too)
In both of these cases, you’ll have to pass medical underwriting unless you qualify for a Guaranteed Issue opportunity. With Guaranteed Issue, you don’t have to go through medical underwriting. You can’t be turned down if you have a Guaranteed Issue right. You can qualify for Guaranteed Issue for Medigap plans based on certain changes in your circumstances. These can be pretty technical, but some common reasons you’d qualify for Guaranteed Issue include:
- Moving out of your Medicare Advantage plan’s service area
- Giving Medicare Advantage a try for less than 12 months and then deciding to return to Medigap. This is known a trial right. There are two versions of the trial right, depending on whether you enrolled in Medigap when you were first eligible, or if you enrolled in Medicare Advantage when you were first available.
Guaranteed Issue rights are fairly rare, so it’s very likely you’ll have to pass underwriting if you want to switch Medigap plans. This means that you should do everything possible to pick the plan that’s best for you over the long term when you first enroll; you can’t assume that you’ll be able to switch in later years.
TALK TO YOUR TAMPA MEDICARE ADVISOR NOW!
How To Choose Between Medigap Plans?
Deciding that you want Medicare Supplement Insurance coverage is only half the battle. After that you need to figure out which standardized Plan to choose. Choosing a Medigap plan is usually a balance of budget and need for comprehensive coverage. You’ll want to consider how much you’re willing to pay out of pocket in exchange for lower premiums.
If you want to get the best fit for you, reach out to Tampa Medicare Advisors. Working together, we can compare quotes for all the plans available to you, and help you figure out which Medigap plan will best suit you. Working with us is free and we always deliver a pressure-free experience. Request your free Medigap consultation today to get started.
