Deciphering eligibility criteria, understanding enrollment periods, choosing between original Medicare and Medicare Advantage plans, evaluating supplemental coverage options such as Medigap policies, and completing the necessary online applications can be challenging. Follow these five steps to make it simpler.
Review your Medicare Part D plan annually during the open enrollment period to ensure that your plan is still the best choice for you. Also, consider supplemental coverage through MediGap.
Medicare, a federal health insurance program primarily for people aged 65 and older, is designed to cover many healthcare expenses. However, it doesn’t cover everything. That’s where Medicare Supplement Insurance, or Medigap, comes in. Medigap policies are sold by private companies and can help cover the parts Original Medicare doesn’t, such as copayments, coinsurance, and deductibles.
What are Medicare Supplements?
Medicare Supplements, or Medigap policies, are standardized plans designed to fill the coverage gaps left by Original Medicare (Parts A and B). These policies can cover out-of-pocket costs. This includes the deductibles, or the amounts you pay for healthcare services before your insurance begins to pay, and copayments, which are fixed amounts you pay for a covered healthcare service after you’ve paid your deductible. They can also cover coinsurance – the shared costs of a covered healthcare service as a percentage.
What are the Types of Medigap Plans?
There are ten standardized Medigap plans, labeled A through N. Each plan offers different benefits.
For example, Plan A covers basic benefits like Medicare Part A coinsurance and hospital costs up to a year after Medicare benefits are exhausted. Plan B includes everything in Plan A, plus the Medicare Part A deductible.
You can read more about the different plans here.
Is There a Medicare Supplement That Covers Everything?
Medicare Supplement Plan F offers the most comprehensive coverage and even covers costs exceeding Medicare-approved amounts, so you may have no out-of-pocket costs.
What Isn’t Included?
The main disadvantage of Medicare supplements is that they don’t cover services not approved by Medicare. If Parts A or B don’t cover it, neither will your Medigap policy. Medigap plans also require a separate Part D plan for prescription drugs, and you’ll need to enroll in Part D, even if you don’t currently need prescriptions. Otherwise, your options are restricted by limited enrollment periods, and you may face future penalties.
Additionally, Medigap policies do not include extra benefits like dental, vision, hearing care, and certain other health and wellness coverages, which Medicare Advantage plans may offer. However, you may find separate, affordable, policies to meet your needs.
How Do Medigap Plans Work?
To buy a Medigap policy, you must have Medicare Part A and Part B. Medicare supplements help pay the costs remaining after Original Medicare pays.
How Do I Enroll?
The best time to enroll is during your Medigap Open Enrollment Period, which starts the first month you are 65 or older and enrolled in Part B. During this period, you have a guaranteed issue right, meaning you can buy any Medigap policy sold in your state without medical underwriting or higher premiums due to pre-existing conditions. It’s critical to enroll in Medicare when you are first eligible, or you may face penalties.
Can People Under 65 Enroll?
People under 65 who have certain disabilities, permanent kidney failure, or amyotrophic lateral sclerosis may be eligible. However, premiums for these people can be higher.
Does Medicare Supplement Program Coverage Vary?
The coverage provided by Medigap policies in Texas is standardized, meaning a Plan G policy from one company will offer the same benefits as a Plan G from another company. However, premiums can vary widely between companies.
What Will My Medicare Supplement Costs Be?
Medigap premiums will vary depending on your:
- Insurance company and plan
- Age
- Location
- Tobacco use
- Gender
Are There Medigap Discounts Available?
Some insurance companies offer discounts for nonsmokers, married couples, or those who pay premiums annually.
What’s the Difference Between Medigap and Medicare Advantage?
Medicare Advantage Plans (Part C) are an alternative to Original Medicare and Medigap. These plans are offered by private companies approved by Medicare and must provide at least the same level of coverage as Original Medicare. They often include additional benefits like vision, dental, and prescription drug coverage.
Can I Have a Medicare Advantage Plan and a Medigap Plan?
No, so it’s crucial to compare the benefits, costs, and network restrictions of Medicare Advantage Plans against Medigap policies to determine which best meets your needs.
Can I Switch Medigap Policies?
You can, but if you’re outside your Medigap Open Enrollment Period or don’t have a guaranteed issue right, you may be subject to medical underwriting and potentially higher premiums or denial of coverage.
Does Medigap Cover Prescription Drugs?
No, Medigap policies sold after 2005 do not include prescription drug coverage. You’ll need to enroll in a separate Medicare Part D plan for prescription drug coverage.
What If I Move To Another State?
Medigap policies are standardized across states, so you can keep your policy if you move. However, you should notify your insurance company of your new address as it may affect your premium.
How Can I Get Help With Getting The Medicare I Need?
Choosing Medicare plans and enrolling can be complicated. Wise Insurance is committed to prioritizing your needs and assisting you in making the most informed healthcare decisions. We provide comprehensive Medicare information, including details on quality, suitable plans, and associated costs, empowering you to be an active and informed healthcare consumer.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
