Have you ever asked yourself a question like: “What is Medigap insurance?” or, “Can I change medicare supplement plans anytime?” Anyone asking these sorts of questions has probably opened a bill from a healthcare provider and been surprised to see a surprise out-of-pocket cost.
If you have wondered about how to take advantage of insurance plans meant to supplement your Medicare coverage, this article is for you.
If you or your loved ones frequently visit doctors or hospitals, you know first-hand how expensive healthcare can be. Even if you have Original Medicare (Part A and B) that often covers much of your medical bill, certain healthcare costs (like copayments, coinsurance, and deductibles) often get passed on to you. Those out-of-pocket costs can add up quickly, and they add a sense of unpredictability to your medical billing.
Did you know that as a Medicare beneficiary, you may be eligible to take advantage of Medicare Supplement Insurance?
Also known as ‘Medigap’ coverage, these plans can help cover what Medicare doesn’t. Keep reading to better understand how Medigap coverage works and how it can help you and your family pay and predict medical bills.
What is Medigap Insurance?
Medigap coverage is formally referred to as Medicare Supplement Insurance and is sold by private insurance companies. This special type of insurance helps to fill in the “gaps” in Original Medicare coverage. If you’re eligible, you can use these private insurance plans to pay some of those remaining costs, holding your out-of-pocket costs to a minimum.
If you have Original Medicare and you then purchase a supplemental plan from a private insurer, Medicare will pay for a part of your medical bill (up to the pre-approved amount for that service under Medicare rules). Then, your Medigap policy pays its part.
They can also cover some services not covered by Original Medicare at all.
Medicare supplement plans work very well for some people and their coverage is standardized by federal code. For instance, Medicare Supplement Plan F coverage is the same, no matter what company you buy it from.
But when deciding what coverage is best for you, all of the choices can make things quite complicated: what’s covered? What’s not? Are you eligible? What about Medicare Advantage plans? How much does it all cost? Is it available where you live?
It can be challenging to sift through all of the options on the market and figure out what’s best for you or your family. But staying informed is crucial if you want to make the right choice.
Keep reading to find out how you and your family can take advantage of Medicare Supplement Insurance.
Who is Eligible for Medigap?
Medigap coverage is not standalone insurance. You can only be eligible if you are already enrolled in Medicare Part A and Part B. You will need to stay enrolled in Original Medicare to remain eligible, so make sure you don’t let any of your current coverage lapse without completely understanding how a change could affect your eligibility.
If you’re under sixty-five years old and have Medicare, your eligibility may be restricted due to your state of residency. Federal law does not mandate that insurance companies provide Medigap coverage for people under 65, but some states do. If you have questions about your eligibility, this tool lets you search for plans by entering your zip code and may help you better understand your options.
Medigap coverage is broken down into different federally standardized plans. All of the insurance companies have to follow the government’s requirements when it comes to benefits. But premiums can vary by as much as 30-50% depending on which insurance company you choose. Medicare Supplement Plans are worth it for many consumers, but it’s up to you to figure out which Medigap plan and which provider are best for you.
In certain circumstances, you can also be denied Medigap coverage. For instance, even if you are enrolled in Original Medicare and over the age of 65, it is illegal for an insurance company to sell you a Medigap policy if you already have coverage under a Medicare Advantage Plan (Medicare Part C).
You can also be denied coverage if you are outside of the 6-month open enrollment period that begins when you are 65 or older and newly enrolled in Part B coverage. Pre-existing conditions can make enrollment more complicated, but you may still be able to find coverage that works for you with a Medigap plan.
Benefits of Medigap Supplement Plans
Depending on your coverage needs, Medigap plans can yield real savings. And if Medicare Advantage plans (that replace your Original Medicare coverage) don’t work for you, Medicare Supplement plans still offer many potential benefits that might make sense for you.
But, to know what Medicare Supplemental Insurance Plan is best for you, you must first determine what specific coverage you need. Then, you can compare the benefits and costs of each of the 10 Medicare Supplemental insurance plans offered. Some Medigap policies even cover services that Original Medicare doesn’t – like medical care while traveling outside the United States.
Freedom of choice
By visiting a doctor who doesn’t participate in Medicare, you can be subject to a bill for 15% more than the maximum Medicare-approved amount for their services.
But, if you have Medigap coverage that includes ‘excess charges,’ you are protected from this sort of billing. And if you travel abroad, you can take advantage of Medigap coverage that includes bills for healthcare costs you may incur while abroad.
If you visit a doctor without a Medigap plan, you may be responsible for paying up to 20% of the bill. Medicare Supplement Insurance Plan F covers Part B coinsurance.
So, if you have coverage under Part F, you can more accurately understand and plan for the cost of your healthcare. This insight can provide you with control over your budget and give you peace of mind that you can afford your healthcare.
Can I Change my Plan at any Time?
Under federal law, you do not have a right to switch Medigap policies unless you are within your 6-month Medigap open enrollment period, or you are eligible to switch under a specific circumstance that guarantees your right to switch.
You are also entitled to 30 days to decide if you want to keep any new Medigap coverage. This ‘free look period’ gives you a chance to see if your new plan works for you, but you shouldn’t cancel your old plan and you will have to pay for both for that month.
What Medigap Plans Do and Do Not Cover
Coverage under Medigap plans varies by the specifics of each plan. But, some of the costs covered include Part A coinsurance & hospital costs; Part B copays; Blood products (up to 3 pints); Part A hospice; Skilled nursing facility; excess charges (due to out-of-plan visits); and foreign travel emergency care.
Medicare offers a detailed chart of each plan’s coverage and costs. Massachusetts, Minnesota, and Wisconsin offer their own different standardized plans.
Medicare Supplement Plan Resources
When evaluating your options for Medicare Supplement PlanMedigap coverage, the best resource is often the federal government’s website for Medicare.
It’s up to you to determine which plan works best for you. Other good resources for questions about Medigap Supplement plans include non-government insurance agencies like eHealth (speak with a licensed provider) or even other government sources like the Department of Health & Human Services.
Contact us today and one of our Medicare experts will help answer any questions you may have about Medicare Supplement Plans as well.