Advantages of Medigap Plans
Health Insurance Companies Access to Doctors on Medigap Plans
Another great feature is that they enable you to see any doctor that participates in Medicare. You will have access to hundreds of thousands of providers across the United States.
Visiting a doctor is easy with Medigap plans because it doesn’t matter which insurance company your Medigap plan is through. As long as the doctor accepts Medicare, he will accept your Medicare supplement too.
People often get confused about this because there are other types of plans, called Medicare Advantage plans, which require you to use networks. As long as you stay with Original Medicare, then you can see any doctor who participates in Medicare. Around 93% of all U.S. primary care physicians accept Medicare.
Medigap Plan A
- Basic Medigap plan
- Covers the 20% on outpatient treatments unlike Medicare.
- If you are under age 65 and qualify for Medigap due to a disability, you may purchase this plan during your open enrollment period (OEP) without underwriting.
- If you are UNDER age 65, you might be paying 3 times more for Medigap A as compared to someone 65 and over.
Medigap Plan B
- Coverage of Plan A
- Also covers Medicare Part A hospital deductible, so you won’t be paying as much as $1,556 or more.
- Pays the deductible multiple times in the same year.
- The rate you pay for the same benefits can differ from Insurance Company to company, based on zip code, age, smoking, gender, and household discounts.
Medigap Plan C
Don’t confuse this with Medicare Part C!
- Coverage of plans A and B
- Doesn’t cover Medicare excess charges.
- The excess charges are surcharges that can go 15% beyond what Medicare pays.
Medigap Plan D
- Covers the gaps in Medicare, including the 20% outpatient charges.
- Does not cover the deductible.
- Does not cover Medicare excess charges.
Medigap Plan F
- Covers all the gaps in Medicare, including deductibles and copays.
- Switching your F carrier means you will have to answer health questions (underwriting)
- The rate you pay for the same benefits can differ from Insurance Company to company, based on zip code, age, smoking, gender, and household discounts.
- There is also a special version of this plan called a High Deductible Plan F. This plan often includes very, very low monthly premiums coupled with protection from high out of pocket costs, by an Annual Maximum Out of Pocket, which is set annually by the Internal Revenue Service. With this plan, you can often save a thousand or more dollars a year in those years where you do not require many expensive medical procedures while preserving your ability to see ANY doctor, ANYWHERE, as long as they accept Medicare.
Medigap Plan G
- Covers everything that Plan F does, except for the Part B deductible.
- It pays for your hospital expenses during hospital stays, including the deductible.
- Most outpatient care, except for the first $250.
Medigap Plan K
- Offers lower premiums with higher cost-sharing with the Insurance Companies.
- You would be paying parts A and B deductibles but you might also get an extra year in the hospital
- Covers all the same basic benefits
Medicare Supplement Plan K – Capped Out-of-Pocket Charges
The limit is set at $6,620, which is how much you might be paying annually. Any more than the cap and the insurance policy will be covering the rest of your expenses for the year.
- Also pays for preventive care services
Medigap Plan L
- Offers reduced premiums for 75% of your medical expenses covered by your insurance carrier.
- You will also be paying the Medicare Part B deductible and surcharges.
Capped Out-of-Pocket Charges
The limit is set at $3,310, which is how much you might be paying annually. Any more than the cap and the insurance policy will be covering the rest of your expenses for the year.
- Also pays for preventive care services
Medigap Plan M
- Cover the basics like other supplements do.
- You pay lower monthly premiums.
- You also pay full annual outpatient and half of the hospital deductibles.
- Also pays for preventive care services
Medigap Plan N
- With this Medicare Supplement plan, you pay lower premiums.
- Plan covers the 20% Medicare doesn’t, hospital deductible, copays, and coinsurance.
- Cost-sharing increases, such as $20 of doctor copay and $50 for an Emergency Room visit.
- Also pays for preventive care services
What Medigap Doesn’t Cover
Medicare Supplement Plans do not cover the following:
- Retail prescription drugs
- Dental exams
- Eyeglasses
- Contacts
- Vision exams
- Hearing aids and exams
- Long-term/custodial care
Open Enrollment Period (OEP)
Beginning on the first day of your birth month, or when you have enrolled in part B, the OEP lasts for 6 months. Since you are buying your supplemental Individual Health Insurance during OEP, you:
- Won’t have to answer any medical questions.
- Be denied insurance due to health conditions.
- Not be charged an additional amount.
- Purchase the Medicare supplemental plan of your choice.
- Don’t mistake the Annual Election Period for the OEP. The former is for Medicare Part D while the latter is for your Medigap plan.
Guaranteed Issued Window
Medicare supplement guaranteed issue rights make you eligible to purchase certain Medigap policies within 63 days of losing your group coverage after retirement. The guaranteed issue window is a shorter time span than the OEP, but it works in the same way.
You may choose between Plans A, B, C, D, G, F, K, L, M and N.
IF moving out of state results in losing your Medicare Advantage coverage, you can avail your guaranteed issue right to apply for it in the new state.
Keep the notices from your former insurance carrier safe since they prove creditable coverage, or you might be charged the Part D late enrollment penalty.
Underwritten
If the time for both OEP and guaranteed issue has passed and you need Medicare supplement, you can purchase it after passing an underwriting. For that, you will have to answer some health questions, giving the insurance company the right to decline you.
The Annual Drug Election Period is NOT the time you can change supplement without underwriting. It is related to Medicare Advantage and drug plans.
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