- Main Parts of Medicare
- Types of Medicare Supplement plans and what they cover
- We make finding a Medicare plan easy
- Who is eligible for Medigap coverage?
- How much do Medicare Supplement plans cost?
- Can you be denied a Medicare Supplement Plan?
- Ready to decide if you need a Medigap policy?
- Let us help find your Medicare Supplement Insurance plan.
What is Medicare Supplement Insurance?
As you approach your 65th birthday or if you just found out you are eligible for Medicare benefits, you may have Medicare plans on the brain. And who wants to be thinking about Medicare? Medicare plans can seem complex, but it can be easier than you think.
Part A and Part B are the two parts of Original Medicare. Medicare Part A usually doesn’t charge a premium (if you qualify for Premium Free Part A) and pays for hospital care, skilled nursing facility care, and hospice care. Part B of Medicare pays for medical care (like doctor visits) and preventive services as well as some medical equipment. There is usually a monthly premium for this coverage.
Medicare Supplement plans, a.k.a Medigap plans, provide State Department of Insurance approved-private insurance coverage. It helps by paying some of your health care costs that Original Medicare doesn’t cover like copayments, coinsurance and deductibles, hence bridging the “gaps” in Original Medicare. Clever, right? Keep reading for a quick guide to Medigap insurance.
Private insurance companies offer Medicare Supplement insurance to supplement Original Medicare coverage. Also known as Medigap, Medicare Supplement insurance helps you pay the portion of medical expenses you would traditionally have to pay out-of-pocket, like Medicare deductibles, coinsurance, and copayments. The monthly premiums that various insurance companies charge for the same coverage can vary considerably regarding Medigap policies. Compare the different Medigap plan types using the same letter when looking for a Medigap policy and consider the premiums each insurer charges. As an example, evaluate Plan G from two different companies. You can always turn to your State Health Insurance Assistance Program (SHIP) for guidance or make life a whole lot easier on yourself by letting Healthpilot analyze your unique situation to identify which Medigap policy could be the best fit for you.
The majority of states offer the same 10 standardized Medigap policies to their residents (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans vary from one another in terms of the services that are covered, coinsurances, the out-of-pocket maximums, and the monthly premiums.
Another important note is that all policies are meant for your individual coverage only, so if you and your spouse need a Medicare Supplement Plan, you will have to purchase plans separately.
Main Parts of Medicare
Medicare was established as a national health insurance program by the U.S. federal government in the 1960s to provide additional financial security for individuals who may have been underrepresented in the traditional insurance market. Medicare is managed by the Centers for Medicare & Medicaid Services. In the beginning, the program comprised of two primary components: Part A and Part B, also referred to as Original Medicare. Medigap followed in 1992 to help cover some of the remaining health care costs for Medicare Part A and B covered health care services.
Find out more about each of the parts of Medicare:
Medicare Part A
Medicare Part B
Medicare Advantage (Part C)
Prescription Drug Plans (Part D)
Medicare Supplement Insurance (Medigap)
All these parts start to feel like Medicare Alphabet soup. To learn more about the entire Medicare Alphabet, please visit the Healthpilot Medicare Basics Page.
Types of Medicare Supplement plans and what they cover
Before you begin researching and comparing the different Medigap plan choices, the first thing to keep in mind is to not let yourself get confused by the Medicare Alphabet. Medigap policy letters have nothing to do with the primary Medicare plan you choose. Medigap plans are standardized and consistent in all but three states, though if you happen to be a resident of Massachusetts, Minnesota, and Wisconsin, you will have your own standard policies.
When considering which Medigap policy or combination of policies is best for you, a best practice is to consider the items that could end up costing the most in the long run without proper coverage, like deductibles and coinsurance for lab tests, doctor visits, and hospital stays.
Most plans cover 100% of Part B coinsurance except plans K and L, which cover only a percentage of your Part B coinsurance but limit how much you have to pay out of pocket. Once you’ve paid your Part B deductible and meet your out-of-pocket limit, the insurance carrier will pay of all of your covered services for the rest of the calendar year. Each year, these out-of-pocket maximums may go up because of inflation.
Remember, too, that Medigap does not cover prescription drugs, dental, vision, or most other needs that Original Medicare also doesn’t cover.
These nuances are what can leave people underinsured or confused when unexpected bills come rolling in. There is, of course, a better way.
Let Healthpilot do all the work. Here are the three easy steps:
- Answer a few questions
- Review your plan recommendation
- Enroll online
The best part? It took you longer to read this so far than it would for us to get you enrolled. Time is precious. Why not get started now?
We make finding a Medicare plan easy
With so many aspects of your lifestyle and healthcare to consider, along with so many plans to choose from, determining the best Medicare plan or plans for your needs can be daunting. But at Healthpilot, this is what we do and, more importantly, what we do better than anyone else.
Let’s get started. We both know you are curious to see your recommended Medicare plan.
Who is eligible for Medigap coverage?
Once you have Medicare Parts A and B, you are eligible for Medigap coverage.
Original Medicare Eligibility
Since you have to be enrolled in Original Medicare Parts A and B first in order to qualify for Medigap coverage, we thought we would quickly include the basics of Medicare Part A and B eligibility.
If you already receive Social Security benefits, or Railroad Retirement Board benefits you will be auto-enrolled into both Medicare Parts A and B when you turn 65. On the other hand, if you aren’t yet receiving Social Security benefits, you’ll need to sign up for Medicare on your own.
How do I get in touch with Social Security?
While it is Medicare that covers you, you have to sign up for it through the Social Security Administration (SSA). This is because the SSA manages some eligibility for Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free, a.k.a. Premium-Free Part A. (They also handle applications to join Medicare Part B.)
Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or, if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 312-751-4701)
You may apply for Medicare 3 months before you turn 65 and up to 3 months after your 65th birth month. The date your Medicare coverage begins depends on when you sign-up. We created a quick visual to simplify everything.
It is also possible to qualify for Medicare Part A and Part B before you are 65 if:
- You have a qualifying medical condition
- A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working
So what happens if you don’t meet the requirements for a Special Enrollment Period (SEP) and miss your Initial Enrollment Period (IEP), as previously explained? Not to worry. The General Enrollment Period, which runs from January 1 to March 31 each year, still allows you to sign up for Medicare Part B, with coverage beginning on July 1.
So that’s the skinny. These are occasions you really don’t want to be fashionably late to because the window to enroll can come and go very quickly.
Starting on the date your Medicare B coverage begins, you have six months to sign up for coverage.
During this six-month period, Medigap providers must let you sign up for any plan you want, and they can’t charge you more based on your health history. This is important to keep in mind since medical underwriting may be used if you apply for a Medigap plan after the Open Enrollment Period (OEP) has ended. That is, unless you are eligible for a guaranteed issue. During a guaranteed issue, the insurance company must sell you a policy, cover all of your pre-existing health conditions and cant charge you more because of previous or current health condition.
How much do Medicare Supplement plans cost?
Medicare Supplement plan premiums vary by state and insurance provider. You pay the private insurance company your Medigap premium in addition to the monthly Part B premium you pay to Medicare. Your Medigap premium are determined by location and age, which are decided in one of three ways:
Community-rated: Also called “no-age-rated” means no matter your age, everyone with a Medigap policy pays the same premium cost.
Issue age-rated: Also called “entry-age-rated” means your age when you buy a Medigap policy determines the premium. The premium is less the younger you are. Your age won’t affect the premium rates as you age; instead, inflation or other factors may cause them to rise.
Attained age-rated: Means your present age will be used to determine the premium, which will rise as you age. Although premiums in this type of rating may begin at the lowest cost, they may increase to the highest price and may also be influenced by other factors such as inflation.
There are many things that can affect how much you pay for a Medigap policy. From the type of plan you choose to the insurance company you buy it from, it can be hard to answer the big question, “How much will it cost me?” It’s not easy to even figure out what the real average cost is.
You’re probably thinking that nothing about Medicare seems easy, but there is one thing you can do to give you the confidence and comfort that you’re making the right decision for yourself: Once you are enrolled in Original Medicare, tag Healthpilot in to take over and do the rest of the work. We crunch the numbers, the small print, the Medicare Alphabet, and everything else that could be complicated, then serve up an expert-recommended plan. Just for you.
Can you be denied a Medicare Supplement Plan?
Short answer? You can be refused Medicare Supplement coverage if you don’t enroll when you first become eligible. Pre-existing medical issues may cause a Medicare Supplement plan to be denied. This is why we keep repeating to not miss the opportunity to enroll during your Medicare Supplement Open Enrollment Period.
Once you sign up for a Medicare Supplement plan, there are few situations in which your insurance company may decide to stop covering you. Medicare Supplement insurance policies typically have renewal guarantees. This means that if you enroll in a plan, regardless of any potential health issues during your OEP, as long as you pay the monthly cost, you will have coverage.
You could lose coverage if you misrepresent your information on your application, don’t pay your monthly premium, or your Medicare Supplement plan provider files for bankruptcy.
You won’t have the option to enroll in another Medicare Supplement plan with guaranteed issue rights if you lose coverage because you missed a payment or if there was misinformation on your application. As a result, if you apply to another carrier, they are free to refuse to provide you with coverage. On the other hand, you will be granted guaranteed issue rights to enroll in another plan regardless of your health if you lose coverage due to your insurance company going bankrupt.
Ready to decide if you need a Medigap policy?
Dizzy yet? No worries, we are in the home stretch.
Whether you are new to Medicare and its own alphabet or already have Medicare and Medigap coverage, it is important to make sure that your current coverage is the best fit for your needs.
And remember that not everyone needs a Medigap plan before deciding which type of Medicare plan is best for you.
Even though, according to The American Association for Medicare Supplement Insurance, 23% of Medicare’s 63.8 million beneficiaries have a Medigap plan in addition to their basic Medicare insurance plan, experts still find that a quarter of Medicare customers are underinsured. This is probably because people don’t fully understand which Medicare plan is best for them and don’t reassess it every year based on changes in their health and lifestyle. You don’t need to be one of those statistics.
Let us help find your Medicare Supplement Insurance plan.
Deciphering Medicare can be complex. Let us do the work for you. Healthpilot’s proprietary algorithm will make an unbiased, more accurate Medicare plan recommendation for you. We take your health care needs and evaluate the Medicare plans to find the right plan for you. Poof! No more Medicare plan worries.
Just answer a few questions about what’s important to you, what you want in a plan and then enroll online. The best news is that once you’re a Healthpilot customer, we give your plan a check-up each year. Just tell us what’s changed and we will check to make sure you’re still in the right plan every year…for the rest of your life.