Did you know that Original Medicare doesn't cover everything?
Why do I still have out-of-pocket costs with Original Medicare?
Many Medicare beneficiaries don’t realize that Original Medicare doesn’t pay for all of your medical expenses.
Approximately 80% of your medical costs are covered, which means that you are left to pay the remaining 20%.
These costs, which are comprised of copayments, coinsurance and deductibles, can add up quickly, especially if you have an unexpected medical condition or emergency!
What is a Medicare Supplement Plan?
A Medicare Supplement plan, also known as Medigap, is health insurance that is offered by private insurance companies to fill the gaps that Original Medicare doesn’t cover. These plans were developed in the 1980’s to strengthen consumer protection regarding exposure to expenses associated with gaps in Medicare Parts A and B coverage.
Today, over 10 million Medicare beneficiaries have purchased a Medigap supplement policy to lower their out-of-pocket costs for deductibles, copayments and services not covered by Medicare Parts A and B.
How Does A Medigap Policy Work?
Each plan is identified by a letter and are referred to as Medigap Plan A, B, C, D, F, G, K, L, M and N. Currently, the most popular plans chosen are Medicare Supplement Plans F, G and N.
It is important to note that, even though prices may vary with different insurers, the benefits of each Supplement Policy are standardized by the government across plans of the same letter. That means that each one of these policies offer the same standard benefits regardless of which company you purchase it from. It is up to you to research and shop around to find the plan that offers the best rate and meets your needs. Contact the team at Medicare Portal today for help finding the right plan for you.
✓ Ability to choose physician and hospitals
✓ No requirement for referrals to see a specialist
✓ Coverage nationwide
✓ No out-of-pocket expenses for any Medicare-covered services
What Does Medigap Cover?
So what specifically will a Medicare Supplement plan cover?
After Medicare has approved your claim and paid their portion, the remainder of your bill is forwarded to your Medicare Supplement plan. Medicare supplements will cover the costs only for services that the plan offers.
✓ Medicare Part A and B deductibles
✓ Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
✓ Medicare Part B coinsurance or copayment*
✓ Blood (first 3 pints)
✓ Part A hospice care coinsurance or copayment*
✓ Skilled nursing facility care coinsurance
✓ Part B excess charges
✓ Coverage for emergency services while traveling overseas, which aren’t covered under Medicare
*Coverage may be partial for some plans. Medigap Plan N covers the Part B coinsurance, except for up to $20 copayment for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.
✓ Retail prescription drugs
✓ Routine vision, dental and hearing exams
✓ Eyeglasses or contacts
✓ Hearing aids
✓ Long-term care
✓ Custodial care
The ideal time to enroll in a Medicare Supplement plan is when you become eligible at the age of 65 and enroll in Part B. During the 6-month enrollment period (that includes your birth month), you can enroll and avoid any late-enrollment penalties. It is also during this time that you can join without medical underwriting.
Should you delay enrollment in Part B or opt for Medicare Advantage, there are opportunities to enroll in a Medicare Supplement plan in the future. Should you choose to change your supplement to another supplement option, medical underwriting will be applied.
Remember that Medicare Supplements DO NOT cover prescription drugs. Enrollment in a Part D plan or a Medicare Advantage plan with prescription drug coverage already built-in will be needed if you need that type of coverage.
You can not have a Medigap policy as well as a Medicare Advantage plan at the same time.
Some Tips About Medigap Policies
Medigap policies are pretty straight-forward, but there are a number of specific rules that apply when enrolling in this type of coverage. Here are some tips that are helpful to know about Medigap policies, but call us at 703-214-4600 if you’d like more information.
- In order to purchase a Medigap policy, you must have Medicare Part A and Part B.
- If you are currently enrolled in a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can disenroll from the Medicare Advantage Plan before your Medigap policy begins.
- Your monthly premiums for a Medigap policy are paid to a private insurance company and are in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy is issued to a single beneficiary. If you and your spouse both want a Medigap policy, you will each have to purchase separate policies.
- You can buy a Medigap policy from any insurance company that is licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. Guaranteed renewable simply means that the insurance company cannot cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past combined medical and prescription drugs benefits. All Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you should consider joining a Part D plan.
- If you have a Medicare Medical Savings Account (MSA) Plan, it is illegal for anyone to sell you a Medigap policy.
Need Additional Coverage?
Want to explore your Medigap options further? Contact us and we’ll assist you in finding the extra coverage that you need.