The Basics of Medicare Supplement Plans

A Medicare Supplement Insurance Plan, also known as Medigap, is different from a Medicare Advantage plan. Instead of offering coverage like HMO, PPO, and MSAs, it helps you pay for the costs that Original Medicare cannot cover.

Medigap plans have different requirements than Medicare Advantage plans. These plans also have varying options that may or may not cover the costs of the care you need. If you have any questions about Medigap policies, call one of our professional health agents today at 888-218-4543.

Medicare Supplement Insurance Requirements and Application

Medicare Supplement Insurance helps cover what Original Medicare doesn't

Medicare supplement insurance plans are sold by insurance companies licensed to sell them. Before you buy a Medigap plan, you must have both Medicare Part A and Part B. Medigap plans only cover one person, so spouses must purchase separate plans. Once purchased, you pay the insurance company a monthly premium as well as the Part B monthly premium.

Insurance companies are not required to sell Medigap policies to people under 65, although some companies may offer them. The availability of Medigap for people under 65 may also depend on your state. The enrollment period opens the month that you are 65, so if you turn 65 in September, the period would open in October. The period is open for 6 months after you turn 65. If you miss the enrollment period, you may lose important benefits or be charged higher premiums.

What Does Medigap Cover?

Medicare Supplement Insurance plans do not pay for coverage like other health insurance plans. Instead, these plans supplement Original Medicare coverage so that copayments, coinsurance, and deductibles are covered.

Medigap coverage is offered in lettered plans, which may be confused with Medicare Part A and Part B. However, Medigap plans are different. When you’re looking to buy a Medigap plan, know that insurance companies may not offer all of the different plans. However, companies are required to offer Plan A at the very least.

Standardized Medigap plans must cover basic benefits such as:

  • Copayments or coinsurance costs for Medicare Part A for up to a year after Medicare benefits run out.
  • Medicare Part A hospice care copayments or coinsurance costs
  • Medicare Part B copayments or coinsurance costs

Additionally, if you need blood during a medical procedure, the first three pints should also be covered.

The best time to apply for Medigap is the month after you turn 65
Medicare Supplement Insurance (Medigap) has some limits, but standardized Medigap plans must cover a few basic benefits.

What Does Medigap Not Cover?

In the past, there were some Medigap policies that covered prescription drugs. However, plans could not cover prescription drugs after January 1, 2006. Also, Medigap coverage does not include vision, dental, or long-term care. Hearing aids or private-duty nursing are not usually covered as well. If you need prescription drug coverage, you will need a separate Medicare Part D plan.

Note that Medicare Supplement plan options are different in Massachusetts, Minnesota, and Wisconsin than in the rest of the country.

If you’re thinking about dropping a current Medicare Supplement plan, make sure you time it right. If too much time passes, or there is a lapse in care, late enrollment fees may apply.

Learn About Original Medicare

Common Questions for Medicare Supplement Insurance

Can I buy a Medigap policy if I have a pre-existing condition?

You can still buy a Medigap plan if you have pre-existing conditions. However, Federal law allows Medigap insurers to deny coverage for any pre-existing conditions for the first six months of your plan. Usually, this time period is called a pre-existing condition waiting period and can be avoided or shortened if you meet certain requirements.

How can I avoid a pre-existing condition waiting period?

In order to bypass a waiting period when buying insurance, you will need to buy a policy while you have a guaranteed issue right. This right automatically exists for any senior age 65 or older who loses or ends their health insurance under certain circumstances.

For instance, you might have a guarantee if you lost coverage from a group health plan that covered Medicare cost-sharing, and you were not at fault. Another example would be if you left your Medicare Advantage plan within the first 12 months of coverage. And finally, you may have a guaranteed right if your previous coverage plan ends their services.

What do Medigap plans cost?

In general, Medigap policies are more expensive than Medicare Advantage plans. However, they cover most if not all a patient’s out of pocket expenses for qualifying coverage. But, because Medigap does not cover prescription drug coverage, you will also need to consider the cost of a Medicare Part D plan.

How to choose the best Medigap Plan

We recommend that anyone who is looking for health insurance should consider their past, current, and upcoming needs. Maybe you have a procedure coming up, or there was a specialist you really liked. You can’t always anticipate every eventual expense, but there are some routine procedures that come up for everyone.

You’ll also want to consider your prescriptions and formulations. Because we might be able to help you find a plan that covers more of one benefit if you don’t need as much coverage somewhere else.

Of course, you’ll also want to look at the different premiums amounts, but you shouldn’t stop there. If you can find it, you should look for a list of past premiums, because rates do increase from year to year. And if you don’t feel like navigating all those ins and outs, give one of our health insurance agents a call!

Is Medicare supplemental insurance tax deductible?

Just like regular Medicare premiums, Medigap expenses are also tax-deductible. However, you should work with a financial advisor in order to accurately itemize your expenses for your taxes.

Are all Medicare supplement plans the same?

The short answer is yes and no. Because all Medigap plans are standardized in order to follow federal guidelines, they will be the same for the most part. However, because every state has different levels of requirements, Medigap policies will look different in some states.

Certain plans may also cover different percentages of particular health benefits. Meaning, that one Medigap policy could cover 100 percent of a benefit, while another could only cover 80 percent. Therefore, you’ll need to carefully compare plans when shopping for health insurance.

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Let Us Help You Find The Right Plan

At Buffalo Health Advisors, we believe in providing solutions to individuals as they transition to Medicare plans. Not only can Medicare Advantage work to protect your health, choosing the right plan can go a long way toward protecting your wealth. This plan is critical if you are going to be living on a fixed income during your retirement years.

It will cost you nothing to learn more about the options available to you. Call or stop by our Nashville, TN office to discuss your Medicare plan options with one of our experienced agents.

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