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WHAT ARE MEDIGAP PLANS

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits and fills in the gaps that Original Medicare has.

Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:

  • Don't have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plan

Keep in mind, that the Medicare Supplement policies covers co-insurance after you've paid the deductible (unless the Medigap policy also pays the deductible).

There are 10 Medigap Plans to choose from. They’re labeled by letters A, B, C, D, F, G, K, L, M, and N (Plans E, H, I, and J are no longer available), and each plan letter has different coverage benefits.

HOW DO YOU GET A MEDIGAP POLICY?

To qualify for a Medicare Supplement, you must first enroll in Medicare Parts A and B. Once you turn 65 and enroll in Original Medicare, you will enter your  Open Enrollment  period.

   

WHAT IS THE MEDIGAP OPEN ENROLLMENT PERIOD?

 

The Medigap Open Enrollment Period  is a  six-month period starting the first day of the month after you turn 65 and have Medicare Part B. , or it is the  six month period after you get your Part B  at any age, like obtaining it after leaving an Employer Group Health plan.  During your Medigap Open Enrollment window you cannot be asked Health questions , so you cannot be declined and also PRE-EXISTING conditions do not factor into the approval process.

WHAT DO MEDIGAP POLICIES COST?

Medigap plan monthly premiums differ depending on several factors.

  • Age
  • Location
  • Tobacco use
  • Plan type (A through N)

Different insurers also vary their monthly rates depending on actuarial models, though many offer discounts to those who live with a spouse.

You do have the option to enroll outside of your Open Enrollment, but acceptance is not guaranteed, and you may have to pass a health underwriting exam. You can learn more about when you can buy Medigap plans here.

 

Here are the 2020 Deductibles,Copays, and Coinsurance that a Medigap policy can pay:

Medicare Part A: Hospitalization

  • Days 1-60:      2020 $1,408.00 deductible (billed the first day)
  • Days 61-90:    2020 $352.00 per day
  • Days 91-150:  2020 $704.00  per day (60  reserve days)
  • Days 150+ Not covered

Skilled Nursing Facility Coinsurance:

  • Days 1-20: $0 per day
  • Days 21-100:   2020 $176.00 per day
  • Days 100+ Not covered


Part B deductible per year* only paid for by Plan C and F   in 2020  $198.00

Medicare Part B Coinsurance: 20%

Medicare Part B Excess Charges: Up to 15%  (in addition to coinsurance)

Foreign Travel Emergency: Not covered

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

Medicare Supplement Benefit Chart

Review the chart and look at  what each Plan pays

What it means is the per cent in the box is the amount the Medigap policy covers. If you don’t have a Medicare Supplement, you will pay these costs associated with Original Medicare. 

 

 

 

 

What You Also Need to Know About Medicare Supplement Policies

 

  • You must have Medicare Part A and Part B.
  • If you have a Medicare Advantage Plan, you can apply for a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before
  • You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
  • You can buy a Medicare Supplement insurance policy from any insurance company that’s licensed in your state to sell one.
  • It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
  • Medicare supplement plans cover only one person. Your spouse must have his or her own individual policy.
  • The annual election period in the fall is for drug plans. It does not apply to Medicare supplements in any way.
  • Many carriers offer household discounts if two or more people enroll in Medicare supplemental plans from the same company.
  • Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medicare Supplement insurance policy if you pay the premium. Medicare Supplement insurance policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage.  If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  • You can drop your supplement at any time. There is no annual election period for Medicare Supplement plans.

Medicare Supplement Policies Are Standardized 

Finally, every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters.

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In MassachusettsMinnesota, and Wisconsin, Medigap policies are standardized in a different way.

 

Link to Medigap 2020 from Medicare.gov

Current Version Available

click on the picture...

 

 

 Medigap Policy Review  

Do I have the right Medigap policy?

MACRA has caused many changes to Medigap policies.  At  LetsTalkMedicare, we  encourage our clients with Medigap policies to Review and Compare, Prices and Policy Benefits frequently.  New Carriers are coming into the market offering lower competitive pricing along with additional ways to save money.  An example is the Household discount. Household discounts can range from 3% up to 15%.  This opportunity is available when 2 or more people live in a residence and either purchase a Medigap policy from the same carrier or make up a household.  This discount can impact the premium you pay monthly for your policy. Feel free to reach out to us for a Medigap Policy Review.  It’s easy and quick. We can search our list of Carriers and see if you may qualify to make a change and present you with a list of options.  The key benefit of the change would be the opportunity to SAVE money monthly.

Fill out our CONTACT US form , give us a call,  or Text Us.  If you have had your policy for a few years you would be surprised that you may save money for the exact same benefits.