What is a Medicare Supplement (Medigap) Policy?
A Medicare Supplement (Medigap) policy is regulated and designed to pay for the expenses Medicare does not fully cover. Medicare covers about 80% of your Part B medical expenses. Medicare Supplements (Medigap) policies are designed to pay for most of what is left after Medicare pays 80% of your Part B medical expenses.
How Do Medicare Supplement (Medigap) Policies work?
Medicare Supplements (Medigap) are policies regulated by the federal government. Each company that offers Medicare Supplement coverage must follow a set of strict guidelines and regulations set forth by the federal government. These guidelines and regulations are designed to protect consumers. Companies must offer the same plans due to federal regulations. Plans available are lettered Plan A – Plan N.
IMPORTANT: All insurers that offer Medicare Supplement coverage must follow the same federal regulations. This is very beneficial to the consumer. For example, a Plan G can be offered by both Red insurance company and Blue insurance company. Although the two insurance companies are different, the benefits provided by the policy are identical. However, the price of Plan G can vary between the two insurance companies.
* Plans F and G also offer a high-deductible plan in some states. You must pay
Medicare-covered costs (coinsurance, copayments, and deductibles) up to the
deductible amount of $2,800 in 2024 before your policy pays anything. (You can’t buy
Plans C and F if you were new to Medicare on or after January 1, 2020. Go to page 75.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly
Part B deductible ($240 in 2024), the Medigap plan pays 100% of covered services for
the rest of the calendar year.
***Plan N pays 100% of the Part B coinsurance. You must pay a copayment of up to $20
for some office visits and up to a $50 copayment for emergency room visits that don’t
result in an inpatient admission.
Common questions about Supplements
Is Medicare Supplement the right Choice for you?
Medicare Supplement plans, aka (Medigap), work alongside Original Medicare. Original Medicare has out-of-pocket costs like deductibles, copayments, and coinsurance; a Medicare Supplement steps in after Medicare has paid its share to cover most of these costs for you, resulting in very few out-of-pocket expenses for the care you receive. The Medicare Supplement plan offers beneficiaries more freedom and flexibility in their care choices, without having to worry about networks, preauthorization, or insurance approvals to receive care. This flexibility and comprehensiveness come with a cost. Medicare supplements do have higher premiums than Medicare Advantage, but with a known outcome. In our experience in serving our clients in Nebraska and Iowa, Medicare supplements allow you to avoid the uncertainty of out-of-pocket expenses and skip the headaches of network and managed care that are offered through Medicare Advantage plans.
medicare Supplement FAQs
Medicare Supplement helps cover medical costs that Original Medicare does not fully cover. Medicare is the primary payer, and the Medicare Supplement steps in to cover leftover costs after Medicare has paid. The plans are standardized by the Federal government (everyone plays by the same rules) and offered through individual insurance companies. The most common plan choices for beneficiaries in our area are Plan G and Plan N. Senior Legacy Partners can help you decide which plan and insurance carriers fit your needs and budget.
Typically, the best time to enroll is during your Medicare Supplement Open Enrollment Period. This is a federally guaranteed 6-month window that starts the first day of the month Part B is effective. During this window, consumers have a guaranteed issue right when they first choose a plan, meaning they cannot be denied coverage. An additional tip: most Medicare Supplement carriers will allow you to apply in advance of your Part B start date; usually, they will accept an application up to 6 months in advance. Applying early allows our clients to avoid a gap in coverage; if you wait until Part B is effective, then you could be without Supplement coverage for a month or more while the application is processed.
Yes-if the doctor or hospital accepts Medicare assignment (national approx. 96%), you can see them and the supplement will pay.
Short answer: No, Medicare Supplements do not include drug coverage. For drug coverage, people with Medicare Supplements use a Part D stand-alone drug plan. These plans usually have a modest premium and can be tailored to the drugs you take and the pharmacy you use.
This is a common misconception that beneficiaries are stuck on the first plan they choose. We find through our work with local clients in the Papillion/Omaha area that although switching does require you to go through underwriting (if you are outside your Open enrollment window or GI circumstance, i.e., lost employer coverage), most clients can switch to a Different plan or the same plan from a different insurance carrier at a lower rate.
This boils down to several factors: underwriting, utilization rates, insurance company overhead, and how old the book of business at that insurance company is. That is why Senior Legacy Partners maintains an independent broker status so we can look for the best value for your premium dollar.