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Medigap (Medicare Supplement Insurance) Policies

Original Medicare pays for many, but not all, health care services and supplies. A Medigap policy, sold by private insurance companies, can help pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. 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. Then your Medigap policy pays its share. Medicare doesn’t pay any of the premiums for a Medigap policy.

Every Medigap policy must follow Federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies can sell you only a “standardized” Medigap policy identified in most states by letters. All plans offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.

Note: In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Medigap Plans

How to read the chart: If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).
Medigap BenefitsABCDF*G*KLMN
Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up✓✓✓✓✓✓✓✓✓✓
Medicare Part B Coinsurance of Copayment✓✓✓✓✓✓50%75%✓✓***
Blood (First 3 Pints)✓✓✓✓✓✓50%75%✓✓
Part A Hospice Care Coinsurance or Copayment✓✓✓✓✓✓50%75%✓✓
Skilled Nursing Facility Care Coinsurance✓✓✓✓50%75%✓✓
Medicare Part A Deductible✓✓✓✓✓50%75%50%✓
Medicare Part B Deductible✓✓
Medicare Part B Excess Charges✓✓
Foreign Travel Emergency (Up to Plan Limits)80%80%80%80%
Out Of Pocket Limit **$6,220$3,110

* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 in 2021 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. See previous page for more information.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($203 in 2021), 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.

Insurance companies may charge different premiums for exactly the same Medigap coverage. As you shop for a Medigap policy, be sure you’re comparing the same Medigap policy (for example, compare Plan A from one company with Plan A from another company).

In some states, you may be able to buy another type of Medigap policy called Medicare SELECT (a Medigap policy that requires you to use specific hospitals and, in some cases, specific doctors to get full coverage). If you buy a Medicare SELECT policy, you also have rights to change your mind within 12 months and switch to a standard Medigap policy.

Medicare Advantage Plans

Medicare Advantage Plans are health plans that are approved by Medicare and provided by private companies. Medicare sets the rules for Medicare Advantage Plans and regulates the private companies who operate the Plans.

Medicare Advantage Plans are also sometimes referred to as Medicare Health Plans, Medicare Part C Plans, and MAs/MA-PDs (and originally, Medicare Advantage Plans were called Medicare + Choice plans). A Medicare Advantage Plan combines your Medicare Hospitalization (or Medicare Part A) and Medical insurance or Doctor’s Visit Coverage (or Medicare Part B) into one Health Plan that provides the same Medically-Necessary Services as Original Medicare. Some, but not all Medicare Advantage Plans also offer Prescription Drug Coverage (or Medicare Part A and Medicare Part B and Medicare Part D) at no additional cost and are called MA- PDs.

What are the types of Medicare Advantage Plans?

There are only a few primary types of Medicare Advantage Plans and most of the different Medicare Advantage Plans may also include prescription drug coverage:

  • Health Maintenance Organization (HMO) – A Health Maintenance Organization that is contracted with Medicare provides you with access to a network of doctors and hospitals that coordinate your care, with an emphasis on prevention.
  • Health Maintenance Organization with a Point of Service Option (HMO POS) – This is a Health Maintenance Organization that provides a more flexible network allowing you to seek care outside of the traditional HMO network under certain situations or for certain treatment.
  • Preferred Provider Organization (PPO) – A Preferred Provider Organization provides access to a network of doctors and hospitals that coordinate your care.
  • Private Fee-For-Service (PFFS) – A Private Fee-For-Service Plan is a type of Medicare Advantage Plan in which you may go to any Medicare-approved doctor or hospital that accepts both Medicare and the plan’s payment (or terms and conditions).
  • Medicare Special Needs Plans (SNPs) – A Special Needs Plan is a Medicare Advantage Plan with coverage designed especially for Medicare beneficiaries with certain chronic conditions (like Diabetes) or have some other specific need.
  • Medicare Medical Savings Account (MSAs) – A Medical Savings Account is a combination of a high-deductible health plan and a bank account where your Plan deposits a certain amount of money per year.

Still got questions? Ask us!

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More About Medigap Policies

  • You must have Part A and Part B.
  • You pay a monthly premium for your Medigap policy in addition to your monthly Part B premium.
  • A Medigap policy only covers one person. Spouses must buy separate policies.
  • It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap costs.
  • The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional open enrollment periods.) After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
  • If you’re under 65, you won’t have this open enrollment period until you turn 65, but state law might give you a right to buy a policy before then.
  • If you have a Medigap policy and join a Medicare Advantage Plan (like an HMO or PPO), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums. If you want to cancel your Medigap policy, contact your insurance company. If you drop your policy to join a Medicare Advantage Plan, in most cases you won’t be able to get it back.
  • If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare. Contact your State Insurance Department if this happens to you.

How does a person choose a Medicare Advantage Plan?

It is of course important to compare the benefits between your current coverage and the Medicare Advantage Plan. Be sure that you understand the additional benefits and any benefits (or freedoms) that you may loose. In general, we usually remind people to look at the Cost, Coverage, Convenience, Company reputation, and Comments from other Members. In particular, be sure to look at the following:

  • Can you change your current doctor(s) or are they in the new plan’s network?
  • If prescription drug coverage is provided, are your medications on the plan’s formulary?
  • How much is the monthly premium?
  • How much will your coverage cost? Co-payments and co-insurance as explained in the plan’s Summary of Benefits. Which additional services are offered, such as preventative care, vision, dental, and health club membership.
  • Are there any treatments that you need that are not covered by the Plan?
  • Can you work within the network restrictions (like paying extra when you visit a doctor who is out-of-network)?
  • Be sure to give us a call to find out what great products and carriers we have for you and your clients!