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Medicare Supplement Insurance: What You Should Know about Medigap

Read on to learn more about what Medigap is and how you could be eligible for it.

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Medicare Supplement Insurance is an optional addition to Original Medicare (also known as Medigap) offered by private insurers to help cover out-of-pocket costs. Understanding Medicare and how different plans work together will help you choose the coverage that meets your individual healthcare and budget needs.

What is Medicare Supplement Insurance

Medicare Supplement Insurance is an optional addition to Original Medicare. It’s designed to help you cover out-of-pocket costs remaining from Original Medicare coverage, like copays, coinsurance, and deductibles. These plans are offered and managed by private insurers approved by Medicare.

There are 10 Medigap plans. Medigap plans are all standardized, meaning that each plan letter (Plan A for example) has the same benefits. However, different plan letters (Plan A compared to Plan K), have different benefits. These plans are standardized differently in Massachusetts, Minnesota, and Wisconsin.

Medigap eligibility is based on your eligibility for Original Medicare. If you’re enrolled in Medicare Part A and Medicare Part B, you are typically eligible for a Medigap plan.

What Does Medicare Supplement Insurance Cover?

Medigap plans only supplement your existing Original Medicare benefits by helping with copays, coinsurance, and deductibles. All Medigap plans cover all or some basic costs including:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
  • Part B coinsurance or copay
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copay

Some Medigap plans also cover all or some additional out-of-pocket costs, including:

  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible
  • Part B excess charge
  • Foreign travel exchange (up to plan limits)
  • Out-of-pocket limit

In some states, certain Medigap plans offer lower premiums in exchange for a higher deductible.

Because Medigap plans in Massachusetts, Minnesota, and Wisconsin are standardized in different ways, plan options and benefits will be different than those listed above.

How Much Does Medicare Supplement Insurance Cost?

Private insurers offer Medigap plans, where they’ll determine the monthly premiums for each of their plans. Medigap plans are priced in 3 different ways: community-rated, issue-age-related, and attained-age-rated.

  • Community-rated plans generally charge everyone with the same plan the same amount, regardless of age. Premiums may change based on inflation or other factors.
  • Issue-age-rated plans base premiums on the age you were when you first purchased the plan. Premiums are lower for people who buy when they’re younger (65) and may vary based on inflation and other factors.
  • Attained-age-rated base premiums on your current age. Premiums are low when you are young (65) but increase as you age, as well as increasing with inflation and other factors.

What you pay for a Medigap plan depends on several factors. These include how the plan is priced, which plan or benefit options you choose, whether you go through medical underwriting (something you can bypass if you enroll when your Part B coverage starts), and if you select a high-deductible plan.

Keep in mind that to enroll in a Medigap plan, you must be enrolled in Original Medicare (both Parts A and B). This means that you will need to continue to pay your Medicare Part B premiums to remain eligible for your Medigap plan.

When and How Can I Sign Up for Medicare Supplement Insurance?

When you first turn 65, if you are already receiving social security benefits, you are automatically enrolled in Original Medicare (Parts A and B); however, you can decline Part B, since there is a premium associated with it. This is important to know regarding Medigap, since you are only eligible to buy a Medigap plan for the first time during your 6-month Medigap Open Enrollment Period, which begins when you enroll in Part B.

Around this same time, you should receive your Medicare Card in the mail, which contains your unique Medicare number. It is helpful to have this card and number available when you begin Medigap enrollment.

You can also enroll in Medigap any time after the enrollment period ends, but you may be subject to medical underwriting. If you are found to have past or current health issues, you may be denied coverage, given a delayed start time to your coverage, or charged more for your plan.

Because costs and coverage vary by plan letter, it’s important to understand each plan’s benefits.

We understand that choosing a plan can be overwhelming. That’s why we are here to help. Our licensed insurance agents can answer your questions, from “What is a Medigap plan?” to “How do I sign up for Medicare Supplement Insurance?” to “What plan is right for me?” Just call and ask at +1-877-343-4684, TTY: 711

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