MEDICARE SUPPLEMENTS 101
If you’re currently enrolled in Original Medicare, Part A and Part B, you’ll know that there can be gaps in your coverage that you must pay out of pocket. Copayments, coinsurance, and deductibles are expenses that you are responsible for paying.
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That’s where Medicare Supplement insurance comes in. Also known as Medigap, Medicare Supplement insurance plans work alongside your Original Medicare coverage to help fill in some of those coverage gaps. These plans may pay for certain costs that Original Medicare doesn’t cover, including cost sharing and benefits like emergency overseas health coverage and Medicare Part B excess charges (the 15% extra amount that non-participating providers may charge you over what Medicare will pay for a covered service).
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When it comes to Medicare Supplement insurance, the timing of your enrollment can greatly determine the options available to you and how easy it is for you to find coverage. It can also affect how much you pay for coverage and whether insurance companies can charge you more or deny you coverage altogether based on pre-existing conditions. Read on to learn more about how enrollment works and the best time to enroll in a Medigap plan.
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When am I eligible for Medicare Supplement insurance coverage?
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You’re generally eligible for Medigap coverage if you’re enrolled in Original Medicare, Part A and Part B.
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If you are under 65 and have Medicare, you may not be able to enroll in Medicare Supplement insurance; federal law doesn’t require states to offer Medigap coverage to beneficiaries under 65. However, some states do offer certain Medigap plans to beneficiaries under 65 with disabilities or certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease). Your eligibility and Medigap options will depend on your specific state, so contact your state’s insurance department to learn whether you qualify for Medicare Supplement insurance coverage.
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When is the best time to enroll in a Medigap plan?
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As mentioned, the timing of your enrollment may affect your coverage choices and costs. In general, the best time to enroll in a Medicare Supplement insurance plan is during your Medigap Open Enrollment Period. This is the six-month period that starts on first day of the month that you are both 65 or older and enrolled in Medicare Part B. Throughout this period, you can enroll in any Medigap plan offered in your service area with guaranteed issue. This means that insurance companies aren’t allowed to use your medical history or pre-existing conditions as the basis for charging you more for coverage or denying you altogether. If you have medical issues or disabilities, it’s especially important to take advantage of this period: Your Medigap Open Enrollment Period may be one of the few times that you have a guaranteed right to enroll in any Medicare Supplement insurance plan in your area.
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Once your Medigap Open Enrollment Period passes, you may not be able to enroll in a Medicare Supplement insurance plan as easily if you’re doing so for the first time. If you’re already enrolled in a Medigap plan, you may not be able to switch plans with guaranteed issue (except in certain situations). Without guaranteed-issue rights, you may be subject to medical underwriting and charged higher premiums based on your health status. Insurance companies can also deny you coverage if you have health problems. It’s usually more difficult to find Medicare Supplement insurance coverage after your Medigap Open Enrollment Period has passed if you have disabilities or pre-existing conditions; even if you can find a Medigap plan that will accept you, your premium costs may be higher.
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Other situations when you may have guaranteed-issue rights
There are some situations when you may still be able to enroll in a Medicare Supplement insurance plan with guaranteed issue. Those situations may include, but aren’t limited to:
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Your Medigap insurance company goes bankrupt or misled you.
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Your Medigap coverage ends through no fault of your own.
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You’re enrolled in Original Medicare and an employer-sponsored group plan, and your employer coverage is ending.
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You’re enrolled in a Medicare SELECT plan (a type of Medigap plan that uses provider networks), and you move out of your plan’s service area.
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You’re enrolled in a Medicare Advantage plan and move out of the plan’s service area, or your Medicare Advantage plan leaves the Medicare program.
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You enrolled in a Medicare Advantage plan at age 65 when you were first eligible for Medicare Part A, but changed your mind within the first year and want to return to Original Medicare.
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You dropped your Medigap plan to enroll in a Medicare Advantage plan for the first time, but changed your mind within the first year and want to return to Original Medicare.
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This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
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A Closer Look at the Standardized Plans
Quick Summary
Medicare Supplement Plan A:
A bare-bones Medigap plan that covers the basics.
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Medicare Supplement Plan B:
This plan is the same as Plan A except it covers the Medicare Part A deductible.
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Medicare Supplement Plan C:
A very comprehensive plan that covers almost all the same bases as Plan F, except any excess costs that arise after the Medicare Part B deductible. In other words, your deductible is covered, but anything above that you must pay out of pocket.
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Medicare Supplement Plan D:
Almost identical to Plan C, but you must pay both the Medicare Part B deductible and any excess costs beyond that.
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Medicare Supplement Plan G:
A popular plan because it covers almost all the expenses left over from Medicare Part A or Part B, but it does not cover the Part B deductible. This is the sole difference between Medigap Plans G and F when looking over the Medicare Supplement plans comparison chart.
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Medicare Supplement Plan F:
As discussed above, Plan F is popular because it leaves no gap – or, covers 100 percent of the costs – after the benefits from Medicare Parts A and B have reached their limit. For example, Medicare Plan F helps with Part B excess charges, hospital costs, Part B coinsurance, skilled nursing facility costs, nursing facility care, hospice care coinsurance and more. It also covers the Medicare Part B deductible, which sets it apart from the other most popular plans. Like Plans C, D, G, M, and N, Plan F covers some of the expenses incurred if you have a foreign travel emergency.
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Medicare Supplement Plans K, L, M:
Typically, these plans are lumped together for two reasons. One, they’re similar, and two, they’re not very popular. None of these plans covers either the Medicare Part A or Part B deductible, and only cover a percentage of the other costs.
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Medicare Supplement Plan N:
Although Plan N offers lower premium rates than Plans G and F, it does require you to cover the Part B deductible, as well as your co-pays for your doctor and emergency room visits.
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While viewing the Medicare Supplement plan comparison chart, it’s important to note some changes that are on the horizon. In 2020, federal regulations will stop allowing Medigap plans to cover the Medicare Part B deductible, thereby precluding any new Medicare beneficiaries from enrolling in Plan F or Plan C. It’s predicted that, as a result, Plan G will be a much more popular choice among the 10 plans in 2020.
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How to Enroll in a Medicare Supplement Plan
Now that you’ve reviewed the Medicare Supplement plan comparison chart and decided on which plan offers you the most cost-effective and comprehensive coverage, we can help you begin the process of enrollment.
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Naturally, that starts with how much it’s going to cost you. Rates vary depending on a number of factors, including where you live and your specific health insurance company, but we can help you find out what’s offered in Florida. We can also help you compare rates from company to company.
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To address your questions and concerns about the Medicare Supplement plan comparison chart or Medicare Supplement insurance in general, call our licensed insurance professionals today.