Medicare doesn't cover everything. Medicare Supplement plans provide extra coverage and fill Medicare's gaps. But they're not necessary for everyone. Find out whether or not you need a Medicare Supplement plan.
Medicare is confusing. It's important to choose a plan that’s a good fit in coverage and cost. There are many choices in today’s healthcare market for Medicare as well as supplement plans to enhance coverage.
Medicare is the federal government health insurance program for people age 65 and older, and for people with disabilities. Medicare covers many health services, but not all. People with healthcare needs beyond what Medicare provides can purchase a Medicare Supplement plan. These policies are sold by private insurance companies. They fill the coverage gaps of standard Medicare plans. Around 9.3 million people use Medicare Supplement plans.
Medicare Supplement plans are also known as Medigap or MedSup plans.
While Medicare helps pay for many healthcare services, it doesn't cover everything. People with unique or extensive healthcare needs have a few options to increase their coverage. One of them is a Medicare Supplement plan, or Medigap.
Medigap DOES NOT replace Medicare. Medigap is designed to work with Medicare. You cannot purchase a Medigap policy without having Medicare Part A and Part B.
Private insurance companies sell Medigap plans. That's a key difference from Medicare, which is provided by the US government. Medigap users pay a monthly premium for their plan alongside the Medicare Part B premium.
There are 10 different Medigap plans. Each comes with different levels of coverage and benefits. These plans are the same across state lines.
However, different companies can charge different prices for the same plans. That's why it's important to shop around and compare quotes from each company. Otherwise, you may end up paying more than necessary. QuoteWizard can connect you with top insurance companies to get the best price on a Medigap plan.
How do you know if you need a Medigap plan? Below we will cover what Medigap does and doesn't cover, as well as when you should or should not purchase Medigap.
Though the level of coverage depends on your specific plan, Medigap covers the following:
Medigap does not cover the following:
According to MedicareRights.org, the national average for a Medigap plan is $183 per month. Coverage levels vary, so your preferred plan may have a different price.
Prices vary between insurance providers. According to Medicare.gov, there are three common pricing structures for Medigap:
Ask your preferred insurance company about their pricing model. Depending on your situation, one structure may fit your needs better than others.
The costs of a Medigap policy can and will vary. Medigap plans are standardized from state to state. However, each insurance company can charge different prices for the same plans.
That's why you need to shop around and compare insurance companies. QuoteWizard can help you easily compare quotes from top insurance companies and find the best Medigap plans.
Do you have retiree insurance? If so, it’s a good idea to compare your out-of-pocket costs for Medicare with your retiree plan versus Medicare with Medigap. When you enroll in Medicare Part B, you also trigger your open enrollment period to buy a Medigap policy.
Although both work together with Medicare, Medigap and Retiree insurance are different. They offer similar assistance, but Medigap isn't offered through employer programs. Both Medigap and Retiree insurance can fill the gaps in Medicare.
"Generally, Medicare is the primary payer (pays first), and the employer-sponsored health insurance is the secondary payer," says Adcock, Director of Government Relations and Policy at NPCSSM.
Your Medigap open enrollment period lasts for six months from the date you enroll in Part B. You have the option to purchase a policy regardless of health problems and without paying a higher premium for the policy.
Sometimes your retiree insurance provider will convert your coverage into a Medicare Advantage plan, a type of managed care (like an HMO or PPO). You would need to be in this plan to receive your retiree benefits, rather than stay in Original Medicare. If you choose to drop your retiree insurance, you may not be able to get it back.
"Most Medicare beneficiaries should enroll in a supplemental Medigap plan which is designed to fill some of the coverage gaps in Medicare," says Adcock.
When you enroll in Medicare Part B, you also trigger your Medigap open enrollment. Your Medigap open enrollment period lasts six months from the date you enroll in Part B. It lets you buy any Medigap policy regardless of any health problems you may have. You won't have to pay more for the policy.
If you let the open enrollment close, you run the risk of rejection. You lose the protection available during open enrollment.
Do you have COBRA insurance? COBRA is a federal law that give people the option of staying on their employer’s group health plan for a limited time after their employment ends (usually 18 months, it may go up to 36 months). COBRA coverage costs more than what you paid for health coverage before your employment ended.
Compare the benefits and costs of having a Medigap policy to COBRA to see which is better for you. If you have COBRA first and then become eligible for Medicare, your COBRA coverage may end.
Since you won't be fully covered with COBRA you should enroll in Medicare Part A and Part B when you are first eligible to avoid a late enrollment penalty. However, you may be allowed to keep your COBRA coverage if it is offered to you. You can use it for extra benefits like prescription drug or dental coverage.
A: You're automatically eligible for Medicare when you turn 65. People under the age of 65 sometimes qualify for Medicare if they receive Social Security Disability Insurance. There are special instances in which others may qualify for Medicare, such as certain diseases or disabilities. Find out if you're eligible through Medicare's eligibility calculator.
A: Yes. It depends on your plan. Some plans are structured to raise premiums as you age. It’s a good idea to review your Medicare plan benefits and costs each year as your needs and income change over time. You can also shop around and compare Medicare Supplement plan prices to find the best deal.
A: The Medigap open enrollment period begins the first day of the month in which you are 65 and enrolled in Medicare Part B. It last six months. During this time, insurance companies cannot refuse to sell you a policy, delay your coverage, or charge you more than others.
If you wait until after the open enrollment period, insurers can reject your application. This can happen to people with preexisting conditions and illnesses.
A: Medigap covers many costs that Medicare doesn't. These include the following:
Here's what Medigap plans DON'T cover:
A: No. They're very different.
Each plan addresses a similar issue: providing extra protection beyond what Medicare offers. Both are offered by private insurance companies.
Medigap policies are usually more expensive and a bit more complex. Many Medigap patients must coordinate between several different plans, which can be a pain. However, Medigap patients usually face lower out of pocket expenses.
There is more flexibility with Medigap because Medicare Advantage requires that you visit doctors and providers within their service network. Medigap allows you to see any doctor that accepts Medicare. You might get coverage for doctors who don't accept Medicare, but that could require negotiating with your insurance company.
For more information on Medigap and Medicare Advantage plans, visit Medicare.gov.
A: Yes. A Medigap plan supplements a Medicare plan. You're required to have Medicare Part A and B in order to sign up for Medigap.
A: Medicare is defined in multiple parts. Medicare Part A and B are the two main tenants of original Medicare.
Part A covers the following:
Part B covers the following:
A: No, you cannot use both plans together.
Some old Medigap plans include prescription drug coverage, but those are no longer for sale. If you need prescription coverage, you will need to purchase a Medicare prescription drug plan. Specifically, Medicare Part D. Part D helps pay for prescription drugs.
Be aware that Medicare Advantage plans include prescription drug coverage.
Read our guide to Medicare Part D for more information.
A: As long as your doctor accepts Medicare, you do not need to switch doctors.
A: If you're covered by Medicare Parts A and B, you can enroll at any time. If you're already enrolled in a Medigap plan, you may have to wait for the open enrollment period.
A: MedicareRights.org states that an average Medigap plan costs $183 per month.
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