If you’re already on Medicare or you’re getting close to enrolling, you may be wondering what a Medicare supplement is. This is a common question that many people ask: To put it simply, a supplement to Medicare is insurance sold to you by a private insurer that will cover your Medicare coverage gaps. Many times, you will hear these plans referred to as Medigap.
You may be wondering, “Why do I need a Medicare Supplement Plan?”
The primary purpose of a supplement or Medigap plan is to cover the costs that you would typically be responsible for once Medicare Part A and Part B have paid their portion. That is right, Medicare pays for a lot of your healthcare, but not all of your healthcare. In the end, once Medicare has paid its portion the remaining costs are ultimately passed on to you. Medicare does cover many things, but there are holes in the coverage or gaps. These can be:
These are items that you will have to pay when you need to access any of your approved healthcare services. Medicare will always pay it part of any services you need if it falls under the category of medically necessary services, or preventative services. After that, your supplement policy will start and will pay its share. This is sometimes what’s left of the remaining bill, but it does depend on which plan or policy you choose.
Original Medicare only pays about 80% of doctor and outpatient visits and will sometimes result in significant hospital deductibles. With a Medicare Supplement plan, these costs can be mostly covered depending on which plan you choose, leaving you with a smaller out-of-pocket expense. There are also no networks involved with Medicare Supplement plans, meaning that you can visit any doctor or hospital within the United States that will accept Medicare.
Medicare Supplement plans will generally cost less compared to other private insurance companies. This is because the supplement plans will set a limit on out-of-pocket costs, and depending on which plan you choose, some premium payments will be less expensive.
You can choose from any Medicare Supplement plan during your initial Open Enrollment Period and will not be turned down. However, after six months of being with Medicare, you will have the option to change plans, but the request will go through a medical underwriting process.
11 Supplements to Medicare
Medicare had created guidelines for each supplement to follow when it was standardized in 1990. Each one is given a letter to identify it, and are called plans rather than parts. Remember, each plan policy under a specific letter will provide you with the same benefit set from insurance company to company (i.e. Plan G from insurance company A vs Plan G from insurance company B). For you, the only difference you’ll see is the monthly premium between insurance carriers for the same plan. The only time benefits will differ is when comparing two different lettered plans (i.e. G to F or N to G). Since there are many carriers for these supplement plans, you do have a lot of freedom in choosing one that will offer you the best rate for your healthcare needs.
What are the most popular Medicare Supplement plans?:
In 2021, the most popular Medicare Supplement plans are MediGap Plan F, MediGap Plan G, and MediGap Plan N. These three plans offer very high coverage at affordable premiums. Each of these three plans, however, differs slightly in their coverage:
- Medicare Supplement Plan F: Plan was previously of the most popular plans on the market. However, if you turn 65 past January 1st, 2020, you are not eligible to enroll in Plan F. It will often pay 100% of any cost that Medicare will bill you. You won’t have to pay deductibles or copays. This plan will ultimately pay your share of your healthcare costs. Although Plan F has a very high coverage level, there are often more cost-efficient plans available. Learn more about Medicare Supplement Plan F here
- Medicare Supplement Plan G: As a popular plan itself, Plan G is very similar to Plan F. The main difference is that you will be responsible for the Part B deductible. Every year, you will pay this deductible, and after that, Plan G become a full coverage plan. As of 2021, the Centers for Medicare and Medicaid Services. Also known as CMS.
Both Medicare Part A and Part B deductible is $203. This plan will save more than this deductible amount for many people, and is often much more cost-efficient plan than Plan F. Learn more about Medicare Supplement Plan G here
- Medicare Supplement Plan N: This plan is relatively new and started in 2010. With this plan, you’ll see lower premiums than F and G. While this may seem reasonable, you’ll be responsible for more of the cost-sharing as you go. You will see a maximum copay of $20 and a $50 copay for an ER visit to see a doctor. There are also the possibility of excess charges if your provider does not accept Medicare Assignment. Although the majority of providers do in fact accept Medicare assignment, excess charges are possible in 42/50 states. Although this does give you a higher cost-share than Plan F or Plan G, you will ultimately benefit from a lower monthly premium. Learn more about Medicare Supplement Plan N here
Give us a call 877-88KEITH (53484) we will walk you through the coverage offered by these Medicare Supplement plans to find the right fit for you!
Do MediGap Plans Cover Everything?
As much as you want all your expenses to be paid for, there is something that the supplements won’t pay for. They’ll only pay after Medicare pays its part of the bill. After that, Medicare will forward the rest of what is owed to your supplement plan. A good way to remember your plans coverage is that, if Medicare covers a service, so does your Medicare Supplement Plan. MediGap plans follow the lead set by Medicare.
Here are a few things that Medicare or Your Supplement Plan Won’t Cover:
- Routine exams like hearing, vision, or dental
- Any hearing aids you may need
- Contacts or eyeglasses
- Any custodial or long-term care that you may need
- Your prescription drugs
- Cosmetic surgery
Benefits of Having a Medicare Supplement Plan
Medicare Supplement Plans are often referred to as Original Medicare. Although Original Medicare with a Supplement. This is because you still retain Medicare room and board” while you are hospitalized as an inpatient. This means that Medicare Part A and Medicare Part B as your primary insurance. Original Medicare is how Medicare was originally intended to function. The Medicare Supplement plan enhances your Medicare coverage and leaves you with reassurance that you won’t be subjected to large medical bills in your retirement.
There are many benefits to choosing Original Medicare with a MediGap plan, such as-
- No networks! This is huge! With Original Medicare and a Medicare Supplement plan, you can use any doctor who accepts Medicare. You are able to use your plan in all 50 states. No more worrying about extra charges from seeing an out-of-network provider with these plans.
- There are no referrals needed. With other plans like HMOs, if you need a specialist, you would generally require a referral. With a supplement, you won’t need one.
- You will never be dropped due to your health conditions. This means you’ll automatically be renewed. Once you are in the plan, you can remain enrolled for life. When you first begin Medicare Part B, you have 6 months to enroll in a MediGap plan without having to answer any health questions, so it is imperative to enroll right away if you have any pre-existing conditions.
- You’ll be able to avoid any extra costs that may come out of your pocket throughout the year. Each month you can rest assured knowing exactly what you will be paying for your healthcare, without worrying about large out-of-pocket maximums
Coverage with MediGap Plans
Each lettered Medicare Supplement plan’s coverage level varies based on the plan. Below is a list of the most common coverage categories for Medicare Supplement plans:
- Medicare Part A Deductible: As of 2021, this deductible will be $1,484. If you need two inpatient stays at the hospital that is more than sixty days apart, you will have to pay this deductible twice in one year. The majority of Medicare Supplement plans cover part, if not all of this deductible, regardless of how many times it may occur in a calendar year.
- Medicare Part B Deductible: As of 2021, this deductible will be $203 annually. You’ll be responsible for paying this every year for any of your doctor’s visits, physical therapy, and lab work. If you turned 65 after January 1st, 2020, you are not eligible for a Medicare Supplement plan that will pay this deductible.
- Medicare Part A Coinsurance: Every Medigap plan on the market offers this as a benefit. It will usually cover the costly daily hospital stays that will start once you hit that 60th day while in the hospital.
- Copayment and Coinsurance for Medicare Part B: Even Medigap supplement will also cover this benefit. Remember that Medicare will only cover 80% when it comes to your outpatient expense in Part B. This benefit of your supplement will cover the other 20%. If you need cancer treatments or other costly medical procedures, this will prove a huge benefit for you.
- Your first three pints of blood: You will see this benefit in every supplement plan. It will pay for your first three pints of blood if you need a transfusion. Original Medicare will pay for the others after the 3rd Since blood is considered a high priced item, this can be a great benefit if required.
- Coinsurance or Copayment for Hospice Care, Part A: You won’t have to worry about any incurred costs as these supplements will often pay for what Original Medicare doesn’t.
- Skilled Nursing Facility Coinsurance: Original Medicare will only pay for the first 20 days if you need nursing care to recover. While Medicare allows for 100 days, a Medicare supplement policy covering this area will give an additional 80 days of coverage.
- Excess Charges for Medicare Part B: When it comes to Medicare, a provider can either accept Medicare Assignment, which is accepting Medicare’s payment in full, or not accept Medicare Assignment and charge an excess charge. This excess charge can be up to 15% above what is designated by Medicare. It’s also costly if it’s done on things like surgery or medical imaging. Many Medicare Supplement plans cover Medicare excess charges.
- Foreign Travel Emergency: Keep in mind that Medicare is a US-only program. It doesn’t offer any coverage outside the country. Some supplements, however, do offer a form of benefit regarding foreign travel. These will pay up to 80% of the cost. This is after a deductible and up to $50,000.
It is important to understand the coverage levels offered by Medicare Supplement plans, and which plan will provide you with the coverage you need.
Give us a call at 877-88KEITH (53484) we can walk you through the coverage offered by these Medicare Supplement plans to find the right fit for you!
Choosing the Right Medicare Supplement
All Medigap plans have been standardized since 1990. This means you’ll know what benefits you’ll be paying for. There are, however, a few factors you should consider about your insurance carriers before going through with a supplement purchase.
- Rates: This will be the monthly premium that you will pay your insurance company for your supplemental coverage in Medicare. Look to see what premium each carrier is charging. Are they going to be affordable? How competitive are these premiums compared to others in your area? Also, even though a premium may be low, it doesn’t mean that it’s a good thing. Dependent on the state you live in, the premium can be rated in three different ways: attained-age, issue-age, and community-rated. It is important to know what category your premium falls into to know how that impacts the initial rate, as well as increase history.
- Trend history for rates: Like many insurance providers, your policy may have a yearly rate increase. This helps keep up with inflation. Check to see what your carrier has done with its rates over the past few years. Are these increases reasonable or higher than those of your carrier’s competitors? If your carrier’s rates get too high compared to others, then seeking another carrier during an enrollment period may help you lower your costs without sacrificing your benefits.
- Financial ratings: Every insurance company gets rated for other companies, so you know how stable your carrier is. This rating is especially helpful from a financial standpoint. They are graded on their fiscal health. If you’re working with an agent, ask them what the A.M. Best and Weiss Rating will be for the carriers you’re interested in. It’s essential to use this information when making your decision as it can affect your future healthcare.
How to Sign Up for A Medicare Supplement
Like everything with Medicare, it comes down to what you need for your current and future healthcare and enrollment times.
- Decide what benefits you are going to want. After that, look through the Medigap plans and see which ones will suit your needs.
- After that, talk to an agent to look into what insurance carriers offer plans in your area. It is important to speak with a professional agent who has access to things such as premiums, rate increase history, and financial ratings.
- Compare costs for the Medigap plan you want with the insurance carriers in your area. Since the benefits are the same across plans of the same letter, is important to make sure you aren’t overpaying for the same product.
- After all this, you can make that policy purchase. You will want to work with an agent to submit an application for the plan you choose. Asking questions is okay as you want to fully understand the policy and how it will help you with your healthcare costs.
Medicare supplements are a great way to get coverage for any gaps in your Medicare coverage. Medical services can be costly, and having the right supplement will save you money when it comes to your healthcare. You don’t want to be surprised with any excess charges or realize that you still need to pay your deductible.
Compare plans and costs to see which one will fit your budget and needs. If you need, ask a trusted friend or family member to help you with your decision or clear up any confusion you may have. Insurance policies aren’t always the easiest to read for anyone, so getting help if needed can help you make the right decision regarding your healthcare. After all, you want your senior years to be spent relaxing and not stressing over medical expenses you thought were already taken care of. Get the information you need upfront so you can rest assured that you’ll be taken care of when the time comes to see your doctor.
Give us a call at 877-88KEITH (53484) we can walk you through the coverage offered by these Medicare Supplement plans to find the right fit for you!