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Medicare Supplement Plans (Medigap)

Medicare Supplement Plans are used by millions of Medicare beneficiaries across the country.  Also called Medigap plans, these plans pay for your share of Medicare expenses, such as deductibles and co-payments. Medicare Supplements are available in all 50 states and are popular with those who want to pay as little as possible when accessing their Medicare services. 

Many people enrolling into Medicare are unaware of the costs they will have after Medicare Part B only pays 80%, leaving them to pay the other 20%, without a maximum limit. This means that the 20% could be financially devastating to you and your family should major health issues arise. Medicare supplements help cover that 20% and other costs (depending on the Plan you choose), giving you the ability to live with peace of mind. 

During your initial enrollment period you are guaranteed the right to purchase a Medicare supplement plan.  Your health status or pre-existing conditions do not apply during this special 6 month window. HERE you can find some videos to help you better see where to start when getting ready for Medicare and a supplement. 

What is Medicare Supplement Insurance?

Medicare supplements are standardized plans set up  with specific benefits to help cover expenses that would otherwise come to you.  This includes the 20% for medical services covered under Part B of Medicare.  There is not a maximum out of pocket with original medicare but with Medicare supplement those costs are passed on to the insurance company instead of you. 

A few of the biggest advantages to a Medicare supplement policy are:

• Freedom to choose any doctor, hospital or facility that works with Medicare
• Close to $0 out of pocket expenses every year
• You don’t need a referral to see a specialist
• You are covered everywhere in the United States
• No need to re-enroll every year ( the plan keeps going as long as you pay your monthly premiums)

Medicare supplements are very easy to understand because they are standardized by Medicare.  You will know exactly what is covered by the plan based on the plan you choose no matter which company you go with.  This means that if you purchase a Plan G with insurance company ABC or with company XYZ,  you are going to receive the same exact coverage and benefits. 

Things you should know about Medicare supplements:

• You must have both Part A and Part B of Medicare to purchase a supplement.
• Medicare supplement plans cover only one person.  A married couple would need one plan for each person.
• You can cancel your Medicare supplement at any time. There is no annual election period for Medicare supplement plans.
• Medicare supplements are guaranteed renewable. This means, that no matter what health conditions you develop, you will have coverage. 
• Many carriers offer household discounts for married couples when enrolling with the same company.  Some carriers are now offering a discount just for living with another person under specific criteria.

Medicare Supplement Plan Coverage

Medicare parts A & B only pay a certain portion of all Medicare approved claims and the rest of that bill will be sent to you.  A Medicare Supplement will pay for your portion of all claims approved by Medicare like deductibles, coinsurance and copays.

You will be able to use your supplement wherever Medicare is accepted. This makes it a great option for those who like to travel all over the country and don’t want to worry about a network.

Medicare supplements do not cover retail drugs. You will need to purchase a Part D drug plan for any medications you need to purchase through a pharmacy.  Medicare supplements also do not cover routine dental, vision or hearing services either. These services are not covered by Medicare Parts A&B so they will not be covered by the supplement either.

Medicare Supplement Plans-Standardized

Below is a chart of all available Medicare supplement plans. This chart is also provided in the “Choosing a Medigap” booklet, that is published by Medicare itself. It goes into detail as to what each plan covers.

What are the different Medigap plans?

Above in the chart, each Medicare supplement is listed by letters A-N.  Each of these plans has a different set of benefits provided. However, each lettered plan must have the same standardized coverage regardless of which insurance company you have that plan with. This means whether you go with a Plan N from United Healthcare or a Plan N from Mutual of Omaha, they both have to provide the exact same benefits. The only difference in the plans will be what the monthly premium will be. 

This chart shows the 10 standardized plans available in most states across the country. Wisconsin, Minnesota and Massachusetts have different options. 

The most comprehensive plan available that covers all of the gaps is Plan F.  The other plans available will offer you coverage but you will be required to share in some of the cost-sharing.  Usually these plans will offer you a lower premium. Right now the most popular plans that involve cost-sharing are Plan G and N, where you will have some cost-sharing but receive a lower premium than a Plan F.

A Medicare supplement agent can help you determine what will best fit your needs and your budget.  

Medicare Supplement Plans- Open Enrollment

According to Medicare’s Guide to Health Insurance, the bet time to buy a supplement policy is during your one-time open-enrollment window. This window begins on the first day of your birth month, or the month that you enroll in Part B of Medicare. It will last for six months and will be the only time you will get this type of enrollment period. 

During this period, the Medicare supplement companies can’t ask you any medical questions and can’t turn you down for any health reasons.  They are not allowed to charge you any extra based on your health, medications or pre-existing illnesses.  You will get to choose any plan from any company that is available to you.

This is not the same as the Annual Election Period. This period runs from October 15th to December 7th and is for your Part D drug plan and not for a medicare supplement.

Medicare Supplement Plans- Guaranteed Issue

Sometimes people will delay their enrollment into a supplement becasue they have group health coverage through an employer. Later when you retire or lose that coverage, you have the right to purchase a Medigap policy within 63 days after losing that coverage. This is called guaranteed issue for a Medicare supplement.

The guaranteed issue window works just like the open enrollment, except now your time frame to make a choice is smaller and your plan options are limited to Plans A,B,C,F,K, and L. The insurance company still can’t deny you for any health or pre-existing conditions. 

There are other times as to when you may have guaranteed issue rights. Please call us if you are wondering if you may be able to get a guarantee issue policy. 

Medicare Supplement Plans- Underwritten

If you have already gone past your open enrollment or no longer have a guaranteed issue option, you can still apply for a Medicare supplement.  You will have to answer some questions about your health on the application and then the insurance company will either accept or deny your application. 

Some people get confused by this because they hear about the Annual Election Period and believe that this is a time that they can switch supplements without any underwriting. The annual election period does not apply to Medicare supplements but only to Part D drug plans and Medicare Advantage Plans.  Any time you change Medicare supplement companies voluntarily, you will be required to go through underwriting in most cases. 

Which Supplement is the Best Plan?

Right now, the most comprehensive plan is Plan F. It will pay for all of your Medicare cost-sharing, leaving you to pay $0 out of pocket for all covered services under Medicare Parts A & B. 

You can choose to buy a supplement from a variety of different companies based on your location. Remember, all plans are standardized by Medicare so the benefits for each plan are set and are the same no matter which company you choose to purchase your plan from. A Plan G with one company will give you the same benefits as a Plan G with another.  The only difference will be the monthly cost for the plan.

The second most comprehensive, and the most popular at this time, is Medicare supplement Plan G. It works just like a Plan F, only you will have to pay the annual deductible which is $185. Once that deductible has been paid by you the plans will pay for your expenses the exact same.  This plan is becoming more popular than Plan F because on average throughout the country there is a monthly savings of around $30. That is $360 a year in savings on your premiums. After paying your $185 deductible, you are still able to keep $175 in your pocket. 

These plans are standardized to fit an individuals needs for their own health care. These plans are not a one size fits all, so if you would like to learn more about which plan best fits your needs please speak with an agent to determine which plan is right for you.

Common Questions About Medicare Supplements

Can you change Medicare supplements at any time of the year?

Medicare supplements can be changed at any time during the year.  If you decide to change your plan, this will require you to go through underwriting and you will have to answer health questions in most states.

You should never cancel your policy before you have been approved for a new plan.  If the company you are applying with should decline you for any reason and you have already cancelled your current plan, you may end up being unable to get another Medicare supplement policy. 

The Medicare supplement company will review your application and either accept or deny you.  There are a few states with different rules.  For example, California, Oregon, Connecticut and Washington have established exceptions to this rule. 

Do you have to have supplemental insurance with Medicare?

No, medicare supplements are optional.  However, without a supplemental insurance policy, you would be responsible for expensive hospital deductibles and copays as well as 20% of ALL outpatient services. This could be a financial nightmare, as there is no maximum out of pocket with original Medicare.

If you have looked at Medicare supplements and feel they are not affordable within your budget. You should consider looking at Medicare Advantage plans. Medicare Advantage plans have lower premiums and will help control your out of pocket costs but usually require you to stay within a network and follow other limitations.

Finding the Right Supplement For You

When purchasing directly from the insurance company,  you are giving up a lot of the benefits that an agent provides at no additional cost to you. What benefits can an agent provide you that the insurance company won’t?

• An explanation of your benefits before ever getting into the sale process
• Quotes from ALL of the major providers in your area
• Free information on what is trending in the market for each company
• Financial ratings for each company 
• Annual rate shopping, making sure that you are always with the best company for your needs
• Free support and help with any claims questions you may have
• Annual Part D assistance

Looking for more answers or looking to speak with an agent about your specific needs? Please call us at (866) 319-5886. 

What Plan is Right for Me?​