Medicare Supplements
Also known as Medigap, Medicare Supplement plans exist to pay for the out-of-pocket Medicare expenses.
Medicare Supplements were created shortly after Medicare itself and standardized by Medicare. Plans are individual, so a married couple would need one for each spouse.
Why Choose a Supplement Plan?
Once you meet your deductible for Part A, you are not in the clear. You will still be charged a daily coinsurance after 60 days as a hospital inpatient or 20 days as a skilled nursing facility inpatient. Part A deductibles are also defined in benefit periods, meaning they begin when you are admitted as an inpatient and end after 60 days of not receiving inpatient care. You may have to pay the Part A deductible more than once in a given year, which can significantly affect your budget.
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Benefits of Medicare Supplements
- Freedom to choose your own doctors and hospitals
- No referrals required to see a specialist
- Predictable out-of-pocket expenses for Medicare-covered services (and zero out-of-pocket with Plan F)
- Nationwide coverage – you can use it anywhere that accepts Medicare
- Guaranteed renewability – the insurance company can never drop you or change your coverage due to a health condition
- No claims paperwork – Medicare supplement companies have crossover filing with Medicare. When your provider files a claim with Medicare, that claim is automatically filed with your supplement company too
What do Medicare Supplements Cover?
After Medicare pays its share for covered services, items, or tests, you will have to contribute toward your healthcare costs. Thanks to cost-sharing, you will owe copayments toward your deductible. Once you meet the deductible, you owe coinsurance. This amounts to 20% of the Medicare-approved amount for covered services. For expensive treatments, this 20% can add up. Medicare Supplements help to pay those out-of-pocket expenses.
The ten available Medicare Supplements are lettered A, B, C, D, F, G, K, L, M, and N. Plans C and F are offered only to those who became eligible for Medicare before 2020. Each plan covers a portion of expenses toward the following:
- Part A hospital coinsurance and hospital costs
- Part B copays and coinsurance
- Part A hospice
- Skilled nursing facility
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergency
Plan F has the most coverage, followed by Plan G. These plans cover everything listed, with 80% coverage for foreign travel emergency, but Plan G does not cover the Part B deductible. Plan N is another popular option with coverage similar to Plan G, but with this plan, you will pay copayments of $20 for doctor visits and $50 for emergency room visits that don’t lead to inpatient status.
Enrolling in Medicare Supplement Plans
Medicare beneficiaries can first enroll in a Medicare Supplement plan when they are 65 or older and enrolled in Part B. The six months after you enroll in Part B are your Medigap open enrollment period, during which time you cannot be turned down from a plan because of your health. You can select any of the plans available to you.
Medicare Supplement Guaranteed Issue Rights
Those who did not enroll in a Medicare Supplement plan during their six-month window may receive the same privileges of avoiding medical underwriting, known as guaranteed issue rights, if they meet certain conditions. These are a few circumstances that grant you Medicare Supplement guaranteed issue rights:
- Retiring and/or losing group health coverage through an employer
- Losing Medicare Advantage coverage when you move out of state
- Losing Medicaid eligibility
Guaranteed issue rules can vary by state, so be sure to check with a licensed agent who can inform you about the laws that apply in your state. We are licensed in Illinois, Missouri, and Iowa. Each state has its own rules.
The guaranteed issue window works just like open enrollment, except that it is a shorter period of time and your plan choices are limited to Plans A, B, C, F, K, and L. The insurance company cannot deny your application for any health reasons.
If you are interested in enrolling in one of the ten supplements, reach out to us today. We serve portions of Illinois, Missouri, and Iowa and are willing to help you find a plan that meets your needs.
