What Are My Medigap Plan Options?

Currently, there are 10 standardized Medigap plans, each represented by a letter: A, B, C, D, F, G, K, L, M, and N. (There’s also a high-deductible version of Plan F.) Plans E, H, I, and J are no longer available to new subscribers. These plans are available in most states; however, Massachusetts, Minnesota, and Wisconsin each have their own different set of standardized Medicare Supplement plans.

Coverage levels and premiums vary, but the benefits of each plan within a lettered category remain the same despite the insurance company or location. What this means is no matter which company you purchase your Medigap insurance from or which state you live in, the benefits of each standard Medigap plan are always the same, even if premiums vary between insurance companies. This holds true except for Massachusetts, Minnesota, and Wisconsin. If a Medicare Supplement plan includes a certain benefit, this benefit is covered 100 percent unless otherwise specified.

IN GENERAL, ALL MEDICARE SUPPLEMENT PLANS COVER THE FOLLOWING BENEFITS:

  • Copayments of Medicare Part A
  • Copayments of Medicare Part B
  • Blood
  • Copayments of Part A hospice care

Medigap policies are designed to protect you. Hence, every Medigap policy must follow federal and state laws, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can only sell you Medigap policies that are standardized and use the letter for clarity.

All Medigap policies offer the same basic benefits. However, in order to meet individual needs, some Medigap policies offer other additional benefits. Again, if you live in Massachusetts, Minnesota, and Wisconsin, Medigap policies are subject to different standards.

Because insurance companies are private entities, each insurance company can decide which Medigap policies to sell, although state laws might impact their options.

INSURANCE COMPANIES THAT SELL MEDIGAP POLICIES:

  • Don’t have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plans
  • Medigap Plans

Remember, as Medicaid Supplement Insurance, this insurance is a supplement, meaning the Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible) and Original Medicare has paid.

COMPARISON CHART OF MEDIGAP POLICIES A THROUGH N

Medigap Benefits Medigap Plans
A B C D F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Part B deductible No No Yes No Yes No No No No No
Part B excess charge No No No No Yes Yes No No No No
Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $5,560 $2.780 N/A N/A

Source: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

WHEN CAN I PURCHASE MEDIGAP INSURANCE?

  • When buying a Medigap plan, the open enrollment period is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B — or within six months of signing up for Medicare Part B.
  • During the first 6 months after your 65th birthday, you can buy any Medigap policy at the same price a person in good health pays.
  • If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage. If you do get covered, your rates might be higher.

HOW MUCH DOES MEDIGAP COST?

  • The monthly premium to the insurance company you purchased your Medigap plan through
  • This premium is in addition to your Medicare Part B premium.
  • Medigap policies vary in cost, depending on several factors such as the type of plan you buy, the insurance company, your location, and your age.
  • As long as you purchase your Medigap policy within the six month window, your policy is guaranteed renewable, even if you have health problems or preexisting conditions, as long as you pay your premiums. This is good news for those with pre-existing conditions.
  • However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs for pre-existing conditions during that six month period you were not covered. After six months, the Medigap policy must cover the pre-existing condition.
  • The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous “creditable coverage,” or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in this case.
  • All insurance companies that sell Medigap insurance options set their own prices and rules about eligibility, so it’s important to shop around.

What You Need to Know About Medigap Plans

  • Most Medigap plans help pay for many of your Medicare co-payments, co-insurance for hospital stays, and some other services.
  • Less expensive plans have fewer benefits and higher out-of-pocket costs.
  • More expensive plans include extra benefits, like some Medicare deductibles, additional hospital benefits, at-home recovery, and more.
  • If you drop your Medigap policy, there is no guarantee you will be able to get it back.

You have to decide what sort of plan makes the most sense for you. Medicare supplement insurance is designed to help you pay for health care costs, which Original Medicare won’t cover — costs that can add up quickly. The experts at Medicaregov Directory in St. Louis can help you sort through the differences in the Medigap insurance plans and choose one that is right for you. Contact us today!