Confused about Medicare Supplement Plans? Read on to find out more about these plans.
Updated June 19, 2018
Medicare Supplement Plans
Medicare Supplement plans, also known as Medigap plans, are sold by private insurance companies to help cover some of the health-care costs and benefits not covered by Original Medicare, Part A and Part B, coverage.
Medigap plans cover things like copayments, coinsurance, and deductibles – as well as, in some plans, medical care when traveling outside of the United States – all of which are not covered by traditional Medicare benefits.
Types of Medicare Supplement plans
In 47 of the United States, there are 10 Medicare Supplement plan offerings, which are designated with the letters A through N. Each type of plan comes with different benefits, with the plans of the same letter offering the same set of benefits. For example, Plan F in Massachusetts offers the same exact benefits as Plan F in Wisconsin. The only thing that varies is the cost of the plan, which will depend on the insurance company offering the plan.
There is also another type of Medigap insurance called a Medicare SELECT plan. These plans require beneficiaries to use hospitals and/or physicians within the plan’s network of health-care providers in order to be eligible for full plan coverage. Any of the 10 standardized Medicare Supplement plan types can be offered in a Medicare SELECT version by an insurance company.
Massachusetts, Minnesota, and Wisconsin each have their own unique plan offerings.
What do Medicare Supplement plans cover?
Here’s a look at the different benefits that may be offered with each of the 10 standardized Medicare Supplement plans in 2018:
** After the out-of-pocket limit is reached for plans K or L, the plan then pays 100% of covered services for the remainder of the year.* A high-deductible version of Plan F is available in which beneficiaries pay up to $2,240 in 2018 in deductibles before the plan begins coverage.
*** Plan N pays 100% of the Part B coinsurance costs, except up to $20 copayment for some office visits and up to $50 for emergency room visits.
Keep in mind that Medicare Supplement plans no longer include prescription drug coverage as of 2006. If you want drug coverage while being enrolled in these plans, you must enroll in a stand-alone Medicare Prescription Drug Plan. Additionally, Medicare Supplement plans do not cover long-term care, routine vision or dental care, hearing aids, eyeglasses, or private-duty nursing care.
Who is eligible to enroll?
In order to be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both parts of Original Medicare, Part A and Part B. You must also live in the state in which the plan is being offered.
The best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six-month enrollment window begins the month in which you are both age 65 or older and enrolled in Medicare Part B. During this time, you can buy any Medigap insurance policy in your state, even if you have pre-existing health conditions, because you cannot be denied due to medical underwriting. Outside of this time, an insurance company can use medical underwriting to deny your application due to your health.
Insurance companies are not required by federal law to sell Medicare Supplement plans to individuals under the age of 65. However, certain state laws vary and do require insurance companies to sell you these plans, even if you’re less than 65 years of age.
There may be certain situations, such as losing employer coverage or moving outside of a Medicare SELECT plan’s network, which would qualify you for guaranteed issue rights. These rights, also known as “Medigap protections,” allow you to enroll in any plan available in your state. In this situation, the insurance company cannot refuse your application, deny coverage for all of your pre-existing conditions, or charge you more because of past or present health conditions.
Why should I consider a Medicare Supplement plan?
Original Medicare doesn’t cover everything. If your health-care needs require you to get services outside of what’s covered by Medicare Part A and Part B, you may be left with large out-of-pocket expenses. These bills may add up without additional coverage. That’s where Medicare Supplement plans come in to help fill in the gaps left by Original Medicare coverage.
Whether a Medicare Supplement plan is right for you will depend on your needs and budget. Be sure to compare all Medicare plan options in your area to find the coverage you need.
Medicare has neither reviewed nor endorsed this information.