MEDIGAP PLANS ARE PRIVATIZED, SENIOR HEALTH INSURANCE PLANS THAT PROVIDE ADDITIONAL BENEFITS FOR SENIORS (65yr.+) WHO HAVE ORIGINAL MEDICARE (PARTS A & B).
- What is Medigap Insurance?
- What is a Medigap Plan?
- What does a Medigap Plan cover?
- How does a Medigap Plan work?
- What type of Medigap Plans are available?
- Why are Medigap Plans so complex?
- How much does a Medigap plan cost?
- When can I buy a Medigap plan?
- How do I pay for a Medigap plan?
- How do I renew my Medigap plan?
- How does a Medigap plan pay my Doctor?
- How does a Medigap plan cover Prescription Drugs?
- What are the Medigap plan eligibility requirements?
- What is NOT covered in a Medigap Insurance plan?
- Can my wife and I share a Medigap plan?
- Can I buy a Medigap plan if I have a Medicare Advantage plan?
- How do I know what Medigap company to choose from?
- What is the history of Medigap Insurance?
- What is OBRA (Omnibus Budget Reconciliation Act(1990))?
- What is the difference between Medigap Plan & Medicare Supplements?
Last Updated: 5/5/2019
Recall, that “Medigap Plans” are synonymous with “Medicare Supplements” both are the same type of Insurance, just a different name (like tomayto, tomahto). In the last page titled, Medicare Supplement Insurance, we presented a general overview, some common questions and a brief history of Medicare Supplements. To avoid sounding redundant, for this page the goal is to provide you with a more concise breakdown of important information about Medigap Plans. The two pages should be equally considered, some information may appear in one or the other. Likewise, some information may sound redundant but by the end of the Medicare Journey, you will truly be we Medicare wise!
What is Medigap Insurance?
avoid confusion, Medicare supplements & Medigap plans are the same thing!
As mentioned, Medigap Insurance is privatized and federally standardized, senior health insurance that provides additional health care benefits to its beneficiaries. Medigap plans are sold through insurance carriers, brokers, and licensed, health insurance Agents.
What is a Medigap Plan?
What does a Medigap Plan cover?
Each Medigap Plan varies in the offer but in general, Medigap plans can cover Medicare Part A & Medicare Part B co-insurance/ co-payments, deductibles, blood, excess charges, hospice care, foreign travel emergency & preventative care. Contact a Bridge Agent to learn more about plan availability and options.
How does a Medigap Plan work?
Medigap Plans cover the additional twenty percent (20%) leftover costs that Original Medicare does not cover. Medigap Plans are also known as “Letter Plans” due to their naming convention (ex: Plan F, Plan G, Plan N) which is similar to how Original Medicare names its “parts” after A, B, C & D. Beyond the additional cost, Medicare Supplements may provide additional benefits like;
- Protection from additional health costs.
- Freedom to choose your Doctor.
- Portability (switch plans/providers anytime).
- Flexibility (Find plans to fit your budget).
- Price Transparency (know your costs separately).
- Freedom to travel (in and out of the country*).
You should not purchase a Medigap Plan on just price alone! Some new carrier plans have been known to hike up prices shortly after enrollment. We recommend working with top-rated carriers who have a tendency to maintain stable prices. Get a Quote today from a Licensed, Bridge Agent and find out what Medigap plans are available for you!
What type of Medigap Plans are available?
There are a lot of factors to consider before knowing what plans are available to you. You may only purchase one plan and you must not have a Medicare Advantage Plan. The general list of plans are listed in alphabetical order as follows (check with Bridge to confirm plan availability);
- Plan A – Available
- (Not to be confused with Part A, Original Medicare)
- Plan B – Available
- (Not to be confused with Part B, Original Medicare)
- Plan C – Available
- (Not to be confused with Part C, Medicare Advantage Plans)
- Plan D – Available
- (Not to be confused with Part D, Prescription Drug Plans)
- Plan E (Unavailable)
- Plan F – Available
- Plan G – Available
- Plan H, I, J (Unavailable)
- Plan K – Available
- Plan L – Available
- Plan M – Available
- Plan N – Available
- Plan O-Z (Non-existent)
Why are Medigap Plans such a complex topic?
Medigap Plans appear complex because health care, in general, is complex and the one-size fits all insurance models designed for simplicity are not always easy to understand. Many people and not just seniors are confused about how Medicare works despite paying into it their entire working life. Overall, it’s not that Original Medicare is complex, it’s these “additional Letter Plans” ie: Medigap Plans that can cause so much confusion for people. More reasons include the number of plans available, the time it takes to learn how Medigap Plans work for you & how to compare Medigap Plans. As a licensed, Medigap Insurance Broker, we compare the top carriers plans to give you an easy to understand, free comparison quotes to help you save time and money.
Need a Guide to help Navigate the Medicare Maze? Bridge can help you find Medicare Supplements to meet your unique needs. Connect with Bridge Today!
How much does a Medigap Plan cost?
Medigap Plan costs can vary based on factors such as your health, age, location, letter plan & the carrier to name a few. Even though all plans are standardized, meaning; the only difference between each MedigapPlan is how much you pay. As with most insurance, rate changes take effect. That’s why it’s best to work with a Bridge Agent to help you navigate the Medicare Maze and find a plan that best fits your unique needs.
When can I buy a Medigap Plan?
In order to purchase a Medigap Plan online, you would need to work with a state licensed, health insurance agent, broker or insurance carrier directly. It’s recommended to buy a Medigap Plan when you are first eligible. This period of time is known as “Medigap Open Enrollment” which is a 6-month period that begins automatically after you turn 65 and enrolled/obtain an effective date for Medicare Part B. If you wait until after this 6-month period, you could be denied coverage or pay higher rates.
Are you interested in getting a price comparison? Click here to Get a Quote.
How do I pay for a Medigap Plan?
In addition to your Medicare Part B costs, you would pay separately for your Medigap Plan to your plan provider/carrier. For example, if you purchased a Mutual of Omaha Plan G, you would pay Mutual of Omaha directly. We recommend paying for your Medigap plans via auto draft through your bank which ensures no lapse in coverage. For example, if you have a hospital stay longer than expected, it’s easy to forget to pay your policy and thus lapsing coverage.
How do I renew my Medigap Plan?
Medigap Plans are guaranteed renewable despite health problems. As long as you pay your premiums, the insurance carriers cannot cancel your Medigap policy.
How does a Medigap Plan pay my Doctor Bills?
Most Medigap Plans get your claim information directly from Medicare by which the carrier will pay your Doctor directly. If the carrier does not have this capability, ask your Doctor if they “participate” in Medicare, which means they “accept assignment” for Medicare patients. If your Doctor does participate, the Medigap Plan is required to pay the Doctor directly. Contact your plan provider or agent to understand your Medigap costs.
How does a Medigap Plan cover Prescription Drugs?
Medigap Insurance Plans do not cover (Part D) Prescription drug coverage. You will need to purchase a stand-alone drug plan along with your supplement plan. Unlike Medicare Advantage which encompasses a drug plan, Medigap Plans are separate policies. In the past, some Medigap plans provided drug coverage. However, after Jan 1, 2006, this has been disallowed. If you are looking for prescription drug coverage, you can join a Medicare Prescription Drug Plan (known as Part D coverage).
What are the Medigap Plan Eligibility Requirements?
In order to be eligible for a Medigap Insurance Plan one must be enrolled in Medicare Parts A & B (Did you know? If you apply for Medicare early and have a “Medicare claim number”, you can lock-in your Supplement Plan before your Part B effective date.). As mentioned, you cannot be enrolled in Medicare Advantage (Part C) and buy a Medigap Policy (you must choose one over the other). Assuming you are 65 years of age (unless disabled or have ESRD), upon enrolling into Part B, recipients are given a 6-month Medigap Open Enrollment window which allows for a Medigap guaranteed issue right to obtain coverage regardless of one’s health conditions. More importantly, beyond that 6-month window, a medical exam or attending physician’s statement may be required by the health insurance carrier.
Bridge Insurance can help you find the right plan to fit your unique needs. Contact us today to get a Free, No Obligation, Medigap Quote over the phone, right now.
What is NOT covered in a Medigap Insurance Plan?
Generally, Medigap Plans do not cover long-term health care plans, vision plans, eyeglasses, dental care, hearing aids, or private-duty nursing care. For more information on specific qualifying questions, Medigap plan options and pricing, contact Bridge today!
Can my wife and I share a Medigap Plan?
No, you and your spouse are considered separate members and each member must purchase an individual Medigap Policy. However, depending on state and carrier, a Medigap household discount may be available. Contact Bridge to learn more.
Can I buy a Medigap Plan if I have a Medicare Advantage Plan?
No, you cannot have both a Medigap Insurance Plan and a Medicare Advantage Plan at the same time. You must choose between one or the other. Pay very close attention to enrollment dates, eligibility rules when deciding & switching plan types. Get the facts, speak with a Bridge, Medigap Agent today.
How do I know what Medigap company to choose from?
It can be a challenge when deciding what Medigap company to choose from because everyone has different needs and preferences. Here at Bridge, we only work with the top, A Rated carriers to ensure stability without compromising price. We listen to your situation and based on your needs, present medigap plans based on factors such as availability, cost & benefits to name a few points.
Remember, you are offered a Guaranteed Issue Right, which means even if you have health problems, you will not be denied coverage and you will pay the same amount as someone who has good health.
What is the history of Medigap Insurance?
The history of Medigap Insurance is extensive since it stems from Medicare. Medicare has been around well before President Lyndon B. Johnson signed The Medicare Bill in 1965.
Moreover, Medicare in continually being honed as with the more recent, “Medicare for All” movement.
Additionally, many of the laws that surround Medigap insurance can be found online, including the social security TITLE 18 (XVIII), and more specifically, the Notice of Medicare Benefits: Medicare & Medigap Information.
Thankfully, there have been many efforts to protect seniors as far back as The Baracus Amendments in 1980 for Medigap Insurance to protect against substandard and overpriced policies using a panel of standards to regulate insurance. Notice, Further Fraud and Kickback prevention: The Medicare and Medicaid Patient and Program Protection Act of 1987. Additional protections included; The Medicare Catastrophic Coverage Act of 1988 an expansion of benefits to include outpatient drugs & limit employee co-payments for example. The H.R.4328 – Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, Medicare Prescription Drug, Improvement, and Modernization Act and lastly, the Genetic Information Nondiscrimination Act.
Furthermore, due to the lack of consistency from private insurers, Medigap Insurance plans were misguiding people with many instances of sales and marketing deception. In response, Federal authorities stepped in to help regulate the Medicare Supplement Insurance market. The attempt to standardize private Medigap insurance created OBRA or Omnibus Budget Reconciliation Act of 1990.
What is OBRA?
OBRA would provide protection to consumers from misleading healthcare purchases and to instantiate Medigap plan consistency standards, the National Association of Insurance Commissioners (NAIC) was created to develop a model for all participating states with a few exceptions, including Massachusetts, Minnesota, and Wisconsin who enacted their own state regulations.
Before June 1, 2010, twelve (12) standardized Medigap plans existed labeled “Plan A through Plan L” ie: “Letter Plans”. Over time, some Medigap Plans have been removed with the addition of two new, letter plans. Any plans purchased prior to June 1, 2010, are grandfathered for life.
As of June 2010, ten (10) Medigap plans remain which are all standardized by the National Association of Insurance Commissioners (NAIC) https://www.naic.org/, Medicare Supplement insurance policies are issued plans from private insurance carriers as an alternative to Part C (Medicare Advantage Plans). Each insurance company is different and may not choose to sell all plans however some plans are required to be sold. All plans must obtain a minimum standard of coverage and adhere to Medicare law revisions. Policies contain a minimum of a 30-day free-look provision and exclude pre-existing conditions capped at 6 months.
What is the difference between Medigap Plan & Medicare Supplements?
There is no difference between a Medigap plan vs. Medicare Supplements because they are the same thing, just a different name.
In our next page, we will go over Medigap Plan A Coverage which is basic Medigap Plan and then covers each additional letter plan to follow. If you would like to skip to Medigap Part D Coverage, Click here.
Not Sure Where to Go Next?
Medicare can be complex without a good guide and we have good news… We can help! Start The Medicare Journey. If you are just joining us, we recommend you start on the first page & follow the simple guide to better understanding Medicare & Medicare Insurance or move to the next page.
- FL225 – Health & life (including annuities & variable contracts) Study Manual Florida 32nd Edition – 2017
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