Medicare Supplement Plans Basics
Medicare Supplement Insurance covers some of the costs that Original Medicare doesn't pay.
What is a Medicare Supplement Plan?
Medicare Supplement Insurance is also called "Medigap" because it helps fill gaps in costs not paid by Parts A and B including copayments, coinsurance and deductibles. Medicare Supplement Insurance Plans are easy to comparison shop because they are standardized under federal law, which requires each plan to offer the same basic coverage, regardless of the carrier.
For many plans, the only difference is the cost.
Why Medicare Supplement Insurance?
Having Medicare Supplement Insurance in addition to Original Medicare may help protect you from unexpected costs, giving you access to the care you need with peace of mind.
Guaranteed Issue means that you can’t be denied coverage due to a pre-existing condition, not that it can’t be taken away. The plan is guaranteed renewable as long as the premium is paid and a misrepresentation is not made on an application. SmartMatch licensed insurance agents work with you to ensure you get the coverage that meets your needs at the price that fits your budget.
Benefits of Medicare Supplement Insurance:
Guaranteed renewability each year
As long as you pay your premium, your coverage will continue year after year and cannot be cancelled (except in specific cases, like providing inaccurate information on your application).
Simplified plan options
Because Medicare Supplement Insurance is standardized, it’s fairly straightforward to understand and compare plans.
Nationwide network of doctors and specialists
Medicare Supplement Insurance enrollees can visit any doctor that accepts Medicare patients. Doctors or hospitals that accept Medicare patients MUST accept all Medicare Supplement Insurance Plans, regardless of the insurance carrier.
Plan Options and Comparison Chart
There are 10 standard Medicare Supplement Insurance Plan types available in most states, each with an assigned letter from A to N (Plans F and C are only available to those who were eligible for Medicare prior to Jan. 1, 2020).
| Medigap Plans | A | B | C * | D | F * 1 | 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 3 |
| 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 | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes | ||
| Part A deductible | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes | |
| Part B deductible | Yes | Yes | ||||||||
| Part B excess charge | Yes | Yes | ||||||||
| Foreign travel exchange (up to plan limits) | 80% | 80% | 80% | 80% | 80% | 80% | ||||
| Out-of-pocket limit 2 | $5,880 | $2,940 |
Standardized Basic Benefits
All Medicare Supplement Insurance Plans must include the same standardized basic benefits regardless of the insurance company selling them.
Note: Medicare Supplement Insurance Plans generally do not cover dental, vision, and hearing costs, long-term care, or prescription drug costs, but they must cover at least a portion of the following basic benefits:
- Medicare Part A coinsurance costs up to a year after Medicare benefits are exhausted
- Medicare Part A hospice coinsurance care or copayments
- Medicare Part B coinsurance or copayments
When is the best time to buy a Medicare Supplement Insurance Plan?
You cannot enroll in a Medicare Supplement policy until you have enrolled in Original Medicare (Parts A and B). After you have Original Medicare, you can choose to enroll in a Medicare Supplement Insurance policy during your Medicare Supplement Insurance Open Enrollment Period.
Open Enrollment Period
The Medicare Supplement Insurance Open Enrollment period is a once in a lifetime chance to enroll in a Medicare Supplement Insurance Plan in which an insurance company cannot use medical underwriting to decide whether to accept your application. The Medicare Supplement Insurance Open Enrollment period starts on the 1st day of the 1st month in which you turn 65 (or older) and are enrolled in Medicare Part B. Some states have additional Open Enrollment Periods, including those for people under 65. During this time, you can sign up for any Medicare Supplement Insurance Plan that suits your needs.
In most cases the best time to enroll in a Medicare Supplement Insurance policy is during your Medicare Supplement Insurance Open Enrollment Period as you may not be able to buy a Medigap policy after that, and even if you are able to, it may cost more.
During your six-month Medigap Open Enrollment Period, insurance companies are required by law to sell you any Medigap policy an insurance company offers regardless of any pre-existing conditions or health history. If you enroll after your Medicare Supplement Insurance Open Enrollment Period, (if, for example, you want to switch insurance carriers) you may have to answer health questions as insurance companies are generally allowed to use the medical underwriting process to decide whether to accept your application and how much to charge you for the Medigap policy, unless you have a guaranteed issue right under certain circumstances.
Guaranteed issue rights
Guaranteed issue rights are available in specific situations outside of your Medigap Open Enrollment Period in which insurance companies must sell any Medigap policy they sell and cover your pre-existing conditions regardless of your past or present health issues. These are usually situations where you lose coverage due to circumstances outside of your control or you are exercising a trial right. There are many situations where you could qualify for guaranteed issue and in some states, there are additional special circumstances that qualify for it. It’s best to connect with a licensed agent if you think you may be eligible for one of these rights.
Your SmartMatch licensed insurance agent will make sure you understand all the details about your Medicare Supplement Insurance Plan’s costs and benefits before you enroll.
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