Medicare Supplement Insurance Plans
What’s Medicare Supplement Insurance (Medigap)?
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
8 things to know about Medigap policies
- You must have Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
- You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
Medigap policies don’t cover everything
Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Insurance plans that aren’t Medigap
Some types of insurance aren’t Medigap plans, they include:
- Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
- Medicare Prescription Drug Plans
- Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
- Veterans’ benefits
- Long-term care insurance policies
- Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap policy (not just the drug coverage)
If you decide to drop the entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
If you drop your entire Medigap policy and the drug coverage wasn’t creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.
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10 Questions To Ask Before Buying a Medicare Plan
To get the most from Medicare — and your health care dollars — you need to carefully evaluate the costs and benefits of all of your plan options.
How much will I have to pay for premiums, deductibles, doctor visits and hospital stays?
Part A Premium – Most people don’t pay a monthly premium for Part A. However, if you buy Part A, you’ll pay up to $458 each month in 2020. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.
Part B Premium – The standard Part B premium amount is $144.60 (or higher depending on your income).
Part C Premium – The Part C monthly premium varies by plan.
Part D Premium – The Part D monthly premium varies by plan (higher-income consumers may pay more).
Will I have to choose hospital and health care providers from a network?
Will my doctors accept the coverage? If not, are there doctors near me who will?
Will I need referrals to visit specialists?
Will the plan cover me if I get sick while traveling in another state?
What will my prescription drugs cost?
Are my drugs on the plan's drug list (or formulary)?
Does the plan include the pharmacies I currently use?
Can I get my prescriptions through the mail?
Does the plan have a good quality rating?
Whether you are new to Medicare or are deciding if you should change plans during Medicare’s Annual Enrollment Period, more commonly called Medicare open enrollment, you should gather information from a variety of sources.
If you’re considering a Medicare Advantage or Part D prescription drug plan, both of which are run by private insurers, don’t rely solely on information from the sponsoring insurance company.
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