8 Things You Should Know About Medicare Supplement Insurance Plans

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Medicare Supplement Plans are Designed To Work With Medicare Parts A and B

Once you enroll in Medicare Part A and Part B, you can purchase additional insurance to cover some of the gaps in your coverage.

1. These plans may help pay some of your share of the cost for hospital and medical care that Original Medicare does not cover

Medigap plans are sold by private insurance companies, and they’re not part of Medicare. They can help pay for some of the share that you would otherwise have to pay for hospital and medical care not covered by Original Medicare.

Medigap plans come in 10 standardized versions (A through N). The letter designations refer to a particular set of benefits that each plan offers. In addition to the standard Medigap coverage, there are also six additional plans: Plan G (International), Plan F (Full), Plan E (Hospital Insurance), Plan D-Savers Rx, Plan C-Saver Rx and Plan M

2. Each plan has a different monthly premium, look for the one that fits your needs best

  • You may want to consider your monthly premium when looking at plans.
  • For example, if you are on a limited budget and can’t afford a higher monthly premium, then you may need to go with the plan that has the lowest monthly premium.
  • However, if you have good health insurance already and don’t expect any major life events in the near future (such as having children), then it might be better for you to go with a more expensive plan because it will provide better coverage for prescription drugs.

3. You must have Medicare Part A and Part B to get a Medigap policy. If you drop Medigap coverage, you might not be able to get another Medigap policy later

  • You must have Medicare Part A and Part B to get a Medigap policy. If you drop Medigap coverage, you might not be able to get another Medigap policy later.
  • You can’t get a Medigap policy if you have Medicare Advantage Plan (Part C) or Medicaid.
  • If you drop your primary insurance plan for any reason (like moving out of the country), then that may affect your ability to buy supplemental insurance from the same company. It’s best to check with them if this is a concern.

4. There are different types of Medigap insurance policies, each with a different set of basic benefits. Most policies help pay for some or all of the coinsurance for hospitals and for skilled nursing facilities

There are different types of Medigap insurance policies, each with a different set of basic benefits. Most policies help pay for some or all of the coinsurance for hospitals and for skilled nursing facilities. They also help cover costs that Medicare does not cover, such as deductibles, copayments and other out-of-pocket expenses.

  • “Plan F” helps pay for hospital coinsurance (the amount you must pay toward your hospital bills after having paid Medicare’s payment) and copayments (the fixed dollar amounts you must pay each time you seek health care). Plan F also covers most out-of-pocket costs related to skilled nursing facility visits after a patient has been hospitalized or received home health services. Plan G adds coverage for prescription drugs not covered by Original Medicare Part A and Part B Plans.
  • Plans N and H offer supplemental coverage to help cover the cost of prescription drugs not covered by Original Medicare Part A and/or Part B plans through pharmacy discounts instead of cash rebates as seen in M plans G & L; however these savings are limited to $20 per month up until 2020 at which point they’ll increase annually based upon inflation rate changes).

5. You need to decide what kind of plan you want. Some are more comprehensive than others and make it easier to see doctors that don’t accept Medicare patients. Some plans allow you to see out-of-network providers, others do not.

If you’re not sure which plan is best for your needs, try to get a feel for how much coverage you want. Do you want to be able to see doctors that don’t accept Medicare patients? Are there certain specialists that are important to you? The answers to these questions will help determine which type of plan will work best.

What’s the difference between in-network and out-of-network providers?

  • In-network means it’s a hospital or doctor within the same insurance network as your supplemental insurance policy. When seeking treatment from an in-network facility and provider, no copayments, coinsurance, or deductibles apply; however, some plans allow members to receive care from out-of-network providers if they meet specific requirements.* Out-of-network means it’s a hospital or doctor that isn’t part of your current supplemental health plan (i.e., Health Savings Account (HSA), Flexible Spending Account (FSA), or Medical Savings Account). If seeking treatment from an out-of-network facility and provider while on medical leave from employment due to disability caused by disease/injury/illness then no copayments will apply; however, coinsurance may still apply depending on state law requirements.* Point of Service HMO: A point of service health maintenance organization allows members access either through their primary care physician or specialist without referral necessary so long as the member pays for services at the time the visit occurs.* Point Of Service PPO: A preferred provider organization allows members access either through their primary care physician or specialist without referral necessary so long as member pays for services at time visit occurs.”

6. You can use any doctor or hospital in the country that accepts Medicare patients

As a Medicare beneficiary, you can use any doctor or hospital in the country that accepts Medicare patients.

If you have more than one insurance plan, your claims will be paid first by your primary supplement coverage and then by secondary coverage if necessary. If there are no benefits available on another plan, then the claim will be processed by Medicare itself.

7. You can’t buy Medigap if you already have Medicare Advantage Plan (Part C) unless you go back to Original Medicare

You can’t buy Medigap if you already have Medicare Advantage Plan (Part C) unless you go back to Original Medicare.

If you’re already covered by a Medicare Advantage plan (Part C), your health insurance will cover some of the costs that Original Medicare doesn’t cover. If you want to purchase supplemental coverage on top of this, it’s important to understand how this impacts your options for supplemental plans. If a person has a lot of prescription drug costs or other out-of-pocket expenses in addition to their monthly premiums, it may be worth considering buying into an add-on Medigap plan rather than joining a private Medicare Advantage program so they can get more comprehensive benefits without having to pay as much out-of-pocket each month.

8. Be careful when shopping for a health or prescription drug plan on your own. Many phone sales pitches are misleading, leaving out important information so customers can’t make good comparisons. The information on this website is unbiased and designed so you can make an informed decision about your benefits.

Medicare supplement insurance plans can be complicated, and there are many things you need to know. Here are some tips for understanding your health plan:

  • Be careful when shopping for a health or prescription drug plan on your own. Many phone sales pitches are misleading, leaving out important information so customers can’t make good comparisons. The information on this website is unbiased and designed so you can make an informed decision about your benefits.
  • Ask questions! If you don’t understand something in the contract or if something seems wrong, ask questions before making any decisions or signing anything. Call the company’s customer service number or call one of us at Colangelo Group at 1-914-633-3333.

Conclusion

Please keep in mind that this guide does not provide all of the information you may need to determine which type of policy best suits your needs and budget. Besides, it’s important to compare plans side-by-side. We hope you found this information useful as an introduction to Medicare Supplement Insurance Plans; however, if you have questions or need more details about these plans please contact us at (914) 633-3333.

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