About this article
Medigap is the Medicare Supplement Insurance plan, which is available to provide assistance to you in filling all the gaps that exist in Original Medicare plans, sold by private companies.
Original Medicare would pay for most of your healthcare expenses, but there will be gaps. You should obtain a Medicare supplement to cover up those gaps. These remaining healthcare expenses would include deductibles, coinsurance, and copayments.
Who can get Medicare Supplement policies?
The Medicare Supplement policies or Medigap policies are offered by private insurance companies. You can find numerous Medicare Supplement policies offered by them, which you can use to cover up the gaps that exist in Medicare. You will be able to use your Medicare Supplement policy and cover up all the gaps in coverage related to copayment requirements, Medicare deductibles, and numerous other coverage attributes.
In order to buy a Medicare Supplement plan, you need to make sure that you have Medicare Part A or Medicare Part B. If you are not over 65 and if you are not disabled, you will not be able to get a Medicare Supplement policy. You will need to wait until the age of 65 to obtain it.
All the people who receive Social Security disability benefits will be able to get themselves enrolled in Medicare Automatically. You just need to make sure that you continuously receive disability benefits for a duration of two years. This would begin 24 months from the month where you are enrolled to obtain the Social Security disability benefits.
Understanding the Medicare Supplement plans
Before you get one of the Medicare Supplement plans, it is worthy to understand what comes along with them to you.
- Core benefits of Medicare Supplement plans
The core benefits that come along with Plan A are available with all other plans. On the other hand, the remaining plans are offering numerous other benefits. However, Plan A would only be offering core benefits. It will cover the following coinsurance and deductibles associated with Medicare.
- Copayment or coinsurance
- The hospital expenses up to a period of extra 365 days after using Medicare benefits
- Hospice rare payments
Plan B is offering all the core benefits along with the deductibles of Medicare Part A.
Plan D is offering Medicare Part A deductible, core benefits, and skilled nursing facility core insurance. You can also get a foreign travel benefit with it.
Plan G is offering Medicare Part A deductible, core benefits, skilled nursing facility coinsurance, Medicare Part B excess up to 100%, and a foreign travel benefit.
You will not be able to get Medicare Supplement Plans C, E, F, H, I, and J as of now. In case if you have already purchased one of them, you will still be able to continue keeping it.
If you are looking for lower-premium plans, Medicare Supplement Plan K and Plan L are the best options to consider. However, these plans are coming to you with high expenses out of your pocket. You can get different core benefits in these plans. They include:
- Approved healthcare expenses of hospitals for the copayments from day 61 to day 90
- Approval of hospital expenses for an extra duration of 365 days
- 50% of the Part B coinsurance will be available with Plan K. Plan L will offer 75% of Part B coinsurance
- 50% of the respite care and hospice care expenses will be available in Plan K. It will increase up to 75% in Plan L.
Plan M and Plan N are offering benefits, which are quite similar to what you can get along with Plan D. however, all the deductibles and co-pays are relatively different.
Optional benefits that come with Medicare Supplement
There are numerous optional benefits available to you with Medicare Supplement. They include:
- Skilled nursing coinsurance
Along with Medicare, you can receive payments to cover up expenses during the first 20 days of skilled nursing care. After that, Medicare would pay up to $185.50 per day. It will only be available for you up to a period of 100 days from the very first day of obtaining care.
- Medicare Part A deductible
Medicare would pay a total amount of $1,484 for the stays in the hospital for the first 60 days. This benefit would pay the deductible of Medicare Part A. Then Medicap Plan B to Medigap Plan G will cover up all the hospital deductibles for every benefit period. On the other hand, Plan K would cover up 50% and Plan L would cover up 75% of the deductible.
- Medicare Part B deductible
Medicare would not make a payment to the first $203 of the patient per year. This includes the costs associated with outpatient hospital services and doctor services. The benefit of Medigap would pay those Medicare Part B deductibles.
- Medicare Part B Excess Charges
If there are differences in charges from the healthcare provider or doctor than the amount approved by Medicare, you can get the remaining amount to be covered up with Medigap. However, the provider will only be able to receive an approved Medicare amount. Then the patient will need to pay the total difference.
- Foreign Travel Emergency
Medicare will not make any payments to cover up expenses related to foreign travel. However, there can be certain exceptions in terms of traveling to Mexico and Canada. Along with this benefit, the patient will have to pay for the first $250 but will be able to receive 20% of the remaining expenses related to the costs of emergency health care during the very first 60 days of the trip. This will be subjected to a lifetime maximum amount of $50,000. Plans of Medigap from Plan C to Plan G would cover the emergency care expenses that take place out of the United States.
- Medicare Covered Preventive Services
You will also be able to use Medicare Supplement to cover up the Medicare covered preventive services. This will help you to receive a waiver for the Part B deductibles. As the insurance policyholder, you will have to pay the yearly deductible for Part B. Then you will be able to get Medicare to pay from 75% to 100% of the preventive services.
Renewing Medicare Supplement Plan
When it comes to renewing your Medicare Supplement plan, you will have two main options to consider as follows.
- Guaranteed renewable
If you go ahead with guaranteed renewable, you will need to renew the policy, unless you stop paying premiums or cancels it. By law, all the Medicare Supplement policies are required to be renewable. Your insurance company will not be able to cancel the policy unless you make a payment to it or request to go for a cancellation.
There are noncancellable policies in Medicare Supplement as well. When it comes to this kind of contract, there is no freedom to change anything.
How are pre-existing conditions treated in Medicare Supplement?
Before you go ahead with Medicare Supplement, you should understand how pre-existing conditions will be treated with it as well. A pre-existing health condition will be something that you will have on the day where you are beginning the health insurance policy. If you had any pre-existing health conditions before you started your Medigap policy, the Medigap insurance company has all the power to refuse your coverage up to a period of six months. This will be considered as the waiting period of the pre-existing condition. During this waiting period, the health insurance company would ask the policyholder to diagnose and treat the health condition, before starting the Medigap policy.
Important things to keep in mind about Medicare Supplement policies
- You need to have a Medicare Part A policy or Medicare Part B policy to obtain the Medicare Supplement policy.
- The Medigap policy would be something different when compared to the Medicare Advantage Plan. In fact, these plans are providing an excellent opportunity for you to get Medicare benefits. However, a Medicare Supplement policy would only supplement the benefits that are offered by your original Medicare policy.
- Once you obtain a Medicare Supplement policy, you will need to keep on making a monthly premium payment to the private insurance company. You will be making this premium payment apart from the Medicare Part B premium, which you are making to Medicare.
- The Medicare Supplement policy will only be able to deliver protection to one person. In case if you and your spouse are in need of a Medicare Supplement, you will have to buy two different policies.
- You will be able to purchase your Medicare Supplement policy from any given insurance company that has a legal license to sell that within your state.
- All the standardized Medicare Supplement policies are renewable and there is a guarantee for it. Even if you are dealing with any health problems, the insurance policy will be renewed. You just need to make sure that you continue to pay the premium.
- From the year 2006, no Medicare Supplement policy is offering coverage for prescription drugs. If you need to get coverage against prescription drugs, you will need to purchase a Medicare drug plan separately. Your insurance company will be able to deliver that to you upon request. However, you will have to make a separate premium payment to it.
- If you own a Medicare Supplement policy, you will not be able to sell it to any other plan legally.
It is also important to keep in mind that a Medicare Supplement plan will not be able to cover all sorts of expenses you have. For example, it is not an option available for people who wish to get long term care. On the other hand, it doesn’t cover dental care, vision care, private duty nursing, eyeglasses, and hearing aids.
Dropping the Medicare Supplement policy
When you continue to use the Medicare Supplement policy, you will come across the need to go to a completely different policy. In such a situation, you should be aware of how to drop your Medicare Supplement policy.
In case if you want to drop the existing Medicare Supplement policy, you should be extra careful about timing. In case if you want to join a separate Medicare drug plan, you will have to pay a late enrollment penalty. There are certain criteria, which would make you pay the late enrollment penalty. They include:
- You drop the Medicare Supplement policy along with the drug coverage that was not under creditable prescription coverage
- When 63 days pass from the new Medicare drug coverage begins.
Who can obtain a Medicare Supplement policy?
There are eligibility criteria for obtaining a Medicare Supplement policy. Here’s a quick overview of it.
- People aged above 65 years
The Medicare Supplement policy is available for all the citizen who is aged above 65 years. In general, all the people who are eligible for Medicare will be able to obtain Medicare Supplement after the age of 65. They should be citizens or permanent residents of the USA.
Even if you are not eligible to receive the social security retirement benefits, you will still be able to obtain Medicare Supplement, as long as you are over 65 years. You will be provided the chance to sign up for your Medicare Supplement from 30 days before your 65th birthday.
- People with certain disabilities
Individuals who are not aged 65 will still be able to get Medicare Supplement policies. If they are having certain health issues, it will be possible for them to go ahead and obtain the Medicare Supplement policies. Such individuals will be provided with social security disability benefits. If you have been getting this social security disability benefit for a continuous duration of 24 months, you will be able to get Medicare Supplement.
- People with end-stage renal diseases
All the individuals who are struggling with end-stage renal diseases will be able to obtain Medicare Supplement policies as well. In other words, the Medicare Supplement is available for people who are struggling with kidney failure. Such people need to go ahead with a kidney transplant. Medicare Supplement policies will be able to deliver much-needed assistance for such people, even if they are not above 65 years.
What is Medicare Advantage?
understanding about it. This can provide you with the chance to get the most out of it. In fact, you can even determine if Medicare Advantage Plans are the right option available for you to consider or not.
What is a Medicare Advantage Plan?
As the very first thing, let’s understand what a Medicare Advantage Plan is all about. A Medicare Advantage Plan is also called Medicare Part C. It can provide Medicare Part A coverage with hospital coverage, Medicare Part B coverage with medical coverage, and Medicare Part D coverage with drug coverage. Hence, it can be considered as a comprehensive method to get yourself covered when moving forward.
You should also keep in mind that Medicare Advantage Plans are a component of the federal Medicare program, which is offered by private insurance service providers. The quality of service offered by the Medicare Advantage Plan is guaranteed. Therefore, you don’t need to keep any doubts or second thoughts in mind when moving forward with it. You will fall in love with what you can get out of it at the end of the day.
Some of the private insurance service providers that offer Medicare Advantage Plan include Cigna. Such private insurance providers are in a position to deliver the extra coverage that you need at all times.
You should also understand that there are many different types of Medicare Advantage Plans. PPO, HMP, and Private Fee for Service Plans are some of the most prominent options out of them. If you are planning to go ahead with such a specific service, you are encouraged to deep dive and take a look at the facts. Then you will be able to make sure that you sign up with the best plan and you are provided with all the freedom to enjoy it.
When you are having a Medicare Advantage Plan, you might have to go ahead and pay a deductible in certain instances. However, you will usually have to pay fixed co-payments for the routine visits that you make to the office of the doctors. In other words, these plans are in a position to provide yearly limits to the expenses that you will have to pay out of your pocket. Then you will not have to pay anything for the remaining months of the year. Therefore, you can keep peace of mind and go ahead without keeping any doubts in mind.
Is it possible for anyone to sign up with Medicare Advantage Plan?
No, any person cannot go ahead and sign up with the Medicare Advantage Plan. There are criteria, which you should meet in order to go ahead and enroll yourself under the program. Then you will be able to go ahead and obtain it without having to worry about anything.
We thought of sharing the conditions that a person should meet at the time of signing up with a Medicare Advantage Plan as well. Then you will be able to make an informed decision without keeping any doubts in mind.
In order to obtain Medicare Advantage Plan, you should be eligible for Medicare. If you are not eligible for Medicare, there is no possibility to obtain Medicare Advantage Plan at any given instance. In addition to that, it is important for you to be enrolled in the Medicare Part A plan as well as the Medicare Part B plan. If you have any doubts in your mind about this, you are encouraged to take a look at the red, blue, or white-colored Medicare card. Then you can overcome all the confusions that you have in your mind.
You should also make sure that you are living within the service area of the plan. It would be based upon the country that you are living in. Your state of residence would not matter here. In addition to that, you need to make sure that you are not having any end stage renal diseases. It will also keep you away from obtaining the Medicare Advantage Plan.
If you have these qualifications, you don’t need to worry about anything. That’s because you have all the freedom to obtain a Medicare Advantage Plan. Go ahead with the decision and you can experience all benefits that come with it.
If you are looking forward to enjoying the benefits that come along with Medicare, you can think about getting yourself subscribed to the Original Medicare Plan or the Medicare Advantage Plan. These plans are much different when compared to the Medigap plans. The Medicare Advantage Plans are usually offered for the private companies, which have received the approval of Medicare. Medicare would pay the companies in order to deliver the benefits to you.
Once you join the Medicare Advantage plan, you would be provided with Medicare Parts A & B coverage. This plan differs a lot from the Medicare Supplements insurance policy. Therefore, you should never get confused between the two options.
How do I choose a Medicare Advantage Plan?
Before you subscribe to a Medicare Advantage Plan, you will need to have a clear understanding of it. That’s mainly because many different Medicare Advantage Plans are available for the people to consider about. Here is a list of some of the most prominent Medicare Advantage Plans out of them.
- Health Maintenance Organization Plan – In most Health Maintenance Organizations, you will only be able to meet doctors and other healthcare professionals who belong to the same network. However, you are not limited to such restrictions during emergency situations. Whenever you get the need to meet other specialists or doctors, you will have to get a referral from the primary care doctor.
- Preferred Provider Organization – With this plan, you will have to spend a lower amount of money in order to meet doctors and other healthcare professionals that belong to the same network. If you meet a healthcare professional outside the network, you will have to make a higher payment.
- Private Fee-for-Service – This Medicare Advantage plan is pretty much similar to the original plan. As a result, you will be able to visit any doctor or other healthcare provider. The plan would determine the amount that you will have to pay for the healthcare providers.
- Special Needs Plans – This is available for specific groups of people, who have special needs. People who are affected with chronic medical conditions or live in a nursing home can think about getting enrolled in this Medicare Advantage Plan.
Apart from the premium associated with Part B, you will also have to pay a monthly premium for all the services that come along with the Medicare Advantage Plan. It is important to keep in mind that different Medicare Advantage Plans are associated with different premiums. Therefore, you will have to compare the premiums and benefits linked with them before you join.
Who qualifies for Medicare Advantage Plan?
You need to live in a covered service area and have Medicare Parts A & B in order to be eligible to obtain the Medicare Advantage Plan. However, it is important to keep in mind that people who are affected with end stage renal diseases are not in a position to get enrolled in Medicare Advantage.
How does Medicare Advantage Plan work?
If you can have a clear understanding of how the Medicare advantage plan works, you will get the opportunity to stay away from the frustration linked with it. After obtaining the subscription, Medicare would pay a fixed amount of money to the companies that offer advantage plans each month. However, these companies will have to follow the rules that are being defined by Medicare.
It is important for you to keep in mind that different Medicare Advantage Plans have the ability to charge different amounts out of pocket. In addition, every single plan is associated with a unique set of rules, which need to be followed. These rules determine how the service would be offered to you. For example, you will be able to determine whether you need a referral in order to see a specialist or you have to go to the facilities, doctors, or supplies that are attached to the plan for non-urgent or non-emergency care. These rules would change on a yearly basis and you will need to keep an eye on them.
Before you subscribe to the Medicare Advantage plan, you will need to be aware of the drug coverage as well. Usually, you would be provided with prescription drug coverage along with the plan. However, you are also provided with the freedom to go ahead and join a separate Prescription Drug Plan. The plan you subscribe should not offer drug coverage such as the Medicare Medical Savings account plans and some of the fee for service coverage plans.
What are the benefits of a Medicare Advantage Plan?
The Medicare Advantage Plans are associated with a variety of benefits. These benefits have contributed a lot towards its popularity among people who live in every corner of the world. The reduced cost can be considered as the most prominent advantage out of all. Even though you have to pay the Part B premium, the additional premiums are relatively inexpensive. Therefore, you will get the opportunity to save a considerable amount of money in the long run.
The Medicare Advantage Plan is pretty much similar to the health insurance that is offered by the employer. If you are looking forward to leaving the job, where your health insurance is offered, you don’t need to worry about anything because Medicare Advantage Plan would provide the necessary coverage. Physician networks, drug coverage, co-insurance, and deductibles would be offered to you as a part of the package.
Medicare Advantage Plan offers more coordinated care for all the subscribers. You will be asked to select your preferred primary physician in some of the plans. The physician you select can be considered as the gatekeeper for your health and wellbeing.
Apart from the above mentioned benefits, you will be able to experience few additional benefits such as dental benefits, hearing benefits, plus vision and prescription drug coverage.