Medicare Supplement plans (Medigap Explained): Enhancing Your Medicare Experience

A Supplement or Medigap plan is a type of extra insurance that can help fill in some of the gaps in your Original Medicare coverage. When I say gaps, I mean the oftentimes expensive out of pocket costs that you have to pay.

What is Medigap?

Medigap, also known as Medicare Supplement Insurance, is a private insurance policy designed to work alongside your Original Medicare (Parts A and B) coverage. Its main job is to help pay for some of the out-of-pocket costs that Original Medicare doesn't cover, such as deductibles, copayments, and coinsurance.

Coverage

So, what exactly does Supplement pay? Well, it depends on which plan you choose, but in general, these policies can help pay for things like:

- Medicare Part A coinsurance and hospital costs

In 2024 this was $1632 when you were admitted to the hospital

- Medicare Part B coinsurance or copayments

This is 20% of your outpatient doctor bills.

- Blood (first 3 pints)

- Part A hospice care coinsurance or copayment

- Skilled nursing facility care coinsurance

There are 10 standard Supplement plans available in most states, labeled Plan A through Plan N. I know more letters yeah!!

Each plan offers a different mix of benefits, so it's important to compare them carefully to find the one that best fits your needs and budget.

Eligibility and Enrollment

To be eligible for a one of these policies, you must have Medicare Part A and Part B. The best time to sign up for a Supplement Plan is during your Open Enrollment Period, which starts on the first day of the month in which you turn 65 and are enrolled in Part B. During this period, insurance companies can't deny you coverage or charge you more based on your health status.

Don't worry if you didn't sign up for Medicare when you turned 65, if you are one of those who retired later on, you still get the Open Enrollment period where the companies can't deny you coverage based on your health.

If you miss this initial signup period, you may still be able to get a Supplement policy, but the insurance company are going to ask you several health questions, check out your health history and then can charge you more or even deny coverage based on your health.

Supplement Plan vs. Medicare Advantage

Now, you might be wondering how these Supplement plans differs from Medicare Advantage plans.

Well, Medicare Advantage plans are an alternative way to get your Medicare coverage (what Medicare Part A and B offer) through private insurance companies, while Supplement policies are designed to supplement your Original Medicare coverage.

With a Medicare Advantage plan, you typically get your Part A, Part B, and often Part D (prescription drug) coverage through a single plan, which could also include extra benefits like dental or vision coverage. However, you'll need to use the plan's network of providers, and you may have to get referrals for specialist care or deal with the insurance carriers prior authorization rules.

On the other hand, Supplement policies let you keep your Original Medicare coverage and see any doctor or hospital that accepts Medicare patients, without needing referrals. Supplement plans do not cover prescription drugs, so you'll need to sign up for a separate Part D plan if you want that coverage.

Additionally if you want those extra benefits like dental and vision, you will have to find separate plans for those as well.

Ok, that was a lot of information, but I hope it's helped you understand the basics of Supplement plans and how it can help fill in some of the gaps in your Original Medicare coverage. Remember, choosing the right extra insurance with Medicare is an important decision that can impact your healthcare costs and access to care.

If you're still feeling unsure or have more questions, don't hesitate to reach out to trusted resources like the State Health Insurance Assistance Program (SHIP) or a licensed insurance broker. We can help you navigate the different options and find the coverage that best suits your unique needs.

As always I'm here to answer questions and offer help!

Notes

[1] "Medicare Supplement Insurance (Medigap)," Medicare.gov, https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap

[2] "Medicare Advantage Plans," Medicare.gov, https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans

[3] "How to Compare Medigap Policies," Medicare.gov, https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies