Medicare Supplement Plans can fill the gaps in Original Medicare.
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Medicare Supplement Plans (also known as Medigap) are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. Medicare supplements will only pay for approved Medicare charges. A supplement plan cannot pay on claims declined by Medicare.
These plans are overseen by state insurance departments and must follow federal and state laws. Plans may cover deductibles for Part A, Part B, copays, coinsurance, and some other out-of-pocket costs. Depending on the type of plan, the cost of Medicare supplement insurance may vary by factors, such as age, ZIP code, plan, smoking status, company and, sometimes, gender.
You have a wide variety of options when it comes to Medicare supplement plans, with up to 10 standardized plans offered in 47 states. The coverage levels are designated by different letters of the alphabet (A, B, C, D, F, G, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to January 1, 2020.
The government standardizes all supplement plans according to the level of coverage they provide. The exceptions are Minnesota, Wisconsin and Massachusetts. These three state exceptions have their own method of standardization. The standardization of plans makes it easy to shop and compare benefits to find the plan that’s right for you.
|Medicare Supplement Plan||Medicare Part A||Medicare Part B||Blood||Part A Hospice Care||Skilled Nursing Facility Care||Part A Deductible||Part B Deductible||Part B Excess Charges||Foreign Travel Emergency||Out of pocket limit for 2022|
|C||100%||100%||100%||100%||100%||100%||100%||80% up to limit|
|D||100%||100%||100%||100%||100%||100%||80% up to limit|
|F||100%||100%||100%||100%||100%||100%||100%||100%||80% up to limit|
|G||100%||100%||100%||100%||100%||100%||100%||80% up to limit|
|M||100%||100%||100%||100%||100%||50%||80% up to limit|
|N||100%||100% copays may apply||100%||100%||100%||100%||80% up to limit|
Plans C & F: Only eligible to those who became eligible for Medicare Prior to January 1, 2020.
Plans F & G: Also offer a high deductible option in some states. These plans require first paying a plan deductible of $2,490 for 2022 before the plan begins to pay. The High deductible G is also subject to a $233 deductible for 2022. Once met, these plans cover 100% for the rest of the calendar year.
Plans K & L: These have an out-of-pocket yearly limit. Once met the plans will cover 100% of covered services for the rest of the calendar year.
Plan N: Pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Foreign travel: Covers 80% up to lifetime limit of 50,000.
Generally, expect to pay as little as about $25 or as much as about $350 per month for a Medicare Supplement Plan. Pricing can vary widely depending on your state and the company offering the plan. Generally, plans will be priced in one of three ways:
Insurance companies may also have preferred rate tiers for people in good health or who don’t use tobacco products. In addition, each company has different internal underwriting policies (excludes Open Enrollment and guaranteed issue) that determine who they will accept into the plan, and this can affect premium amounts.
It’s important to shop around before purchasing a plan to be sure you are getting the best price. Plans usually increase annually and companies can make overall premium adjustments to all individuals in a particular state or ZIP code.
For reference, below are example premium ranges for individual Medicare Supplement Insurance plans in 2022 in Nashville:
|Medigap plan||Monthly premiums*|
|A||$59 to $239|
|G||$107 to $348|
|G (high deductible)||$24 to $76|
|K||$55 to $133|
|N||$81 to $355|
*Pricing will depend on where you live and your personal health situation. The numbers above are based on plans available to a 65-year-old, nonsmoking man living alone in the Tennessee 37072 ZIP code.
You can buy a Medicare supplement policy anytime (subject to underwriting) enrolled in Part A and Part B. However, there are enrollment periods that offer certain advantages with no underwriting.
The best time to purchase a Medigap plan is during the six-month Open Enrollment Period. It begins on the first day of the month in which you are 65 or older and enrolled in Part B. When you apply for a supplement during this time, you will have guaranteed acceptance and you cannot be charged a higher premium because of health conditions. If you delay enrolling in Part B because of group coverage based on your (or your spouse’s) current employment, the Medigap Open enrollment period won’t start until you sign up for Part B.
There may be other enrollment periods that offer similar protections, such as when you leave an employer-sponsored health plan.
Following a few simple steps can make it easy to enroll:
1. Contact a licensed agent in your area for assistance (which usually gives you the most company options)
2. Use Medicare.gov find a plan search tool (the tool may not have all the companies listed)
3. Contact a plan directly to join (when you have a favorite company)
4. Call (800) MEDICARE or (800) 633-4227. TTY users can call (877) 486-2048 (the service may not have all company options available to compare and purchase).
No, you can change your supplement anytime as long as you meet the underwriting requirements and have Part A and Part B.
Medicare provides a special 12-month period for people who joined a Medicare Advantage Plan for the first time and want to go back to a supplement. During this period, you have the guaranteed right to get your supplement back from the same company at the same rate. After 12 months, you must reapply for a supplement as a new customer and be subject to medical underwriting.
Yes, anyone enrolled in Part A and Part B can get a supplement regardless of the reason. However, supplements may be more expensive and limited in these situations.
All Medicare supplement policies have a 30-day “free look” period during which you can cancel it and get a refund on your purchase. After that, you may cancel your policy at any time, but you might not be able to get a refund.
No. It is illegal to sell a Medicare supplement to someone who is on a Medicare Advantage Plan unless you intend to cancel it and return to Original Medicare.
No, the company can’t unilaterally cancel your policy as long as you pay the premium, except possibly in cases of material misrepresentation. (Example: saying you don’t have a condition on underwriting questions but know you do.)
Your friend qualified for Medicare before January 1, 2020, and is grandfathered in. People qualifying for Medicare after that date can no longer get plans C or F.
This is a type of Medicare supplement that is not available in certain areas. The plan requires the policy holder to receive services within a defined network and require referrals from the primary care physician. This type of plan is more restrictive than a standard Medicare supplement.
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.