If you are beginning Medicare soon, you might have realized that Medicare does not cover 100% of the cost for your hospital and medical services. Therefore, you might be wondering what you can do to help with your cost-sharing. You can purchase Medicare Supplement plans from private insurance companies to help cover the gaps in Medicare and leave you with little out-of-pocket costs. These plans are also called Medigap plans, and they have specific features that set them apart from Medicare Advantage plans. Here are five facts about Medicare Supplemental insurance that you should know before choosing a plan.
Medicare Supplement Plans are standardized
There are 10 Medicare Supplement plans. Supplement plans are standardized, which means the coverage for one plan will be the same regardless of the insurance carrier. For example, Medicare Supplement Plan G with Carrier A will have identical coverage as Plan G from Carrier B. The only difference is the monthly premium.
However, not all of them may be available to every beneficiary. For example, anyone eligible for Medicare after January 1, 2020, cannot enroll in Plan C or Plan F. Those two plans have been phased out to new Medicare beneficiaries.
In addition to the ten standardized plans, there are two high deductible plans you could choose. There is High-Deductible Plan F and High-Deductible Plan G. The high-deductible limit is $2,490 in 2022.
Nationwide network of providers
Another feature of Medigap plans is their network of providers. Since Supplement plans are secondary to Original Medicare, you can see any doctor or go to any facility that accepts Original Medicare. The provider must accept your Supplement plan no matter which carrier you have. You’ll be able to go across the nation with Original Medicare and Medigap, and your coverage will be the same as if you were in your home state.
Many beneficiaries love the freedom of choosing their providers, and if they travel frequently, Medigap plans can continue to provide them with comprehensive coverage while they travel.
Prescriptions are not covered
You also need a Medicare Part D drug plan when you enroll in a Medicare Supplement plan. Original Medicare will only help cover drugs administered by a healthcare professional in the hospital or outpatient setting or through durable medical equipment. Therefore, other medications you get filled at the pharmacy will not be covered by Original Medicare or a Medigap plan. A Medigap plan will only cover costs after Medicare pays first.
Foreign Travel Can Be Covered
Six of the ten standard plans provide foreign travel emergency coverage. Medicare Supplement plans C, D, F, G, M, and N cover 80% of the cost for emergency services when you are out of the country. However, the emergency must be within the first 60 days of traveling for the Medicare Supplement plan to cover it. Additionally, you must meet the $250 deductible before the plan kicks in. You will be responsible for the 20% coinsurance, and the plan will only pay $50,000 during the lifetime of the policy.
Pre-Existing Conditions Could Affect Your Enrollment
Every Medicare beneficiary has a one-time Medicare Supplement Open Enrollment window. When you are within 6-months of your Part B effective date, you will be able to apply for a Supplement plan with no health questions asked. You cannot be denied coverage based on pre-existing conditions when you apply during that window. However, when you are outside of that window, you could have to answer health questions which means the insurance carrier could deny you coverage.
Some states have exceptions to medical underwriting, so you will want to check with your state’s rules to know your options. Additionally, if you qualify for Medicare early due to disability, you will have a second enrollment window to apply for a Supplement plan at 65 with no health questions asked.
Medicare Supplement plans can be an excellent fit for many people. It is essential to know the features of these plans and what your options are before you choose a plan to go with your Medicare insurance. A Medicare broker can help you compare several kinds of plans and insurance carriers to find the most cost-effective option.