Understanding Medicare Supplement: Your Guide to Medigap Plans

If you’re new to Medicare, you might have heard about Medicare Supplement, also known as Medigap Plans. Let’s break it down to make it simple and straightforward.

What is Medicare Supplement (Medigap Plan)?

A Medicare Supplement, also known as a Medigap policy, is sold by private insurance companies to cover costs not covered by Original Medicare. These costs include deductibles, copayments, and coinsurance. Unlike Medicare Part C plans, each Medigap plan is standardized. A plan G, for instance, will mirror any Plan G available on the market covering Medicare benefits the exact same way, with the only difference being pricing and any additional benefits an insurer may offer.

How does Medicare Supplement Work?

A Medicare Medigap Plan works will only supplement Original Medicare. Once Original Medicare is billed, the supplement will pay its portion to the Medicare contracted provider based on the Plan you choose. A point of note: A Medicare beneficiary can NOT be enrolled in both a Medicare Advantage plan and Medicare Part C. It can only be paired with a Medicare Part D plan.

1. Enrollment

   A Medicare beneficiary who has both Part A and Part B can enroll in a Medicare supplement at any time; however, the optimal time to enroll is during open enrollment period or any other time guarantee issue rights are available.

   The Open Enrollment Period (OEP) for a Medigap plan begins on the 1 st day of the month you are both 65 or older and enrolled in Medicare Part B and lasts for 6 months. During Medigap OEP, an insurance company can NOT use medical underwriting to decide whether to accept your application, refuse to sell you any plan it offers, charge you more for the plan, or make you wait for the coverage to start. The only caveat, a pre-existing condition waiting period may apply if the insured was not covered at any time during the previous six months before enrolling in a Medigap policy or the coverage was not creditable, meaning it was not as good as Medicare’s coverage. If a waiting period is required, the insurer will not cover certain services for 6 months; however, Medicare will still cover its portion.

   Guaranteed Issue Rights offers the right to buy certain Medigap policies. During this time, an insurance company must sell you a Medigap policy, cover all your pre-existing health conditions, and not charge you an additional premium for the plan. Medicare beneficiaries that qualify for guarantee issue rights must act quickly as it is a time sensitive election, so act quickly. Some triggers to activate guaranteed issue rights are loss of current coverage, moving to a new service area your plan doesn’t cover, or trial rights under a Medicare Advantage Plan. Keep in mind, you will need to submit proof of prior coverage to activate this election period, so keep your documentation handy. Outside of OEP and the Guaranteed Issue Rights, a Medicare beneficiary can enroll in a Medicare Supplement at any time and will be subjected to medical underwriting. This process will determine if your application is accepted by the insurance company, if they will require a pre-existing condition waiting period, and if an additional premium will be required.

2. Choosing the Right Plan

   There are many factors to consider when choosing the right plan, like costs, your current and future health and needs. This is critical as some insurers will not allow plan changes without medical underwriting.

3. Costs

   Each insurance company decides how it’ll set the pricing for its Medicare Supplement Plans; therefore, different insurance companies may charge different amounts for exactly the same Medigap policy. All premiums will increase based on inflation and other factors; however, the three rating systems determine how pricing and annual increases are assessed:

   • Attained Age rated plans are based on your current age, meaning your premiums increase as you age. Generally, these plans are initially less expensive, but will usually become the most expensive.
   • Community rated (no age-rated) plans generally charge the same premium to everyone, but there is no increase based on age. A 65 and 70-year old will pay the same base rate in monthly premium.
   • Issue-age rated (entry age-rated) plans charge premiums based on the age you purchase the plan, so a person who purchases the plan at age 65 will pay less than a 70-year old who purchases the same plan on the same day. The increase in premium will also not be based on age.

Monthly Premium

The actual monthly premium is based on how the plans are rated, the percentage or amount of Original Medicare costs the plan will cover, discounts, male/female classifications, smoker/non-smoker classifications, current age, whether (or not) underwriting is required and other factors.

What is and is not covered by Medicare Supplement Plans?

What is NOT covered:

How Can At Your Service Insurance Brokerage, LLC Help?

Navigating Medicare Part C can be overwhelming, but you don’t have to do it alone. Our experienced agents are here to help you choose the right plan:

• Answer Your Questions: We’ll explain the details in simple terms and clarify any confusion.
• Compare Plans: We’ll help you review and compare different Part C plans to find the one that fits your needs, budget, and covers the prescriptions you take.
• Provide Enrollment Assistance: We’ll guide you through the enrollment process to ensure you get the coverage you need without hassle.

Contact Us Today!

Your health and peace of mind are our top priorities. Contact At Your Service Insurance Brokerage, LLC today to learn more about Medicare Part C and how we can help you secure the Medicare Advantage Plan you deserve.

Remember, we’re here to support you every step of the way, making Medicare Part C easier to understand and more accessible for you.