Medicare Supplement Plans 101: Points to Know

 Original Medicarecovers inpatient and outpatient services. The benefits for these two parts are set by the Centers for Medicare and Medicaid Services (CMS)and are the same for everyone.

 Fortunately, there are Medicare plans you can add on to your Original Medicare to customize the coverage to better fit your needs. Medicare Supplement plans,also known as Medigap plans, are just one way you can do this.

Here are the top points to know about Medigap plans.

Medigap plans cover the gaps in Medicare

Medicare has deductibles, copayments, and coinsurance just like any other health insurance. These are considered the “gaps” in Medicare. For example, all Medigap plans cover the Medicare Part A coinsurance for inpatient hospital stays at 100%. 

Other gaps that Medigap plans can cover are the Part A and Part B deductibles, the coinsurance for skilled nursing facility stays, and the Part B coinsurance.

There are requirements to have a Medigap plan

Because Medigap helps to pay the cost-sharing amounts for Part A and Part B, you must be enrolled in both parts to enroll in a Medigap plan. If you were only to enroll in one part of Original Medicare, you wouldn't be eligible to enroll in a Medigap plan. 

There are ten standardized Medigap plans

In 2019, there are ten options within Medigap. The plans are, Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. 
Starting January 1, 2020, there will only be eight standardized Medigap plans. Both Plan C and Plan F will be discontinued in 2020. However, this only apply to people who became Medicare eligible on or after January 1, 2020. 

This means if you were Medicare eligible before 2020, you will still be able to apply for Medigap Plan C and Plan F. Beneficiaries who enroll in Plan C or Plan F before 2020 will be grandfathered in and will be able to keep their plan as well.

Medigap plans do not have networks

Unlike most Medicare Advantage plans, Medigap plans do not have networks. Networks are basically a list of doctors you much choose from when you need an appointment. 

Since Medigap plans don’t have networks, you can see any doctor that accepts Medicare.These no-network plans allow you to travel throughout the country and not have to worry about being denied coverage. 

Accepting Medicare means accepting Medigap

If your doctor accepts Original Medicare, which over 90% of doctors do, then they must accept your Medigap plan. Because doctor office staffs are usually not well versed in Medicare, they can lead you to think the doctor won’t accept your plan due to the carrier you have your plan through. 

This is because doctors are able to decide which Medicare Advantage plansthey want to be in network with. However, since Medigap plans do not have networks, the doctor can’t choose which carrier they do and don't accept plans from.

If you have a Medigap plan, there is no need to ask the doctor if they accept your carrier. If they accept Medicare, they will accept your Medigap plan.

Coverage is the same regardless of the carrier

Some people think that each carrier can offer different coverage for each Medigap plan they offer. However, this is untrue. No matter which carrier you buy your Medigap plan from, your coverage will be the same. 

For example, a Medigap Plan G from Aetna will cover all gaps except the Part B deductible, just like a Medigap Plan G from UnitedHealthcare would. This means when looking to buy a Medigap plan, you will want to find the plan you want from the carrier that has the lowest monthly premium and lowest annual rate increases.

Open Enrollment is the best time to apply for a Medigap plan

When applying for a Medigap plan, most people must answer health questions and based on their answers, the carrier can choose to deny them. However, there is a special time that every Medicare beneficiary gets when they can enroll in a Medigap plan without having to answer health questions. 

This period is called the Open Enrollment (OE). The OE starts on the day your Part B becomes effective and lasts for six months. This is the best time to apply for a Medigap plan because you are guaranteed acceptance since you don’t have to answer health questions. 

The Annual Election Period is not for Medigap Open Enrollment

The Annual Election Period (AEP) runs from October 15th until December 7th every year. Sometimes, this is called the Open Enrollment Period, which confuses people into thinking it is the same as Medigap Open Enrollment. 

The AEP is only for enrolling and changing Medicare Advantage and Part D drug plans. It is not a time for beneficiaries to apply for a Medigap plan without having to answer health questions. 

Although there are countless details within Medicare, these are the top points to know about Medigap. Remembering these key points will help you navigate Medicare and Medigap easier. 
 
 
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