Facts about Medicare Supplement Insurance plans

  • Medicare Supplement and Medigap mean the SAME thing.
  • These are the Medicare plans that have the alphabet letters A through F. (See Medigap plan chart HERE).

  • Medicare Supplement plans run along side of Original Medicare Parts A and B. They fill in the “gaps” of Original Medicare. Example: Under Part B, Original Medicare pays 80% of the allowed expenses and your Medigap (depending which plan you have), would pay the remaining 20% coinsurance.
  • It doesn’t matter which plan letter or insurance company you have, if the provider accepts Original Medicare, they MUST also accept your Medicare Supplement (aka Medigap plan).

  • Medigap Plans are “Guaranteed Renewable” for life. Once you’re enrolled in a Medigap plan the insurance company can never cancel or drop you from the plan as long as you pay the premium. (Click HERE for more on Guaranteed Renewable)

  • Medigap Insurance companies can not increase premium due to your specific health conditions, they can only raise rates for the entire group.

  • If you travel frequently, a Medigap plan is recommended (over Medicare Advantage) because over 90% of providers across America accept Original Medicare which means they have to accept your Medigap plan, as well. Also, most Medigap plans have 80% coverage for foreign travel emergency care.

Original Medicare and Medicare Supplements do NOT include drug coverage. You may purchase a Stand-Alone Part D Drug Plan (PDP). NOTE: Medicare Supplements “mirror” the same coverage as Original Medicare Parts A and Part B but fills in the gaps. Whatever approved services Medicare will pay, your Supplement will also pay. If the medical service is not covered by Original Medicare, your supplement plan won’t cover it either.

Original Medicare does not cover “routine” dental, vision or hearing, therefore, a Medicare Supplement would cover not it either. However, Original Medicare Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures. Some situations in which Medicare would cover dental services may be:

* You need surgery to correct fractures of the jaw
* You need dental splints as a result of jaw surgery
* You need tooth extractions in preparation of radiation treatment for neoplastic diseases
* You receive a dental exam in a hospital before a heart valve replacement or kidney transplant
* You have oral cancer or another disease that affects the jaw and require dental services for treatment

NOTE: For more information on what Original Medicare covers for Dental services, please click HERE.

** We offer stand alone Dental, Vision and Hearing plans from national carriers, click HERE to see our providers.

Original Medicare might offer some vision coverage, but it is also restricted. Original Medicare does NOT cover routine eye exams for glasses or contact lenses. Medicare Part B does, however, cover the following vision benefits :

* Annual eye exams for beneficiaries suffering with diabetes
* Annual glaucoma testing for those at high risk for the disease
* Age-related macular degeneration diagnostic testing and treatment (for some)
* Cataract surgery and associated corrective lenses
* Prosthetic eyes

NOTE: For more information on annual glaucoma testing covered by Medicare, please click HERE.

  • All Medicare Supplement (Medigap) plans are “Standardized” by the government. Meaning the coverage is exactly the SAME regardless which insurance carrier you purchase the plan from. The only difference is the premium the carrier charges. Click HERE to see Page 9 from the 2020 Choosing a Medigap Policy from the Center for Medicare and Medicaid Services (CMS), where it states “Cost is usually the only difference between Medigap policies with the same plan letter”.

  • The Medigap Open Enrollment Period (NO health questions to qualify), this “one-time” period lasts for 6 months beginning the first day of the month that you are both 65 or older AND enrolled in Medicare Part B. During Medigap Open Enrollment, insurance companies MUST offer you a Medigap plan regardless of your health or pre-existing conditions and they must offer it at the best price.

  • Medicare Supplement (Medigap) plans can be purchased anytime during the year as long as you are Medicare eligible and enrolled in Medicare Part B. However, If you apply for a Medigap plan outside your “one-time” Medigap Open Enrollment period, you will need to answer health questions from the insurance carrier to qualify for the plan, you may be subject to a pre-existing waiting period (up to 6 months), and you may not get as good of a price as somebody with perfect health.

  • Not all Medicare Supplement (Medigap) insurance companies have the same underwriting questions. There are typically around 20 health questions. Just because you don’t health qualify with one company doesn’t mean you won’t qualify for a Medigap plan with a another insurance company. (NOTE: The above underwriting scenario is when you apply for a Medicare Supplement “outside” of your one-time Open Enrollment (first 6-months after activating Part B) or you don’t have a Special Election Period (SEP). Open Enrollment and SEP’s give you “Guaranteed Rights” where you don’t have to answer any health questions to qualify for a Medicare Supplement plan). Click HERE to see sample underwriting questions that could be on the Medigap application.

    *NOTE: If you do need to go through Medical underwriting to apply for a Medigap plan, there could be a “pre-existing condition waiting period”. It is possible you are healthy enough to qualify for the Medigap plan, however, if you have pre-existing conditions the Medigap insurance company could make you wait 6-months before they will pay any claims associated with that pre-existing condition. The exception to not having to wait 6 months for pre-existing conditions is when you have had continues “creditable coverage” for at least 6 months prior to applying for the Medigap plan.

Guaranteed Issue Rights – This is a Right you have in some situations when Medigap insurance companies MUST offer you certain Medigap plans and cover all pre-existing health conditions and cannot charge you more for a Medigap plan because of your past or present health problems. In most cases, you qualify for a Guaranteed Issue Right when you have other health coverage that changes in some way, like when you lose or end employer health care coverage. In other situations, you may have a “Trial Right” (one of the Guaranteed Issue Rights), to try a Medicare Advantage plan and decide you don’t like it and want to switch to Original Medicare. In this scenario, you have a “Trial Right” if you disenroll from the Medicare Advantage plan within the first 12 months. “Trial Right” applies if you were new to Medicare at 65 and started with a Medicare Advantage plan from the beginning OR, if you started with Original Medicare and switched to Medicare Advantage (for the first time) and decided to switch back to Original Medicare – as long as you disenroll from the Medicare Advantage plan within 12 months, you qualify for this “Trial Right”.

  • Guarantee Issue Rights: Example 1: You have a Medicare Advantage plan. You are moving out of the plan’s service area. You decide at your new location you would like to switch to Original Medicare and get a Medicare Supplement (Medigap) plan. You qualify for a Guarantee Issue right to apply for a Medigap plan as early as 60 days before your Medicare Advantage (MA) coverage ends and you have 63 days to exercise your Guarantee Issue right for a Medigap plan AFTER your coverage ends. (Your old MA plan cannot continue to cover you in your new location because MA plans are very location/county specific). Example 2: You’re already enrolled in Original Medicare (Part A and Part B) and still working past age 65, but instead of a Medicare Supplement (Medigap) plan you have employer group health insurance as the “secondary” (supplemental) payer to Medicare. This secondary group health coverage is ending. In most states, you have 63 days from the date the secondary employer coverage (including COBRA) has ended to exercise your Guarantee Issue Right to purchase a Medigap Plan. For more information on Guaranteed Issue Rights, please click HERE.
  • You can NOT have a Medicare Advantage and a Medigap policy at the same time. If you wish to switch, you must make sure the old policy ends before you start the effective date of the new policy – they can’t overlap.
  • ** CAUTION ** Guarantee Issue Rights are ONLY available if you have a “special circumstance” which would provide you a Special Enrollment Period (SEP). In the event you want to leave a Medicare Advantage plan without an SEP, you would have to wait for the fall Annual Election Period (October 15th – December 7th), with an effective date of January 1st. You do NOT want to CANCEL your Medicare Advantage plan that includes prescription drug coverage (MAPD) BEFORE you go back to Original Medicare and get accepted into a Medigap plan. The reason is as soon as you go back to Original Medicare, your MAPD plan which included drug coverage, will automatically be CANCELLED, as you can’t have a Medicare Advantage plan AND Original Medicare at the same time. The problem is when your MAPD coverage is cancelled and then you suffer the misfortune of NOT being accepted into a Medigap plan due to health reasons, you no longer have ANY drug coverage because your MAPD plan just got cancelled! Therefore, it is important to apply and make sure you get ACCEPTED into a Medigap plan during AEP (you can start applying as early as October 15th), BEFORE you cancel your Medicare Advantage (MAPD) plan. *Note: All Medicare Advantage plans are calendar year contracts that start on January 1st and end on December 31st.

*NOTE: ALL Medigap plans are “Standardized” by the government. This means the coverage you see is the exact same regardless which company you purchase it from. This only difference is the monthly premium.

For more information about Medigap plans, please click icon below.