What Are Medicare Supplement Plans(Medigap)?

Medicare Supplements Plans Fix the “Gap” in Medigap.

What Is The Gap In Coverage?

Medicare Part A- Inpatient Hospital Stay-

Days 1-60 $1632 Deductible

Days 61-90 $408 per Day

Days 91-150 $816 Per Day

Medicare Part B- Medical Coverage-

Annual Deductible- $240.00

20% Co-Insurance

Your Medicare Supplement(Medigap) Plan Will Cover Most or All Of Your “Gaps” In Coverage.

Medicare Supplements have been around since 1980. Since Original Medicare does not cover 100% of the Hospital (Part A) and Medical (Part B) costs, Medicare Supplement Medigap plans were devised to help Medicare Beneficiaries cover their cost share or, “Gaps” in the Original Health Insurance coverage. Since Original Medicare is still the Primary Payer and the Medigap plan is Secondary there are no Doctor or Hospital networks. The only requirement is that the Doctor or Hospital accept Medicare making the plans portable and able to be used in any state. As if things weren’t confusing enough with A, B, C, and D Medicare, Medicare Supplement Medigap Plans are also designated(Plans A-F).

Medicare Supplement Medigap plans have “Standardized Coverage,” meaning the coverage between them is generally the same, with differences being the cost of the monthly premium and cost share associated with it. Some plans offer enhanced benefits such as 100 Days in a Skilled Nursing Facility instead of the standard Medicare 20 days. But, Original Medicare does not cover items like Dental, Vision, Hearing Aids, and Gym Memberships, which means your Medicare Supplement Medigap doesn’t either.

Prescription Medications–

Original Medicare does not cover prescription medications so your Medicare Supplement Medigap plan won’t either. A Part D Prescription Drug Plan must be added and is available from private insurance companies.

State Rules–

There are differences between states as when someone can enroll in a Medigap plan including Medical Questionnaires and pre existing conditions issues. Our discussion pertains to individuals residing in the State of New York where preexisting conditions are limited with no Medical Questionnaire used.
To better see plan differences I have included a plan chart for your convenience.

Medicare Supplement Plans FAQ

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Mike Miligi- Owner- Michael M Insurance Services

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(Part D), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information available.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.