Medigap Plans

Maybe you’ve heard some information about Medigap Plans from friends & family but what exactly are Medigap Plans & dow does Medigap fill the gap of exisiting Medicare Insurance benefits? We consolidated & simplified all the important details for you by answering common questions to help save you time, money & energy!

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What is Medigap Plan Insurance? (condensed)

A Medigap Plan also known as a “Medicare Supplements“, is a private, Medicare “add-on” insurance policy that covers the additional 20% leftover costs that are NOT paid by Original Medicare (Part A & Part B). Medigap Plans can provide more personal freedom & flexibility opposed to Medicare Advantage Plans. Key benefits of Medigap Plan Insurance include freedom to keep your doctor, travel coverage & the ability to change plans year-round.

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Am I eligible for a Medigap Plan?

Eligibility for a Medigap Plan can sometimes depend on complicated factors that are unique to you and speaking with Bridge Agent can help you identify options to fit your needs. the overall general eligibility (not in any particular order) for a Medigap Plan include (but are not limited to);

• ✔ Age: must be at least 64.5 yrs. with a Medicare Part B effective date and/or Medicare card/number present.
• ✔ Enrollment: depending when you chose to enroll in Medicare based on the enrollment periods guideline.
• ✔ Existing coverage: Sometimes your existing coverage can effect eligibility (ie: switching from Medicare Advantage).
• ✔ Health: be in decent health unless under a guaranteed issue right which means you cannot be denied coverage even based on preexisting conditions. All new Medicare enrollees who enroll “on time” are given this right.
• ✔ Income: Although price is not a direct disqualifying factor, it is unethical for any insurance agent to sell you a policy you cannot afford.

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How do Medigap Plans work?

Medigap Plans only work with Original Medicare (Part A & Part B) and do not work with Medicare Advantage (Part C). Confusingly, Medigap Plans are also called “Medicare Supplements”, they are both the same thing. Another point of confusion among folks is that Medigap Plans are categorized by what the industry calls; “letter plans” (ex: Plan G, Plan N ect…) which has a similar naming convention to Medicare “letter parts” (ie: Part A, Part C ect…). A good rule of thumb is to remember that “Parts & Plans” are not the same as they refer to separate concepts within the structure of Medicare Insurance. Moreover, Medigap Plans are designed to cover the additional 20% out-of-pocket, health care costs that Medicare will not cover in which, beneficiaries (you) are responsible for paying. Medigap Plans can provide more comprehensive benefits, freedoms and flexibility of choice unlike its rival Advantage Plan. Similar to Advantage Plans, Medigap Plans are managed by privatize insurance carriers and are federally standardized which means the only difference between Plans and Brands (ie: Carriers) is…the price you pay (that’s it). For example, some carriers have higher ratings due to price stability & claim fulfillment. Supplement Insurance is not for everybody and while some make decisions based on price alone, one should consider weighing their options between Original Medicare over Medicare Advantage. Medigap Plans can offer more protection over your Medicare liabilities. Although a spousal discount is not uncommon, policies are usually purchased under separate applications. If you are considering a Medigap Plan, Bridge has a plan to help you discover options & select a plan that fit your needs!

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What does a Medigap Plan cost in 2019?

The costs of a Medigap Plans in 2019 can vary based on factors such as your health, age, location, letter plan & the carrier to name a few. As with most insurances, rate changes happen periodically. For example; choosing a low cost carrier could have significant premium increases down the road. That’s why it’s best to have Bridge help you do all the heavy lifting by providing you with side-by-side Medicare comparison when considering Medigap Plans.

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What do Medigap Plans cover?

In general, Medigap Plans cover a variation and/or all of the following items;

• ✔ Medicare Part A Coinsurance or Copay.
• ✔ Medicare Part B Coinsurance or Copay.
• ✔ First Three (3) Pints of Blood.
• ✔ Medicare Part A Hospice Coinsurance.
• ✔ Skilled Nursing Facility Care Coinsurance.
• ✔ Medicare Part A Deductible.
• ✔ Medicare Part B Deductible.
• ✔ Medicare Part B Excess Charges
• ✔ Foreign Travel Emergency Insurance.

The National Association of Insurance Commissioners (NAIC), standardized all Medigap Plans which must adhere to the following guidelines;

• ✔ Must cover costs for both Original Medicare Part A & Part B.
• ✔ Must reflect statutory changes in Medicare.
• ✔ Cannot deny pre-existing conditions after a policy has been active for 6-months.
• ✔ Must include a 30-day look back period.

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What do Medigap Plans not cover?

Medigap Plans do not cover or replace the following items;

• ✘ Part D Prescription Drug Coverage
• ✘ Medicare Advantage
• ✘ Critical Illness Insurance (Cancer, Heart Attack & Stroke Insurance)
• ✘ Cosmetic Surgery
• ✘ Long-term care (also called custodial care)
• ✘ Most dental care
• ✘ Eye exams related to prescribing glasses
• ✘ Dental, Vision or Hearing Insurance
• ✘ Dentures
• ✘ Acupuncture
• ✘Hearing aids and exams for fitting them
• ✘ Routine foot care
• ✘ Life Insurance
• ✘ Check plans for more details

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What are the Medigap Plans for 2019?

The 2019 Medigap Plan listed in alphabetical order are;

• Plan A ^Available
• (Not to be confused with Part A, Original Medicare)
• Plan B ^Available
• (Not to be confused with Part B, Original Medicare)
• Plan C ^Available
• (Not to be confused with Part C, Medicare Advantage Plans)
• Plan D ^Available
• (Not to be confused with Part D, Prescription Drug Plans)
• Plan E ^Unavailable
• Plan F ^{Available Popular}
• High Plan F ^{Available Popular}
• Plan G ^{Available Popular}
• Plan H, I, J ^Unavailable
• Plan K ^Available
• Plan L ^Available
• Plan M ^Available
• Plan N ^{Available Popular}
• Plan O-Z ^Unavailable

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What are the benefits of Medigap Plans?

Some overall benefits of adding a Medigap Plans to your existing Medicare benefits are;

• ✔ Freedom to choose your Doctor.
• ✔ Portability (switch plans/providers anytime).
• ✔ Flexibility (Find plans to fit your budget).
• ✔ Price Transparency (know your line item costs).
• ✔ Freedom to travel (in and out of the country).
• ✔ Additional Benefits

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How do I buy a Medigap Plan?

After enrolling in both Medicare Part A & Part B, one can then shop for a Medigap Plan by contacting Bridge Insurance (Get Quote✨). Many websites trick folks into thinking they can “view pricing” or even purchase coverage directly online but later find this only leads to an inquiry form with an agent calling them shortly thereafter. By-law, one must work directly with a state-licensed agent either in-person or by phone. Depending on the type of enrollment & issue rights, additional health information may be required. Your application will then be reviewed & approved or denied. If approved, you will begin paying the scheduled premiums to unlock the Medigap Plan benefits which are used in conjunction with your Medicare insurance. Generally, services are billed to Medicare first and any overages are directly billed to your Medigap Plan. In some instances, you may still be responsible for paying some portion of services (review your plan details). Be sure to ask your health professionals if any services are not covered under Medicare Assignment to avoid additional costs.

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How do I compare Medigap Plans?

Comparing Medigap Plans can be confusing and time consuming when vetting multiple carriers and plans. It takes more than reading a 2019 Medigap PDF Guide to get all the Medicare FAQs! Simplify the process by speaking with a Bridge Agent who can answer your questions & run all your Medigap comparisons for you at no cost!

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Can my wife and I share a Medigap Plan?

No, you and your spouse are considered separate members. Each member must purchase an individual Medigap Plan. However, depending on state and carrier, a Medigap Plan household discount may be available. Contact Bridge to learn more.

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What company offers the best Medigap Plans?

It can be a challenge when deciding what Medigap Plan company to choose from because everyone has different needs. Here at Bridge, we only work with the top, A+ Rated carriers (Mutual of Omaha, Aetna, Cigna, Humana, Americo ect..) to ensure stability without compromising price. We listen to your situation and based on your needs, present plans based upon factors such as availability, cost & benefits to name a few. Contact a Bridge Agent today to learn your options and find a plan to meet your needs.

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What Medigap Plan is the best?

Because everyone has different needs, determining the best Medigap Plan offers no simple answer. If you would like to find out what options are available to you in your area, connect with a Bridge Agent today!

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What are the most popular Medigap Plans in 2019?

Depending on if and when one enrolls in Medicare, Plan F has been the contender for the most popular Medigap Plan due to its first-dollar coverage benefits. However, Plan F is not available to NEW enrollees after Jan 1, 2019. So, for new Medicare enrollees after Jan 1, 2019, the most popular Medigap Plan will be Plan G because it offers the most comprehensive coverage than any other Med Supp Plan on the market.

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How do Medigap Plans compare with Part C Medicare Advantage (MA)?

Overall, Medigap Plans may offer more comprehensive coverage when paired with a Part D drug plan. Both options have similarities and vast differences. For example, both are similar in that they are managed by private insurance companies. A Medigap Plan covers only 20% of your total coverage unlike Medicare Advantage (Part C) which covers 100% of your health plan and is managed 100% by private insurance. Part C may contain a drug plan within it called MA-PD vs. PDPwhich is a stand alone drug plan that works with a Medigap Plan. Comparing Medigap vs Medicare Advantage Plans can be difficult going at it alone. You cannot be enrolled in both Original Medicare and a Medicare Advantage at the same time. Read about comparing Original Medicare vs Medicare Advantage.

But wait…although, Medicare Advantage Plans are appealing based on price & perks, they can also come with a few medicare pitfalls that may have you reconsider the real “advantage”. For example;

• Prices have been historically unstable.
• Your coverage will change annually.
• You could be locked-in without the future option for a Medigap Plan
• You’re responsible for out-of-network, Physician costs.
• No coverage beyond your service area.
• Must use in-network providers.
• No travel coverage.
• May need a referral to see a specilist.

Additionally, If you have a MA plan & diagnosed with a critical illness such as cancer, heart attack or stroke, costs for treatment if the hospital is out-of-network may not be covered in your plan. The max out-of-pocket only applies to covered services and could require a specialist referral. People with MA plans, think they have more coverage than they actually do unlike Medigap plans, which is considered more comprehensive senior health coverage plan.

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How do Medigap Plans work with Medicare Part D prescription drug coverage?

Medigap Plans are compatible with Original Medicare, enrollees who choose a Medigap will also need to enroll separately in a Part D drug plan. Enrollees have a guaranteed eligibility for a Part D plan when they enroll in Plan D (on-time). It’s best to avoid the Part D Enrollment Penalty by enrolling during your initial enrollment period (also known as, IEP). Did you know that drugs administered in a Hospital setting are generally covered under your Medicare Part A? For more information on enrollments, visit the Medicare Enrollment Periods page.

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How does Dental, Vision & Hearing Insurance (DVH) work with Medigap Plans?

Good news! Medigap Plans are compatible with DVH plans however since they are considered standalone plans, DVH’s would need to be purchased separately. By working with a Bridge Agent, we can help you find an affordable DVH insurance plan to fit your needs.

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How does Medigap Plans work with a Critical Illness Insurance for cancer, heart-attack & stroke coverage (CHAS)?

A Medigap Plan is compatible with CHAS insurance / cancer plans however since they are considered standalone plans, they would need to be purchased separately. By working with a Bridge Agent, we can help you find an CHAS and/or affordable critical illness insurance plans to fit your needs.

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How does Medigap Plan work with a Long Term Care Insurance (LTC)?

A Medigap Plan is compatible with LTC plans however, since they are considered standalone plans, they would need to be purchased separately. There is talk about developing a new Medigap plan to include LTC coverage. By working with a Bridge Agent, we can help you find an affordable LTC insurance plan to fit your needs (LTC).

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How does a Medigap Plan work with a Health Savings Account (HSA)?

As with all Medigap Plans, they is not considered a qualified expense to pay out of your Health Savings Account (HSA). However, your HSA can pay for Medicare Parts A, B, C & D. Once enrolled in Medicare, enrollees are no longer able to contribute to their Health Savings Account. However, the funds can be used to pay for qualified Medicare costs stated above. If one postpones Medicare enrollment they may still contribute to their Health Savings but enrolling late will also be subject to a Medicare Late Enrollment Penalty which is a percentage increase of costs per year. Speak with your Financial Advisor to determine what works best for you!

What is the difference between Medigap Plans & Medicare Supplements?

There is no difference between a Medigap Plan vs. a Medicare Supplement because they are the same thing, just a different name.

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Can I buy a Medigap Plan if I have a Medicare Advantage Plan?

No, you cannot have both a Medigap Plan and a Medicare Advantage Plan at the same time. You must choose between one or the other. Pay very close attention to enrollment dates, eligibility rules when deciding & switching plan types.

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How much per month is a Medigap Plan?

A Medigap plan supplements your exisiting Medicare Part A & B payment + Drug Plan and could cost between $49.99-$299.99 per month additional depending upon the plan.

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What is the history of Medigap Plan Insurance? (condensed)

The history of Medicare Supplement Insurance is actually quite extensive since it is and an offshoot of Medicare in general. As you will see, Medicare was an idea long before President Lyndon B. Johnson signed The Medicare Bill back in 1965. ().

Moreover, Medicare in continually being refined & even redefined as with the more recent, “Medicare for All” movement proposing a shift to a single-payer network.

Additionally, many of the initial/foundational laws that surround Medigap Plan insurance can be read online, including the social security TITLE 18 (XVIII), and more specifically, the Notice of Medicare Benefits: Medicare & Medigap Information

Thankfully, there have been many efforts to protect seniors health insurance as far back as The Baracus Amendments in 1980 for Medigap Insurance to protect against substandard and overpriced policies using a panel of standards to regulate insurance. Further Fraud and Kickback prevention: The Medicare and Medicaid Patient and Program Protection Act of 1987. Additional protections included; The Medicare Catastrophic Coverage Act of 1988 an expansion of benefits to include outpatient drugs & limit employee co-payments for example. Notice, the H.R.4328 – Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, Medicare Prescription Drug, Improvement, and Modernization Act and lastly, the Genetic Information Nondiscrimination Act.

Furthermore, due to the lack of consistency from private insurers, Medigap Plan Insurance plans were misleading folks with several instances of sales and marketing deception. Thus, Federal authorities stepped in to help regulate the Medigap Plan Insurance market. Although participation was considered voluntary for each state, the attempt to standardize private Medigap Plan policies took form in what is known as; OBRA or Omnibus Budget Reconciliation Act of 1990 which ultimately settled the discrepancy.

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What were the results of OBRA?

The results of OBRA would provide protection to consumers from misleading health care purchases and to instantiate Medigap consistency standards, the National Association of Insurance Commissioners (NAIC) was created to develop a model for all participating states with a few exceptions, including Massachusetts, Minnesota and Wisconsin whom enacted their own state regulations.

Before June 1, 2010, twelve (12) standardized Medigap Plans existed labeled Plan A through Plan L or “Letter Plans”. Over the years, some Medigap Plans have been removed with the addition of two new plans. Any plans purchased prior to June 1, 2010 are grandfathered Medigap Plans for life.

As of June 2010, ten (10) plans remain which are all standardized by the National Association of Insurance Commissioners (NAIC), Medigap insurance policies are issued plans from private insurance carriers as an alternative to Part C (Medicare Advantage Plans). Each insurance company is different and may not choose to sell particular plans. All plans must obtain a minimum standard of coverage and adhere to Medicare law changes. Policies contain a minimum of a 30 day free-look provision and excluding preexisting conditions are capped at 6 months.

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In Conclusion

It’s easy to see how Medigap Plans are comprised of many details which at the end of the day, comprise of a health insurance contract. Essentially it all boils down to contract law. Medigap Plans, like Medicare is a deep subject of study filled with confusing nomenclature and wrought with individual complexities between providers, plans and the folks it serves. On this topic, we reviewed the important highlights of Medigap Plans to help you better understand Medicare Insurance in 2019 from a “complete health plan perspective”. We discussed common questions about Medigap Plan coverages, benefits, misconceptions and even comparisons details. If you have any question regarding this information contact us at [email protected] for clarification or plan support.