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What are Medigap Plans?
September 19, 2023 at 9:00 PM
by Tara Taws Claghorn-Nicastro
Rittenhouse Square Insurance

Medigap or Medicare Supplement Plan Basics

  • Fill the “gaps” that Original Medicare A&B don’t cover
    • Can help pay for copays/coinsurance/deductibles of Medicare A & B
  • Sold by private insurance companies
  • Medicare Supplement Plans are differentiated by letters ( Plan A - Plan N)
    • Plans A - N cover different parts of the Medicare A & B deductibles, coinsurance, and copays
    • Plans A - N are priced differently
  • Standardized = offer same basic benefits regardless of insurance company
  • Must follow all federal & state laws to protect you (i.e. be clearly identified, etc.)
    • For example, all Medicare Supplement plan Gs have to cover the same basic benefits regardless of the insurance company selling it - what varies is the PREMIUM (price)

How are Medigap Plans Different from Medicare Advantage Plans?

  • Medicare Advantage Plans = another way to manage/get your Original Medicare A & B benefits
    • Medicare Advantage PPOs/HMOs manage your Medicare Part A, B and D benefits for you
    • The PPO/HMO process your medical claims
  • Medigap Plans only help pay for costs that Original Medicare A & B don’t cover
    • Medigap plans are secondary insurance to your Original Medicare A & B
    • CMS (Medicare) processes your medical claim first, then your Medigap is a secondary insurance and covers some or all of what Medicare A & B don’t cover (depending on Medigap Plan choice/benefit outline)
  • Can’t have a Medicare Advantage plan AND a Medigap Plan
  • Medigap plans don’t have networks, if provider accepts Medicare, they accept your Medigap
  • Medigap plans don’t cover: Vision or Dental Services, Eyeglasses, Hearing Aids
    • More and more Medigap plans are coming with Vision, Dental, Eyeglass, and Hearing Aid Discounts
    • Medicare Advantage plans often include limited coverage on these services included in their plan
    • Note, certain medically necessary vision/dental services are covered by Medicare A, B and Medigap like cataract surgery, diabetic eye exams, glaucoma treatment, etc.

What are the Guaranteed Issue Times to Enroll in a Medigap?

  • Guaranteed issue = cover all your pre-existing health conditions and cannot deny or charge you more for a Medigap policy due to past/present health issues
  • Initial enrollment period
    • Lasts 6 months & begins the first day of the month you’re both 65 or older AND enrolled in Medicare Part B
    • Guaranteed Issue period with no medical underwriting
  • Medicare Advantage Trial right periods
  • Move out of service area
  • You are losing employer (retiree/group/union) coverage
  • See the 2023 Choosing a Medigap Policy book for other GI enrollment periods

What if I want to enroll in a Medigap at a Non-Guaranteed Issue Period?

  • You will be subject to medical underwriting due to past and present medical conditions
    • Can be denied coverage
    • Can be subjected to higher premiums

To learn more, click the resources and references below or