Medigap Insurance is often referred to as Medicare Supplemental Insurance. These Medigap/Medicare Supplement Policies help individuals pay for your share of the Medicare expenses that Medicare does not pay for and that your are responsible for.
Medigap Policies are popular because they cover the cost of Co-Pays for Doctor visits and they give their members the ability to access Medicare Healthcare providers in every state.
Most new Medicare Beneficiaries are taken back by the fact that Medicare pays for 100% of their Part A Hospitalization but only 80% of their Medicare Part B services, leaving them responsible for the other 20% themselves. This additional cost can be a real eye opener for people, this is where Medigap Insurance comes into play. Medigap Insurance or Medicare Supplemental Insurance pays that 20% for you. Medicare Supplemental Policies also pay for cost sharing items like Co-Pays & Excess Charges.
What Is Guaranteed Issue For Medicare Supplemental Insurance?
When you reach age 65 you are able to sign up for Medicare. Your Guaranteed Issue Time includes the three months prior to your birth month, your birth month and the three months after your birth month. During this time you can sign up for Social Security Benefits and Medicare. You can choose to participate in Original Medicare, eroll in a Medigap Plan which is commonly referred to as a Medicare Supplement Policy or you can choose a Medicare Advantage Plan. During your initial guarantee period you can not be turned down for any reason and any/all pre-existing conditions are accepted.
Medicare Supplement or Medigap Policies are sold to Medicare Beneficiaries by private insurance companies and they pay for the things that are not covered by Original Medicare. These include things like Cost Sharing of Part B services, Outpatient Services, physicians Co-Pays and Excess charges.
Medicare Supplement Plans allow you to:
Medigap is insurance to cover the "Gaps" in what is not covered by Medicare, like your deductibles and co-pays that are not covered by Original Medicare.
Some other things to know about Medicare Supplement insurance:
Each Medicare Supplemental or (Medigap) Plan is identified by a corresponding and identifiable letter. Medicare refers to these plans. These are Medigap Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M and Plan N. Each one of these lettered policies provides the same set of benefits regardless of which company you choose A Plan K Policy from United Healthcare will have the exact same benefits as a Plan K from BCBS or Mutual of Omaha.
What is different is the pricing structures used by each company. Every Insurance provider has their own pricing structure for each area of the country they operate in. I have to emphasize that ALL Plans with the same letter have the same coverage but the price is always different so use your Agent/Broker to help identify the best value and the best coverage for you and your family. Medigap Plans C and F are only available to those people who were enrolled in Medicare prior to January 1, 2020.
In 2020 Medicare Supplemental Plan G is the most comprehensive plan. It works exactly like Plan F except that you pay for the Part B deductible once per year. Your premiums will be lower though, and sometimes this creates annual savings.
For Medigap Plans K and L, after you meet your annual out-of-pocket limit and your annual Part B deductible ($203 in 2021), the Medigap plan pays 100% of covered services for the rest of that calendar year.
Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $40 copayment for emergency room visits that don’t result in an inpatient admission.
Each Medicare supplement plan in the chart above has a letter, A – N. Each plan letter provides a different set of benefits. However, each lettered plan must have the same standardized coverage regardless of which insurance company you choose. For example, Medicare supplement Plan N at Blue Cross Blue Shield has the same benefits as Plan N from Humana Healthcare.
Plan F is the one and only supplemental insurance plan that covers ALL of the gaps, leaving you with nothing out of pocket. There are others where you agree to do some cost-sharing and in return you get a lower monthly premium. If you prefer something like this, in the middle, you could look at Plan G and Plan N where you pay a few things yourself, in exchange for lower premiums.
Most people enroll in Medicare supplement plans G or N. That’s because these offer the most coverage. However, the reason for the choices is to let you decide what is most important to you. Some beneficiaries want a plan that covers all the gaps and leaves them with no worries about the cost of medical procedures. Others prefer a Medicare supplement plan in which they cover some of their deductibles and copays out of pocket in order to achieve lower premiums. Refer to our Medicare Supplement Plan Chart to compare the benefits of all plans side by side.
Medicare Open Enrollment is a one-time window to enroll in any Medicare supplement plan in your area.
According to Medicare’s Guide to Health Insurance, the best time to buy a supplement policy is during your one and only Guarantee Issue/Initial Enrollment Period.
During your one-time Medigap open enrollment, the Medicare supplement company cannot ask you any medical questions. They cannot turn you down for any health conditions. They cannot refuse you a policy or charge you any additional amount due to health conditions, medications or pre-existing illnesses. You will have your choice of Medicare supplemental plans.
After this window passes, however, future insurance companies that you might apply with can accept or decline you based on health. That is why the Medicare Handbook states that open enrollment is the best time to enroll.
Medicare Supplement Plans – Guaranteed Issue
Some people delay enrollment into a supplement because they have group health coverage through an employer. Later when you retire or lose that coverage, you have the right to purchase certain Medigap policies within the 63 days following the loss of your group coverage. This is called your Medicare supplement guaranteed issue rights.
The guaranteed issue window works just like open enrollment, except that is a shorter period of time and that your plan choices are limited to Plans A, B, C ,F, G, K, N and L. The insurance company cannot deny your application for any health reasons.
Can You Change Medicare Supplement Policies Anytime?
You can apply to change your Medicare Supplement at any time, but if you are past your open enrollment window, you will have to answer health questions in most states. The Medicare supplement insurance company will review your health history and medication history. They can accept or decline you.
What Is Guaranteed Issue For Medicare Supplemental Insurance?
In certain circumstances, an insurance company must accept you for coverage without asking health questions. For example, if you are on Medicaid and you lose your Medicaid eligibility, you have a short window to apply for Medigap without health questions. Another example would be for someone coming off employer health coverage that is primary to Medicare. They will have a short window to apply for certain Medigap plans under guaranteed issue rules.