MEDICARE SUPPLEMENT (MEDIGAP)

Helping People 65+ In New York & Long Island Choose The Right Health Insurance Plans

Medigap Medicare Supplement Plans: Your Guide to Coverage

Americans with Original Medicare get a lot of the costs of their medical care covered. Yet, there’s always a chance you’ll have outstanding costs to pay. For help covering these costs, consider investing in a Medigap supplemental insurance plan. It’s there to help you with the costs your Medicare won’t cover.

A "Medigap" Policy (also called Medicare Supplement Insurance) is private health insurance that is designed to work with, or supplement, your original Medicare. This means Medigap policies help pay some of the health care costs (or "gaps") that the Medicare you receive at age 65 doesn't cover, like co-payments, coinsurance and deductibles. 

Come to Senior Healthcare Solutions, and we’ll help you get the Medigap plan that is of the most benefit to you. 

What is Medigap?

Original Medicare is the government-funded program that provides health insurance for senior citizens and others. It contains a couple of different types of coverage – Medicare Part A and Medicare Part B. These elements will cover things like hospitalizations, doctors visits, testing and other medical costs.

However, even with Original Medicare, you’ll have to pay costs like copayments, coinsurance and deductibles. Medigap insurance exists to help you cover those outstanding bills.

Medigap plans are private plans offered by major insurers. They exist alongside your Original Medicare and help cover items like:

• Co-payments
• Coinsurance
• Your Part A & Part B deductibles
• Emergency medical care if you travel internationally
• Excess charges from Medicare Part B 

One advantage of Medigap Plans is that Medicare remains your primary insurance, so you will be able to see any doctor or go to any hospital that accepts Medicare without referrals. Some Medigap plans even cover benefits that Medicare does not.When you opt for a Medigap Policy, Medicare will pay its share of the Medicare approved amounts and then the Medicare Supplement plan will pay its share. 

Every Medigap policy must follow Federal and State laws designed to protect you. There are 11 Medigap policies ranging from letter A to Letter N. They are called standardized plans which means a Plan F from one insurance company must be the exact same coverage as Plan F through another company--although premiums will vary greatly. Since the only variance is price, your individual healthcare needs will help determine how much you stand to save by purchasing a Medigap Plan.

Prices range in New York from $69 per month to $567 per month.

Understanding Medigap Plans

There are a lot of Medigap plan options out there. Each state manages its Medigap system differently. They usually offer:

• Plan A
• Plan B
• Plan C
• Plan D
• Plan F
• Plan G
• Plan K
• Plan L
• Plan M
• Plan N

Not all Medigap plans are available in all areas. It is always best to buy coverage in your community.

Insurance companies that offer Medigap coverage must offer at least Plan A coverage. Also, if they plan to offer more than one plan, they must offer either Plan C or Plan F. Plans offer consistent coverage based on their letters. For example, buying a Part A plan in Manhattan will get you the same coverage as a plan offered in Buffalo (or even in another state).

Your plan will come with its own premiums. You will also still have to pay your Original Medicare Part B premium at the same time. One of our agents is happy to assist you in getting the right plan to maximize your cost savings.

Who qualifies for Medigap?

Original Medicare is a government-supported program. Only certain individuals qualify for coverage. Therefore, if you want to get a Medigap plan you’ll face similar requirements.

• You must meet all qualifications to enroll in Medicare Part A & Part B. You must enroll in Parts A & B before getting Medigap coverage.
• You must remain enrolled in Original Medicare if you want to keep the Medigap plan.

Please note: If you have Medicaid, you usually do not qualify for Medigap plans.

What is the Medigap open enrollment period?

Most people enroll in Medigap coverage at the same time they become eligible for Original Medicare

If you are turning or have already turned 65: You become eligible for Medigap plans during a 6-month period. The enrollment period starts on the first day of the month you turn 65 and are enrolled in Part B coverage. For example, if you turn 65 and enroll in Part B in January, then you can buy Medigap coverage from January – June.

If you are under 65: Sometimes, Medicare policyholders under age 65 do not qualify for Medigap coverage. However, certain states require insurers to offer plans for those under 65.

If you have health insurance from an employer: Those with health insurance from an employer might put off enrolling in Medicare Part B until they retire. This might be after they turn 65. However, when you do decide to enroll in Part B coverage, you will receive a 6-month enrollment period. Check out the details on enrollment periods.

Is Medigap and supplemental insurance the same thing as Medigap?

You might hear an insurance company refer to Medigap plans as Medicare Supplements or Medicare Supplementals. These are different terms for the same product. However, your agent can help you learn about any differences in your specific plan.

Do you need Medigap with Medicare Advantage?

Medicare Advantage plans and Medigap plans are not the same thing.  If you enroll in Medicare Advantage (Medicare Part C) plans, you cannot receive a Medigap plan.

Medicare Advantage plans are private Medicare plans offered by major insurers. However, they do not cover the costs paid by Medigap plans. Medigap plans likewise do not cover the benefits offered by Medicare Advantage coverage. You cannot switch from Original Medicare to Medicare Advantage and keep your Medigap Plan.

Is it better to have Medicare Advantage or Medigap?

If you anticipate needing assistance for things like copayments and deductibles, a Medigap plan is your best bet. However, if you want coverage for extra services like dental, vision and prescription costs, consider a Medicare Advantage plan. Talk to one of our agents to determine the right course of action.

Can you change Medigap plans at any time?

In certain situations, you can change your Medigap plan. For example, if you move, or switch from a Medicare Advantage plan to Original Medicare, you might be able to qualify for a new Medigap plan. Call one of our agents to determine if you can change your coverage today!

Who do You Call with Medicare Questions?

To get help with all your Medigap insurance questions and needs, call Senior Healthcare Solutions today at 631 539-6351. We can help you get covered today!

You can also contact the Medicare system directly at:

• www.Medicare.gov/forms-help-resources
• National Phone Number: 1-800-MEDICARE (1-800-633-4227)
• TTY Phone: 1-877-486-2048
• Medicare Contact Center Operations
  PO Box 1270 Lawrence, KS 66044