Medicare Supplement OR Medigap Plans

Medicare Supplement or Medigap plans are the second option for you to close the coverage gap of just having Original Medicare.  These plan ARE NOT Medicare Advantage plans.  It's important to note that if you choose this route for your healthcare that your primary coverage is still Original Medicare (Parts A and B) and your Medigap plan becomes your secondary coverage.

Example= Generally speaking, Original Medicare covers 80% of the cost of medical procedures , and you as the consumer are responsible for the remaining balance.  The Medigap plan you choose will help cover the remaining 205 of medical expenses, depending on the type of plan (below) that you select.

Lastly, and very important, Original Medicare does not provide prescription drug coverage; therefore, Medigap will not cover prescription drugs either. Individuals that choose to enroll in a Medigap will also want to enroll in a separate stand-alone prescription drug plan known as PART D.  Go to More button on upper right and select PART D to learn more. (no worries we will help you get coverage that compliments your Medigap plan)

Just like any health insurance options, the cost of Medigap will be faced with two buckets of cost=

1. Fixed Monthly Costs
2. Variable Out of Pocket Costs

Compared to a Medicare Advantage plans Medigap generally have higher fixed monthly premiums BUT have lower variable out of pocket costs should you need medical care.  Again, these costs will vary depending on the standardized Medigap plan you selected.

Because Medigap plans are standardized, you will often hear them referred to by a specific letter ranging from Plan A to Plan N.  (see the chart below)  For your knowledge equally important to note is these standardized plans all have the exact same benefits regardless of who the carrier is.  The only difference between Medigap policies sold by different insurance companies is the cost.

The best time for you to enroll is during your Open Enrollment Period.  This period is directly related to you the individual and it is unique to everyone that is beginning their Medicare coverage.  IMPORTANT: This Open Enrollment Period is not the same as Annual Election Period that runs from October 15th every year to December 7th.  Instead, according to the rules set by CMS "Your individual Medigap Open Enrollment Period begins the first day of the month that you are both 65 or older AND enrolled in Medicare part B"

The importance of enrolling during this "one time" Open Enrollment Period is that should you miss it and choose to enroll in a Medigap plan outside of this window you will have to go through medical underwriting. (complete a health questionnaire and potential medical background checks)

You can enroll into a Medigap plan OR switch from one Medigap to another after the Open Enrollment Period has passed but again beware of the Medical Underwriting requirements.

1. Nationwide Coverage- unlike Medicare Advantage plans there is no "in-network" requirement.  You are free to receive care/treatment from any facility or provider in the country that accepts Original Medicare.  When calling your doctor's office simply ask: "do you accept Original Medicare"?
2. Annual Budget- Plans G & N the two most popular plans cover most of the costs remaining after Original Medicare has paid their portion- thus your out of pocket costs are much more predictible throughout the year.
3. Comprehensive Coverage- choosing again one of the nations most popular plans (G, N, or F) you will have very little out of pocket costs.  For example, Plan G will cover the same out of pocket medical costs as Plan F after you've paid your Part B deductible of $240 for 2024.
4. Stand Alone Part D- Having "choice" to choose your Prescription Drug Plan (Part D) can be to your advantage as you can pick a plan that best fits your unique needs AND every AEP (Annual Enrollment Period) you can actually change your Part D plan if you choose to without disruption to your Medigap Plan. (remember this is a separate policy)
5. Renewing is Guranteed- Your Medigap Insurance company can't cancel your policy as long as you stay enrolled and pay your premiums- giving you piece of mind knowing you'll have the same benefits year after year.

1. High Monthly Costs- receiving the comprehensive medical coverage of a Medigap plan will come with a higher monthly premium then that of a Medicare Advantage Plan. (Part C)
2. Annual Rate Increases- Besides having higher monthly premiums Medigap monthly premiums also increase during the lifetime of your policy.  Every year you can anticipate your Insurance Carrier to increase  premiums by a few percentage points due to various factors.  (for your knowledge the premium rates are based on three different factors:  Your attained age, issue age rating & community rating)
3. Less Extra Benefits- Medigap plans cover the out of pocket costs for medical care approved by Original Medicare Parts A & B so they do not include any extra benefits not provided by Original Medicare like; dental, vision, hearing which do come with Medicare Advantage Plans.
4. Separate Part D- Although mentioned above as an advantage with flexibility there is a cost impact of having to make a separate monthly premium payment for your Part D coverage.

• These plans come in 10 "standardized" packages regardless of who Insurance Carrier
• Clearly understand these plans are NOT the same as Medicare Advantage Plans
• Outside of your OEP it may be difficult to enroll for the first time. (Medical Underwriting)
• Don't go it alone-  give us a call and let's have a conversation before enrolling on your own