As your dedicated team at Emerald Medicare, we understand that navigating the Medicare enrollment process can be overwhelming. That’s why we’re here to provide clarity on one of the most valuable options available to Medicare beneficiaries: Medicare Supplement Insurance, also known as Medigap. This comprehensive guide will walk you through what Medigap plans are, how they work, and how they can benefit you by filling the gaps left by Original Medicare.
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What are Medicare Supplement (Medigap) Plans?
A Comprehensive Guide
A Medigap plan (Plan G, Plan N, etc.) is private health insurance designed to work alongside Original Medicare (Parts A & B).
While Original Medicare provides broad coverage, it doesn’t cover everything. For example, beneficiaries are still responsible for certain deductibles, co-pays, coinsurance, and out-of-pocket costs. Medigap plans help cover these “gaps” in Medicare, providing financial protection and peace of mind.
Here’s how it works:
- Original Medicare pays for its share of covered healthcare services (typically 80% of approved costs).
- Medigap plans help pay for the remaining out-of-pocket costs, like the 20% co-insurance on doctor visits or hospital stays.
What Do Medigap Plans Cover?
Medigap plans can help pay for various out-of-pocket expenses that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may cover:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayments
- The first three pints of blood used in a medical procedure
- Part A hospice care coinsurance or copayments
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible (for some older plans)
- Part B excess charges
- Foreign travel emergency coverage (up to plan limits)
Each Medigap plan is standardized, meaning that the benefits for each plan type are the same no matter which insurance company offers the plan. For example, Medigap Plan G from one insurance company will offer the same benefits as Medigap Plan G from another. However, premiums can vary based on things like your home state, income, and more, so it’s essential to compare offerings or work with a Medicare broker, like our team at Emerald Medicare, to find the best plan for your needs and budget.
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Why Should I Choose a Medigap Plan?
Medigap plans, as opposed to Medicare Advantage (Part C) plans, are particularly beneficial for individuals who:
- Want predictable healthcare costs: If you want to avoid unexpected out-of-pocket expenses, a Medigap plan can provide peace of mind by covering those costs.
- Travel frequently: Some Medigap plans offer coverage for medical care when traveling outside the U.S. (a benefit not offered by Original Medicare).
- Need frequent medical care: If you visit doctors or specialists regularly or require frequent hospital stays, Medigap plans can help reduce the financial burden of these services.
- Prefer flexibility in healthcare providers: Unlike Medicare Advantage plans, Medigap plans don’t have network restrictions. You can see any doctor or specialist nationwide who accepts Medicare.
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Medigap vs. Medicare Advantage: What’s the Difference?
It’s essential to understand that Medigap and Medicare Advantage plans are different, and you cannot have both – only one or the other.
- Medigap works with Original Medicare (Parts A and B) to cover out-of-pocket medical costs, like co-insurance and/or certain deductibles. However, as prescription medications are not covered by Medigap plans, you are also required to enroll in a Part D plan (Prescription Drug Plan) when enrolling in a Supplemental plan. In tandem, A Medigap plan + a Prescription Drug Plan is a highly comprehensive option for a higher monthly premium – with less restrictions than Medicare Advantage. Any doctor’s office in America will accept your Medigap insurance as long as their office accepts Medicare.
- Medicare Advantage (Part C) is an alternative to Medicare Supplement + Part D coverage that combines hospital, medical, and drug coverage into one all-encompassing plan, often including additional benefits like dental or vision. However, Medicare Advantage plans all have their own unique network of ‘preferred’ medical providers that beneficiaries are limited to, meaning the patient will be 100% financially responsible for services received from Out-Of-Network doctors. Furthermore, some Medicare Advantage plans provide less comprehensive drug coverage when compared to dedicated Prescription Drug Plans (Part D) and their formularies.
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How to Enroll in a Medigap Plan
You can enroll in a Medigap plan during your Initial Enrollment Period [IEP] – which begins as you approach age 65 – after enrolling in Original Medicare (Parts A & B). This six-month IEP window is critical because during this time, you have guaranteed issue rights, meaning insurance companies can’t deny you coverage or charge higher premiums based on your health status. After this period, you may still be able to apply for a Medigap plan, but insurers can use medical underwriting to determine your eligibility and rates.
How to Choose the Right Medigap Plan
Choosing the right Medigap plan depends on your specific healthcare needs, budget, and lifestyle. Here are a few tips to help you decide:
- Assess your current health needs: If you frequently visit doctors or specialists, a Medigap plan that covers Part B copayments and coinsurance can be very beneficial.
- Consider your travel habits: If you travel frequently, especially outside the U.S., look for a Medigap plan that includes foreign travel emergency coverage.
- Plan for the long term: While some Medigap plans may have higher premiums, they can save you money in the long run by limiting out-of-pocket expenses.
- Consult with a Medicare broker: A licensed Medicare broker, like the experts at Emerald Medicare, can help you compare different Medigap options, review costs, and find the plan that best suits your needs.
For advice on choosing a Prescription Drug Plan, read our Blog Post to learn more:
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Explore Medigap Options with Emerald Medicare
At Emerald Medicare, we’re here to help you make informed decisions about your healthcare. Medigap plans can be a great way to secure financial peace of mind while ensuring that you get the care you need. Our team of licensed Medicare experts will guide you through the process, helping you understand your options and choosing a plan that fits your unique needs.
If you’re interested in learning more about Medigap plans or need help finding the right one for you, we’re here to help. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us directly:
Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com