How to Choose Your Plan
When selecting a Medigap insurance policy consider your health care needs and what you want from a Medigap insurance policy. The process can be simple and easy, as long as you have the right information.
Medicare Plan Details
Outline of Medicare Supplement Coverage(Benefit Plans A-L) |
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| Medicare Supplement Insurance can be sold in only ten standard plans. This chart shows the benefits included in each plan. Every company must make available Plan "A". Some plans may not be available in your state as indicated below. | |
| Basic Benefits | Included in Plans A-L |
| Hospitalization: | Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. |
| Medical Expenses: | Part B coinsurance (20% of Medicare-approved expenses). |
| Blood: | First three pints of blood each year. |
| A | B | C | D | E |
|---|---|---|---|---|
| Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits |
| Skilled Nursing Coinsurance | Skilled Nursing Coinsurance | Skilled Nursing Coinsurance | ||
| Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | |
| Part B Deductible | ||||
| Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | ||
| At Home Recovery | ||||
| Preventive Care Not Covered By Medicare | ||||
| F* | G | H | I | J* |
| Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits |
| Skilled Nursing Coinsurance | Skilled Nursing Coinsurance | Skilled Nursing Coinsurance | Skilled Nursing Coinsurance | Skilled Nursing Coinsurance |
| Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible |
| Part B Deductible | Part B Deductible | |||
| Part B Excess (100%) | Part B Excess (80%) | Part B Excess (100%) | Part B Excess (100%) | |
| Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency |
| At Home Recovery | At Home Recovery | At Home Recovery | ||
| Preventive Care Not Covered By Medicare | ||||
| K** | L** | |||
| 100% of Part A coinsurance plus coverage for 365 days after Medicare benefits end 50% of hospice cost-sharing 50% of Medicare-eligible expenses for the first three pints of blood 50% Part B coinsurance, except 100% coinsurance for Part B preventive services |
100% of Part A coinsurance plus coverage for 365 days after Medicare benefits end 75% of hospice cost-sharing 75% of Medicare-eligible expenses for the first three pints of blood 75% Part B coinsurance, except 100% coinsurance for Part B preventive services |
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| 50% Skilled Nursing Coinsurance | 75% Skilled Nursing Coinsurance | |||
| 50% Part A Deductible | 75% Part A Deductible | |||
| Out-of-Pocket Annual Limit*** | Out-of-Pocket Annual Limit*** | |||
* Plans F and J also have a high-deductible option. You will have a lower premium with the high-deductible option, but you will have to pay more out of pocket before the policy will begin to pay benefits. There is a separate deductible for the foreign travel emergency benefit.
** Plans K and L provide for different cost-sharing for items and services from plans A-J. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges". You will be responsible for paying excess charges.
*** The out-of-pocket annual limit is different for plans K and L and will increase each year for inflation.
Things to consider when choosing a plan:
Cost: What you pay out-of-pocket for your health care.
Benefits: Extra benefits and services, for example eye exams or hearing aids may be covered.
Doctor Choices: Can you see the doctor(s) you want to see? Do you need a referral to see a specialist?
Convenience: Where are the doctor's offices? What are their hours? Is there paperwork?
Quality of Care: All plans must meet quality standards. Medicare measures the quality of the care people like you get in many Medicare health plans.
These are all important, but some may be more important to you than others. You need to look at which plans are available in your area and what each plan offers. Then make the best choice for you.
Give yourself time to shop around before your open enrollment deadline. Give yourself a few months to shop around before you need coverage. Medigap insurance is sold by private insurance companies and is designed to help fill in the gaps between what you spend on your health care and what Medicare covers. This shopping period will be beneficial to you. It will give you time to decide which Medicare supplement insurance plan is right for you and will allow you to compare insurance companies. But be sure to ask questions and get the answers you deserve.
Give yourself a few months to shop around before you need coverage. Medigap insurance is sold by private insurance companies and is designed to help fill in the gaps between what you spend on your health care and what Medicare covers. This shopping period will be beneficial to you. It will give you time to decide which Medicare supplement insurance plan is right for you and will allow you to compare insurance companies. But be sure to ask questions and get the answers you deserve.
Take advantage of your open enrollment period
The Federal law requires a six-month open enrollment period when you enroll in Medicare Part B and are at least age 65. Once your 6month open enrollment period starts, it cannot be stopped or changed. During this period, Medicare supplement insurers (insurance companies) cannot refuse you coverage or charge higher premiums because of health conditions. However if you do submit an application for “Medigap” insurance during this period, a company cannot refuse you because of your health or prior claims experience nor can they place conditions on a policy or charge you more because of your health conditions. However you may be subject to a pre-existing waiting period.
But if you had health coverage that qualifies as “creditable coverage,” the company must shorten any pre-existing condition waiting period by the number of months that you had “creditable coverage” in the 6 months before you applied for Medigap coverage.
Open enrollment eligibility requirements may vary by state. They generally require you to be at least 65 years of age and enrolled in Medicare Part B; or, in select states, under age 65, with a disability or end-stage renal disease, and enrolled in Medicare Part B.
Note: Benefits Not available in any plan are vision, dental care, hearing aids, private duty nursing, skilled Nursing care after 100 days, and prescription drug cost that exceed $3,000 per year.
What is a Pre-existing Medical Condition?
A pre-existing medical condition is one in which a person has received medical advice, treatment or recommended treatment from a physician within 6 months from the effective start date if Medigap coverage. A pre-existing condition may make you uninsurable if you fail to sign up for Medigap coverage during your open enrollment period.
What if you missed your Open Enrollment?
Just remember there is no open enrollment if you are over the age of 65 and have been enrolled in Medicare Part B for more than 6 months. You may apply for Medigap insurance but you will be subject to medical underwriting and a pre-existing condition waiting period or exclusion. If you fail to meet the Medigap insurance policy health standards, the insurance company does NOT have to insure you.
This same situation may arise if you drop your current Medigap insurance. There is not a guarantee that you can get another policy except in very limited situations. Also if you are under age 65 and receive Medicare because you are disabled, you are not eligible for open enrollment and must meet a company's medical standards to purchase Medigap insurance.
Can a Medigap Policy be canceled?
NO, all Medigap insurance policies are guaranteed renewable, no matter how many claims you have filed, but a company can cancel you if you do not pay the premiums or you give false information of a material fact on your application.
If you want to switch to another Medigap insurance policy, don't cancel your first Medigap policy until the new Medigap insurance policy is in place and you have reviewed it and decided to keep it. You have 30 days to return the Medigap insurance policy and receive a full refund.
Note: You do NOT need a Medigap insurance policy if you are institutionalized or at home and on Medicaid; or if you are eligible for the Qualified Medicare Beneficiary (QMB) program; or you join a Medicare Advantage Plan. These programs pay for all you medical care. To check you QMB eligibility, submit an application to your local County Department of Job and Family Services.
