As a Medicare beneficiary, you’re probably already familiar with your coverage for medical costs and hospital care. You may also be aware of the gaps in Medicare coverage for necessary services and supplies. What you may not know is how these coverage breaks can be filled using supplemental insurance plans also known as Medigap plans. If you’re not one of the one in five Medicare beneficiaries enrolled in a Medicare supplement plan, let us help you understand your plan options so you can make an informed choice.

Medigap

Medicare supplement insurance, or Medigap, is provided by private insurance companies. It can be used to help with some healthcare costs not covered by Medicare, like deductibles, copayments, and coinsurance. Some Medigap policies even provide coverage for other services like medical care for international travelers. Medicare recipients who purchase supplemental policies have coverage to the approved amount for covered healthcare costs, after which Medigap coverage kicks in.

What You Need to Know

Let’s look at some basic facts about Medigap policies that will help you understand your options. First and foremost you need to have both Medicare Part A and Medicare Part B to purchase any supplemental policy. To make the most of your Medicare supplemental plan options, enroll during your six-month Medicare Supplement Open Enrollment Period. This begins the first day of the month you are both over the age of 65 and enrolled in Medicare Part B. Why should you aim for this period? Because during your open enrollment period, insurance providers can’t deny you coverage based on medical underwriting. If you don’t enroll during this period of time, providers can use medical underwriting to deny coverage. This can make finding an affordable plan that will accept your coverage more difficult.

If you and your spouse want supplemental coverage, you’ll have to buy separate policies; Medigap policies only provide coverage for one person. Finally, be aware that dental or vision care, eyeglasses, hearing aids, long-term care, and private-duty nursing usually aren’t covered under Medigap policies.

Premiums and Coverage

You can buy supplemental coverage from any private insurance company that is licensed to sell Medigap policies in your state. You will pay a monthly premium in addition to your Part A hospital deductible and your Part B coinsurance. Premiums and out-of-pocket costs associated with each plan may differ based on which private insurer you purchase coverage from, but benefits and plan coverage are standardized. As long as you pay your premium, your standardized supplemental policy is guaranteed to be renewable, and it can’t be cancelled by your insurance company, even if you have health problems.

Advantage and Prescription Drug Plans

Medigap policies are not the same as Medicare Advantage Plans. A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most Medicare Advantage Plans also offer prescription drug coverage.

If you have an Advantage plan and you want to apply for a Medigap policy, be certain that you can leave the Advantage plan before your Medigap policy goes into effect. If you have a Medicare Medical Savings Account (MSA) Plan, you can’t legally be sold a Medigap policy. Medigap policies sold after January 1, 2006 cannot include prescription drug coverage. For that, you’ll have to enroll in a Medicare Prescription Drug Plan, otherwise known as Part D.

Medicare Supplement Plans can be confusing. Why do the heavy lifting when we can do it for you? HealthMarkets Insurance Agency has a nationwide network of licensed local agents to help you find the Medigap or Advantage plan option that suits your specific coverage needs at a price that fits your budget – and we do it all no cost to you. Visit HealthMarkets or call (800) 488-7621 today.

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