Medigap FAQs
Medicare Supplement Answers
1. What is the Medicare Supplement Plan?
Medigap, also known as Medicare Supplement Plans, are additional insurance that you buy from a private company to pay health care costs not covered by Medicare. More about the definition here.
2. What are the gaps that I need to cover with a Medicare Supplement?
Know that if you rely on Original Medicare alone, there will be no out-of-pocket spending cap or spending limit on your Medicare costs.
Medicare Part A (Hospital insurance):
Deductible per benefit period: $1340
Coinsurance per day of each benefit period (hospital stay Day 61-90) – $335
Coinsurance per each “lifetime reserve day” (hospital stay Day 91 and up to 60 days over your lifetime) – $670
Beyond lifetime reserve days – you pay all the costs.
Skilled nursing facilities:
Days 21-100 Coinsurance per day of each benefit period – $167.50
Days 101 and beyond – You pay all the costs
Medicare Part B (Medical insurance):
Annual deductible – $183
You are also responsible for 20% of the costs of medical services under Medicare Part B.
3. Who is qualified to buy Medigap?
Anyone who is already under Medicare parts A and B.
4. Does everyone need Medicare Supplement Plans?
Not everyone needs Medicare supplements. If you own other health coverage, the gaps in your Medicare might have already been covered. You don’t need a Medicare supplement insurance if you:
- Have a Medicare Advantage plan.
- Are on Medicaid
- Has Qualified Medicare Beneficiary program that pays your Medicare premiums and out-of-pocket costs.
- Has employer group health plan
5. When Can I Buy Medicare Supplement plans?
You can apply for Medicare Supplements during your Open Enrollment period which includes:
- The six months period from the date you enrolled in Medicare Part B and are already 65 years old.
- Up to 6 months after you turn 65 years old if you became eligible for Part B before you turned 65 years old.
- If you became eligible for Medicare Part B before age 65 because of a disability, you are guaranteed to have Medicare Supplement policy of your choice within the first six months that you are 65 years old and has Medicare Part B.
Download our Ultimate Guide to Medigap Open Enrollment Period when you request for a free quote HERE.
6. How Do I enroll?
Contact a licensed agent. Since the prices of Medigap policies vary from one insurance company to another, the best way to get a plan is to compare prices. To do that, you need a licensed insurance agent who will provide you with an unbiased wide range of plan options and price quotes.
7. Can I apply for Medicare Supplements without Medicare Parts A and B?
No. You must have Medicare Part A and are already enrolled in Medicare Part B.
8. How much does Medigap plan cost?
Medigap plans are sold by private insurance companies which are free to set prices for the plans they offer. The costs also vary depending on various factors. Learn how companies set Medigap costs here.
9. How does Medigap work with Medicare?
Original Medicare will pay first and your Medicare Supplement plan will fill in the cost gaps or the remaining Medicare-approved health care expenses that Medicare did not cover.
No. You can’t use Medigap to pay for your Medicare Part B premium. The premium you pay for Part B is different from the premiums that you need to pay for Medigap. Medigap can’t be used to pay for any other insurance premiums.
11. Will I be accepted into a Medicare Supplement Plan if I have preexisting conditions?
Yes, but it will depend on when you acquired your Medigap policy. There is also a pre-existing condition waiting period which varies according to your guaranteed issue rights, creditable coverage and if you buy your policy during your Open Enrollment period.
Learn more about the pre-existing condition waiting period and guaranteed issue rights HERE.
12. Are there any networks of doctors that I need to only use?
None. You can go to any doctor as long as they accept Medicare.
13. Do I need to switch new doctors if I have Medicare Supplement policy?
No. You don’t have to switch doctors. You will be covered as long as you seek consultation or your doctor accepts Medicare.
14. Do I need to have an appointment to visit my specialist to get Medigap benefits?
No. You can visit your specialist whenever you want. Take note that your out of pocket costs will be less if your specialist accepts Medicare assignments.
15. Can I switch from one Medigap plan to another?
Yes! You may be able to downgrade your plan any time but might need to submit a new application if you want to upgrade.
16. Can I be denied Medicare supplement insurance?
Yes. If you opt to have Medigap after your Open Enrollment Period, an insurance company offering Medicare Supplements may not accept your application if you don’t meet the underwriting requirements.
Take note that during your Open Enrollment Period, insurance companies can’t deny you a Medicare supplement policy or charge you a higher premium because of pre-existing conditions.
17. Is Medicare Supplement Insurance necessary?
No. Enrolling in Medicare supplement insurance is not mandatory, but please do remember that without it, you might end up with staggering out-of-pocket medical expenses.
18. What is the best Medicare supplement insurance plan?
Medicare Supplement Plan F offers comprehensive benefits, but not everyone needs this much coverage. Therefore, the best Medicare supplement insurance plan will depend on your needs.
19. How to choose a Medigap supplemental policy?
Look at your needs first then check for the various benefits that each Medicare supplement plan offers. Comparing types of plans side by side and requesting a Medicare Supplement quotes will also help you compare and choose a Medigap policy.
20. What if I travel or move to another state?
Usually, your Medigap plan will travel with you even if your plan is not offered in that state. To make sure, consult your Medigap plan provider before heading to any location.
21. Where can I buy Medicare Supplements?
Find out which insurance companies offer Medicare Supplements by getting a Medicare supplement quotes here. When you request for a free quote, you will be contacted by a licensed insurance agent who will help you find the company and Medigap policy perfect for your needs.
22. Is Medicare Advantage plan same as Medicare Supplements?
No. Medicare Advantage is not the same as Medicare Supplement plans.
Medicare Advantage plan provides your Medicare Part A and B coverage with some additional benefits while Medigap supplements your Original Medicare by paying all or part of the Medicare-approved health care expenses that Medicare did not cover (Medicare excess or gap).
Learn more about the differences between Medicare Advantage and Medigap here.
23. I already have Medicare Advantage, can I also-enroll in a Medigap?
Yes and No. Yes, you can join Medigap while you are still enrolled in Medicare Advantage. But you can’t have them both at the same time. You have to drop your Medicare Advantage plan before Medigap coverage starts.
Learn more about switching from Medicare Advantage to Medigap here.
24. Can I switch from Medicare Advantage to Medigap?
Yes. You can switch from Medicare Advantage Plan to a Medigap policy within the first year of your enrollment. Learn other circumstances when you can switch from Medicare Advantage to Medigap here.
25. Can I use my Medicare Supplement plan with a Medicare Advantage plan?
No. Medicare Supplement plans can only be used with Original Medicare (Part A and B). If you currently have Medicare Advantage plan and enroll in a Medigap, you will have to drop your Advantage plan before Medigap start its effectivity.
Some of the common words that you will most likely encounter as you take your journey towards Medigap:
Assignment
Health care providers who accept Medicare patients on assignments cannot charge more than the Medicare-approved amount.
Benefit Period
The moment when you are admitted to a hospital and ends when you have already stayed out of the hospital or skilled nursing facility or haven’t gotten any inpatient hospital care for 60 days in a row.
Coinsurance
Refers to the percentage of the cost that you are required to pay. It is the amount that you share as payment of a medical service or item covered by Medicare. The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).
Coordination of Benefits
A system that ensures that your medical bills are sent to the right insurers in case you have more than one. It decides which one of your multiple health coverages (also called as the payers) will pay first. Your “primary payer” pays what it owes on your bills first and then sends the rest of your bills to the secondary payer.
Copayment (or Copay)
It is the specific or set amount in dollars that you will pay to the cost of a medical service or item that Medicare covers.
Creditable Coverage
A health coverage under other source or health benefit plans such as employer-sponsored benefits that meet a minimum set of qualifications or at least equal to Medicare.
Deductible
Any amount of out-of-pocket payment that you are required to give for medical services prior to the start of your coverage.
Dual Eligible
The person who can obtain benefits from both Medicare and Medicaid benefits.
Lifetime Reserve Days
Medicare offers an additional 60 days that you can get or withdraw to get a Medicare coverage beyond the 90 days a hospital per benefit period. These 60 days good for a lifetime but are not necessarily needed to use it all in one hospital stay.
Open Enrollment Period
The first day of the month that you are both 65 years old and are enrolled in Medicare Part B and will last for only six months. This is the time that you can apply for Medigap policies that insurance companies cannot decline your application.
Pre-existing Conditions
Are medical conditions that you already have before your Medicare supplement started.
Primary Insurer
The insurance that pays your medical bills first in case you have more than one type of health coverage.
Service Area
The area, place or location where you need to live to get the benefits of your coverage.