Medicare Supplement/Medigap Plans

Medicare Supplements/Medigap Plans

Many Medicare beneficiaries choose to purchase a Medicare Supplement, also called a Medigap Plan, to create a smooth pathway to their healthcare by eliminating coverage barriers like networks and prior authorizations for treatment. A Medicare Supplement, also known as a Medigap Plan, is a government-standardized secondary policy sold by private insurance companies to cover some of the deductibles, copays and co-insurance of Medicare Part A & B. Medigap plans only cover what Medicare covers and only pay after Medicare pays. Some companies include a free gym membership to help you stay active and healthy.

There are ten Medicare Supplement plans: Plan A-D, F, G and K-N. The benefits are standardized by the government which means that the benefits are the same no matter which company you buy the plan from; the only difference is the premium. The government has closed enrollment to Plan F and C to anyone not already on Medicare by January 1, 2020, meaning that if you turn 65 after 1/1/2020, you cannot buy the F or C. If you already have the Plan F or C, you can keep it and if you were age 65 before 2020 or your Part A is before 2020, you can still buy a C or F.

Medicare Supplements Explained

A Medicare Supplement drastically reduces your out-of-pocket for hospital and medical costs by covering most or some of the deductibles, copays and co-insurance of Part A and B. To purchase a Medicare Supplement, you must have Medicare Part A & B and live in the state you are applying for coverage. If you are enrolled in a Medicare Advantage plan, you do not need a Supplement. Advantage Plans and Supplements cannot work together and you should not have both; the Medicare Supplement will do nothing if you have an Advantage Plan.

You are Guarantee Issue for a Supplement 6 months from your 65th birth month or your Part B effective date. This means that you do not have to answer health questions, and your premium rate is not affected by your health. After that 6-month period, you can apply or change your plan at any time during the year but will have to go through underwriting (answer health questions) and could be denied or rated up based on your health. Companies typically do a 5-year look-back on medical records and will consider the reasons you take your medicines.

If you are covered by a retiree group health plan, you may not need a Medicare Supplement because your employer coverage may act as a Supplement. You do need Part A & B if you have retiree coverage, as that coverage is primary, and Medicare is secondary. If you involuntarily lose a retiree Group plan, or if you lose employer coverage, you have 63 days to get a Medicare Supplement with no underwriting.

Medigap for Those Under Age 65

The rules for Medicare Supplements for beneficiaries under 65 years old on Medicare for disability vary by state. There are limited circumstances when you can get a policy without underwriting. Premiums will be higher than for someone over age 65. In Kentucky, as of January 1, 2024, people who are new to Medicare for disability have the same rights to get a Medicare Supplement as someone 65 or older.

At Imagine Insurance Advisors, we not only specialize in Medicare options, but in coverage for people under age 65 on Medicare for a disability. There are few agents who understand this segment of the market as well as we do. We have been honored to establish relationships over the years with several regional organizations who generally serve under age 65 Medicare beneficiaries to be their professional referral for their patients. This has given us extraordinary experience in this area. We work with many people with disabilities and work hard to find the coverage that will work best for your unique situation.

Choosing a Medicare Supplement Plan

Not only do you have options for the Medicare Supplement plan you choose, but the company you choose to buy your plan from is even more important. Every company will have premium rate increases at least annually. This is because the deductibles in Medicare rise each year and the amount of claims that the pool of policyholders you are in had (how much did everyone as a whole go to the doctor). After your Guarantee Issue period has ended, if you want to change your Supplement, you must be able to pass underwriting which are health questions. Rate stability is just as important as the initial premium because of underwriting and its potential to restrict your ability to change companies or plans. If you choose an unstable company and experience a major health accident or diagnosis, you may not be accepted by another company with a more affordable premium because you will not be able to pass underwriting.

What Are "Select" Plans?

Some companies establish a "Select" version of a plan. "Select" means that they have a network of hospitals for non-emergency, in-patient hospital stays (like a knee replacement or scheduled surgery). You can go for out out-patient for treatment anywhere in the U.S. that accepts Medicare, but will have a network of hospitals you need to use for in-patient, non-emergency admittances. Premiums are generally lower and have the same benefits as their Standard counterparts. If you choose a "Select" plan, make sure that any hospital you may want to go to is in their network. Also, be aware that the network can change at any time, but you may not be able to change your plan due to underwriting.

What Does a Medicare Supplement Not Cover?

Medicare Supplements do not cover long-term care (beyond Medicare's 100-day skilled nursing benefit), dental, routine vision care and glasses, hearing aids, or prescription drugs. The Supplement only covers what Original Medicare covers. We can help you find plans to fill these gaps through separate policies.

The exception is that most Medicare Supplements offer limited foreign travel emergency coverage. The lifetime amount is limited and may not be sufficient for more serious accidents or illnesses, so check out our page on International Travel Coverage.

Medicare Supplement Experts

At Imagine Insurance Advisors, we are continually evaluating the various Medicare Supplement companies we recommend and deciding if we feel they will remain stable for the long-term. The carriers we recommend are ones that have proven rate stability over the last 15-20+ years and maintain satisfactory credit bureau ratings. We can help you decide which company and plan will meet your expectations. We look for strong rate stability, competitive rates and a dedication to the senior market. Give us a call today to schedule a no obligation Medicare Supplement review.

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