Medicare covers most, but not all, of a members medical expenses. Medicare Supplements are health insurance policies sold by private health insurance companies to fill these “gaps” in Medicare coverage. Hence the name “medigap” policies. Medigap plans pay something after Medicare pays. Medigap benefits were “standardized” by Medicare in 2010 into 11 categories – listed as A – N in the benefit tables. Get Quotes & Apply

It is important to know that the Departments of Insurance in each state determine the eligibility and underwriting rating structures of the Medicare supplement plans sold in their states. To be eligible to purchase a Medicare supplement plan in all states you must be enrolled in both Medicare Parts A & B, and be a resident of that state.

Medicare Supplements marketed after January 1, 2006 do not have prescription drug coverage. If you choose to remain in your older plan with prescription coverage, check with your plan provider to see if they are maintaining “creditable” drug coverage.

However, after June 1, 2010, all supplement plans sold will fall under the new MIPPA standards (Medicare Improvements for Patients and Providers Act). Carriers will no longer offer E, H, I, and J plans. If you are enrolled in one of these plans you may keep your coverage and the beneftis will not change.

Carriers after June 1, 2010 may offer only A, B, C, D, F, Hi-Deductible F, G, K, L, M and N plans. M & N plans are totally new. They have much lower premiums but require the member to take on a higher share of cost with Part A hospital deductibles and all of the Part B medical deductible. Carriers are not required to offer all plans. And they may offer different plans in different areas, or none at all.

The “modernized” plan benefits cover some or all of the following costs:

  • Part A coinsurance and deductible
  • Part B deductible, excess charges, and coinsurance charges
  • Additional hospital days
  • Foreign travel emergencies
  • Skilled Nursing Facility (SNF) coinsurance
  • Preventive Care coinsurance
  • Hospice Care coinsurance
  • First 3 pints of blood
  • Out-of-pocket expense limits

What is no longer covered in all Medicare supplement plans are At- home Recovery, Preventive Care, and Hospice Care.

  • Hospice is now added to  every plan as part of Part A Basic (Core) benefits.
  • At-Home Recovery has been updated to coordinate with Medicare guidelines and is no longer a separate benefit.
  • Preventive Care has been updated to coordinate with Medicare’s expansion of preventive care coverage.

The best time to buy a Medigap policy is during your Open Enrollment Period – the 6 months after you turn 65 years of age. During this period, an insurance company can not deny you coverage, place conditions on a policy, or charge you more because of a pre-existing medical condition. There is no guaranteed issue provision for those existing standardized plan members 65 or over to switch to the modernized plans.

There are some exceptions. In California, there is the Birthday Rule which allows all members to downgrade or move to a lateral plan during the 30 days following their birthday. And disabled members are allowed to downgrade or move to another Pre-65 supplement plan with lesser benefits and at a lower cost.

Applicants for Medicare supplements will be denied coverage for any of the following reasons:

  • End Stage Renal Disease (ESRD)
  • Dialysis is required
  • The applicant was admitted to a hospital with in the past 90 days.
  • A medical professional has recommended or discussed with the applicant as a treatment option any of the following that has not been completed: hospital admittance; organ transplant; back or spinal surgery; joint replacement; and cancer, heart or vascular surgery.

All Medicare supplements share these benefits:

  • Guaranteed renewability each year regardless of your health condition with no reduction in benefits as long as you pay your premiums on time.
  • No “lock-in” periods like Medicare Advantage plans and Part D prescription plans.
  • A 30 day “free look” evaluation period.
  • National coverage anywhere in the United States
  • The freedom to choose any doctor that accepts Medicare assignment.
  • Foreign travel emergency medical coverage.
  • No claims forms to file.

It is important to consider both your current medical condition and your future medical needs before buying any Medicare plan. If you have ongoing medical challenges now and anticipate needing increased medical care, a medicare supplement may be your best option. It will help you to better manage your out-of-pocket medical expenses.