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Supplemental (Medigap)

A Medicare supplemental plan, often referred to as Medigap, is a supplemental insurance plan that you purchase from an insurance company. They are designed to cover some of the out-of-pocket expenses that Original Medicare (Medicare Parts A and B) do not cover, such as coinsurance, copayments and deductibles.

When choosing a Supplemental plan, you will have 10 standardized plans to choose from (A,B,C,D,F,G,K,L,M and N). Each plan is different and you will have to compare benefit options and costs for each plan. Plans will generally cover between four and nine of the following benefits:

  • Medicare Part A coinsurance for hospital costs (up to an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance or copayment
  • The first three pints of blood for a medical procedure
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergencies

All plans cover Medicare Part A coinsurance and hospital costs at 100%

Under Original Medicare, prescription benefits are not covered after you reach a certain dollar amount until you reach a “catastrophic” level, at which time they will pay 95% of prescription drug costs. This creates a whole in your prescription coverage that you will have to personally cover. Again a Supplemental plan can help cover this gap in coverage.

Once you are enrolled in Medicare, you have six months to enroll in a Medicare Supplemental insurance plan. If you enroll during this six months period, the insurance companies cannot refuse you coverage.

If you have a pre-existing condition, insurance company can make you wait up to six months for coverage of your pre-existing condition to begin. Pre-existing only applies to the supplement – not the original Medicare.

Important things to also consider is vision, hearing and dental coverage? Neither Original Medicare nor a supplemental plan provide for these benefits. If you want insurance coverage for these services, you will want to consider a personally owned insurance policy.

There is a lot to consider when electing your benefits and it can quickly become overwhelming. We know and understand these plans and can help you determine the write plan or combination of plans for your needs.