Medicare Supplements – In Detail

Medicare Supplement Plans/Medi-Gap Plans

Eligibility

  • Must be enrolled in Medicare Parts A & B
    • This is what the policy fills the “holes” of
  • Resident of the state in which they are applying for coverage
    • This means per state income taxes, which state you file taxes in as your primary/main/resident state.
  • In Colorado, all carriers have to offer all plans to those under age 65 that they do to those who are over age 65.
    • Client must meet certain criteria
      • SSDI for 24+ months- now on Medicare A and B
      • Must be in a guarantee issue window
    • Other states will vary.
      • Several states do not offer any Medicare Supplement plans to those under age 65.

Medicare Supplement/Medi-Gap Fast Facts

  • Helps cover some or all of what Medicare Parts A and B do not pay (FILLS IN THE GAPS- A.K.A. MEDIGAP)
    • Deductibles
    • Coinsurance
    • Copayments
  • Offered by private insurance companies
    • Benefits/Coverage standardized by government
      • Plans A with company A is identical in COVERAGE to Plan A with company B
    • Price, Agent Compensation, and Customer Service are what separates them
  • Plans are named A, B, C, D, F, High-F, G, K, L, M, and N
  • Generally, the more comprehensive the coverage, the higher the premium for the plan. Plan F is most comprehensive and thus most expensive (most of the time)
  • Regulated by state and federal laws- Not regulated by CMS

Medicare Supplement Plan Strengths:

  • Depending on the plan, some or all out-of-pocket costs for care under Medicare Part A & B are covered
    • Copayments, Deductibles, Coinsurance
  • Guaranteed the right to buy a Medi-gap policy during the open enrollment period and other guarantee issue windows
  • Predictable costs.
    • Plan F for example
      • Pay the premium, pay nothing later. Premium is only out of pocket maximum
    • No network restrictions, no referrals
      • Use anywhere Medicare Part A and B are accepted

Medicare Supplement Plan Weaknesses:

  • Pricing for plans can vary greatly between carriers for the same coverage
  • Premiums can rise annually, semi-annually, and other intervals depending on the type of plan and insurance carrier you are enrolled with.

NO COST, NO OBLIGATION

Answers To Your Medicare Questions