Medigap and Medicare Supplements
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Medigap / Medicare Supplement Policies
Medigap policies are Medicare Supplement plans that helps cover the “gaps” in Original Medicare and are sold by private insurance companies. Not all Medigap policies are available in all areas. Contact us or find a agent to find out what is available in your area. We will need to go over Original Medicare coverage in order to know what “gaps” need to be covered.
Original Medicare
Original Medicare is a federal health plan that began on July 30, 1965 with President Lydon B. Johnson as the first person to receive a Medicare card. Medicare has since grown to cover more medical services with approximately 63 million beneficiaries.
Original Medicare is broken down into Part A and Part B.
Medicare Part A
Medicare Part A helps cover your inpatient care, critical access hospitals, hospice, and some home health care, and skilled nursing facility with limitations. Original Medicare Part A DOES NOT COVER ALL COSTS.
Costs Associated to Medicare Part A
Most people will not have a premium for Medicare Part A because they have paid Medicare taxes for generally at least 10 years. (called Premium Free Part A). However, if you do not qualify for premium free Part A, you will have a monthly Part A premium depending on how long and how much you or your spouse has paid Medicare taxes.
Additionally, you will have a deductible each time you are admitted to the hospital per benefit period (from first day of admission till 60 days after last inpatient hospital care date). There is no limit to the number of benefit periods.
After the deductible, you will have a cost share from day 61-90 at a copay per day and day 91-150 at a different copay per day (lifetime reserve days). After you have used up your lifetime reserve days you will pay all costs. See here for current cost-share
Medicare Part B
Medicare Part B helps cover medical services like doctors’ visits, outpatient care, durable medical equipment, and other medical services not covered under Medicare Part A. Generally, Medicare Part B will cover medically necessary services and preventative services.
Specifically, you may pay nothing for preventative services. Alternatively, you will likely pay 20% of the cost for each Medicare-covered services or items after you have paid the annual deductible for Part B. See here for deductible
How to get help with the gaps in coverage?
Medigap policies benefits were standardized into 10 plans through the Omnibus Budget Reconciliation Act of 1990.
* Plans F and C aren't available for people who were newly eligible for Medicare after January 1, 2020.
1 Plans F and G also offer a high-deductible plan option in some states. Call us for more details
- Plan N covers 100% of the Part B coinsurance, except for a copay of $20 for some doctor office visits and up to $50 for emergency room visits that do not result in inpatient hospitalization.
Call us today or find a agent to find out more information about Medigap plans!
What is not covered?
Generally, you will not have coverage for long-term care, routine vision, routine and comprehensive dental, hearing aids, eyewear, and annual physical (Original Medicare will only cover a welcome to Medicare physical and after will pay for annual wellness visits.)
Who fits a Medigap Plan
Still interested in a Medigap plan? As a broker, we find that Medigap plans may not be for all of our clients. Here are some factors to consider when talking with one of our agents.
- Medigap / Medicare Supplement policies have an additional premium to Medicare Part B Premium
- If you need prescription coverage, you will need to enroll in a separate Part D policy with its own premium.
- You must have Medicare Part A and Part B
- Medigap policies are not the same as Medicare Advantage. Medigap policies supplement Original Medicare benefits.
- Medigap policies are only for 1 person. If you have a spouse on Medicare, you will both need to get your own policies.
- You can only purchase Medigap policies from insurance carriers who are licensed to sell Medicare Supplement plans in your state. As a broker, we can help you shop for the plans with a competitive rate and right fit for you. (Find an agent to help you find your Medigap options)
- All standardized Medigap policies are guaranteed renewable, which means your policy cannot be cancelled except for non-payment of premiums. We highly suggest enrolling in automatic payments to ensure your plan does not get cancelled in the event you are not able to make a premium payment personally due to a health event or other life situation.
- It is illegal for an agent to sell you a Medigap policy if you are on Medicare Advantage plan, unless you are switching back to Original Medicare. You are not allowed to be enrolled in a Medicare Advantage plan and Medigap policy at the same time.
When can you enroll?
You may have heard from your family or friends that there are only certain times of the year you can enroll or change your plan. Hopefully, we will be able to clarify when you can enroll in this section.
You can apply for a Medigap policy at anytime. Typically, the best time to buy a Medigap policy is during your 6 month Medigap open enrollment period. You will usually get better prices and more choices of carriers and plans with no medical underwriting. The 6 month period will start the first month you have Medicare Part B and are 65 years old or older.
After your Medigap open enrollment period, you will need to go through medical underwriting unless you qualify for a guaranteed issue right. If you do not have a guaranteed issue right, there is no guarantee that an insurance company will sell you a Medigap policy. The insurance company may deny or charge a higher premium if you do not meet the medical underwriting guidelines.
We know that your situation may not be as simple that it can be answered by this guide. Call us today to find out your options. You can also find a agent in your area.
We do not offer ever plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get more information on all of your options.
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ADDRESS
805 N. Dobson Rd. Ste 111-1, Mesa, AZ 85201
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PHONE
602-837-5959