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Medicare Supplements

Medicare Supplement Insurance, also known as Medigap, is a private health insurance policy that helps pay for some of the costs not covered by Original Medicare (Part A and Part B), such as copayments, coinsurance, and deductibles. Medigap policies work with your Original Medicare coverage, not a Medicare Advantage Plan. 

How Medigap works

  • Standardized plans: Medigap policies are standardized and identified by letters (e.g., A, B, C, F, G, K, L, M, N) in most states.
  • Identical benefits: A policy of the same letter (for example, Plan G) has the same basic benefits no matter which insurance company sells it.
  • Varying premiums: The only difference between Medigap policies with the same letter is the premium charged by different insurance companies.
  • Part B enrollment is required: You must be enrolled in Original Medicare Part A and Part B to buy a Medigap policy.
  • Not a replacement for Original Medicare: Medigap policies do not replace Original Medicare; they only supplement it. 

Key differences between Medigap and Medicare Advantage

It is important to understand the distinctions between Medigap and Medicare Advantage plans, as you cannot have both at the same time. 

 

Feature Medigap Policy Medicare Advantage (Part C) Plan Relationship to Original Medicare Works with Original Medicare (Part A and Part B). Replaces Original Medicare. You get your Part A and Part B benefits from a private insurance company. Coverage Gaps Fills in gaps in Original Medicare coverage, such as deductibles, coinsurance, and copayments. Often includes prescription drug coverage and may offer extra benefits not covered by Original Medicare, like dental or vision. Provider Networks Allows you to see any doctor or visit any hospital that accepts Original Medicare. Typically requires you to use doctors and hospitals within the plan's network.  Premiums You pay a monthly premium to the private insurance company in addition to your Part B premium. Plans may have low or zero-dollar monthly premiums, though you must still pay your Part B premium.

 

How to buy a Medigap policy

  1. Be enrolled in Part A and Part B: You must first be enrolled in Original Medicare.
  2. Wait for your Open Enrollment Period: The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This is a one-time, six-month period that starts the month you turn 65 and are enrolled in Medicare Part B. During this time, insurers cannot deny you coverage or charge you more for pre-existing conditions.
  3. Choose a plan: Compare the benefits of the different standardized plans (A, B, C, F, G, K, L, M, N) and select one that fits your needs.
  4. Find an insurer: Find insurance companies in your state that sell the standardized plan you want. You can compare rates between different companies for the same lettered plan.
  5. Look into state resources: For assistance with your Medicare supplement needs, you can contact your State Health Insurance Assistance Program (SHIP).

Medicare Advantage

 

Medicare Advantage (Part C) is a private alternative to Original Medicare that bundles Part A (hospital insurance), Part B (medical insurance), and usually Part D (prescription drug) coverage into one plan. These plans, offered by Medicare-approved private companies, can provide extra benefits like vision, hearing, and dental services but often require using providers within a specific network and may require referrals to see specialists. You can join a Medicare Advantage plan during specific enrollment periods, such as the Annual Election Period (October 15–December 7) or the Medicare Advantage Open Enrollment Period (January 1–March 31).

 

What It Is
  • Bundled Coverage: Medicare Advantage plans combine your Part A, Part B, and often Part D (prescription drug) coverage. 
  • Private Plans: These plans are offered by private, Medicare-approved insurance companies. 
 
Key Benefits 
  • Extra Benefits:.
    Many plans offer additional coverage not found in Original Medicare, such as vision, hearing, and dental services.
  • Cost Savings:.
    Some plans may offer lower out-of-pocket costs for certain services or even help pay for your Part B premium.
     
Things to Consider 
 
  • Provider Networks:
    You typically need to use doctors and other healthcare providers who are in the plan's network for non-emergency care.
  • Referrals:
    Some plans require a referral from your primary doctor to see a specialist.
  • Plan Premiums:
    You may have to pay a monthly premium for the Medicare Advantage plan in addition to your standard Part B premium.
     
How to Enroll 
 
  • Annual Election Period (Open Enrollment):.
    This period, from October 15 to December 7, is when you can join, switch, or drop a Medicare Advantage plan.
  • From January 1 to March 31, people already in a Medicare Advantage plan can switch to another plan or switch back to Original Medicare.