Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap policies do not cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Every Medigap policy must follow federal and state laws and is standardized by the government. They are designed to protect you, and they must be clearly identified as “Medicare Supplemental Insurance.”
Most states offer Medicare supplemental insurance lettered A through D, F through G, and K through N. Each plan having different coverage levels, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
What else should I know about Medicare Supplement Insurance (Medigap)?
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.
If you delay enrolling in Part B because you have group health coverage based on your (or your spouse’s) current employment, your Medigap Open Enrollment Period won’t start until you sign up for Part B.
Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65. If you’re able to buy one, it may cost more. Ask us for details.
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll get your Medicare Part A (Hospital) and Medicare Part B (Medical) coverage from the Advantage Plan, not Original Medicare. In most cases, you’ll need to use health care providers who participate in the plan’s network and only within the plan’s coverage area. Some plans offer out-of-network coverage. You must use the card from your Medicare Advantage Plan for services. Keep your Original Medicare card in a safe place because you’ll need it if you ever decide to switch back to Original Medicare.
What are the different types of Medicare Advantage Plans?
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
Some Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, gym memberships, over-the-counter benefits, and other health and wellness programs. Most include Medicare prescription drug coverage (Part D). Most Medicare Advantage plans do not have a monthly premium but there are some that do.
Medicare prescription drug coverage is an optional benefit. Medicare offers drug coverage to everyone with Medicare. Even if you don’t take prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage.
To get Medicare prescription drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can varies in costs and coverages.
There are 2 ways to get Medicare prescription drug coverage:
In either case, you must live in the service area of the Medicare drug plan you want to join.
Below are descriptions of what you pay in your Medicare drug plan. Your actual drug plan costs will vary depending on:
Long-term care is a variety of services which include medical and non-medical care for people who have chronic illnesses and/or disabilities. This type of care provides support with activities of daily living in or out of nursing homes. It is important to remember that you can need long-term care at any age. Statistically more than 73% of people will need long term care services at some point in their life, it is crucial to have a plan of action in place. You can receive long-term care in your own home, adult day care center, nursing home, memory care, or assisted living facility.
There are two types of long-term care services:
Long-term care can be expensive. The cost depends on the amount and type of care you need, and where you receive it. There are multiple ways to protect yourself against this exposure. You can have a stand-alone long-term care insurance policy or include the coverage as a rider on a life insurance or annuity policy.
There are several ways to pay for long-term care. The most common include: