Medicare Supplement Insurance (Medigap)

Understanding How Medicare Supplement Insurance Can Help Protect You from Out-of-Pocket Healthcare Expenses

Medicare Supplement Insurance, commonly known as Medigap, is additional health insurance offered by private insurance companies to help pay certain healthcare expenses that Original Medicare (Parts A and B) does not fully cover.

Although Original Medicare provides valuable hospital and medical benefits, beneficiaries may still be responsible for deductibles, copayments, and coinsurance.

Medicare Supplement insurance is designed to help reduce these expenses and provide greater predictability when managing healthcare costs.

At My Health Insurance Spot, our goal is to help you understand how Medicare Supplement policies work and how they may complement your Original Medicare benefits.

How Does Medicare Supplement Insurance Work?

Medicare Supplement insurance works alongside Original Medicare rather than replacing it.

1. Works with Original Medicare

To purchase a Medicare Supplement policy, you generally must be enrolled in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).

You continue receiving your Medicare-covered healthcare services through Original Medicare.

2. Helps Pay Remaining Medicare Expenses

When you receive covered healthcare services, Original Medicare generally pays its share of the Medicare-approved costs first.

Your Medicare Supplement policy then helps pay eligible remaining expenses according to the benefits provided by your specific policy.

For example, Medicare Part B generally pays 80% of the Medicare-approved amount for covered medical services after the annual deductible has been met. Depending on the Medigap plan selected, your supplemental coverage may pay the remaining 20% coinsurance.

3. Standardized Insurance Benefits

Medicare Supplement policies are standardized by plan letter in most states, including Florida.

This means that a standard Plan G offered by one insurance company provides the same basic medical benefits as a standard Plan G offered by another company.

However, monthly premiums, customer service, and certain policy features may differ between insurance companies.

4. Freedom to Choose Healthcare Providers

One important advantage of Medicare Supplement insurance is the flexibility to receive covered healthcare services from any doctor, specialist, or hospital in the United States that accepts Medicare.

Medigap policies generally do not require you to use a specific network of healthcare providers.

5. Guaranteed Renewable Coverage

Standardized Medigap policies sold today are generally guaranteed renewable. As long as you pay your premiums, the insurance company generally cannot cancel your policy because of changes in your health.

Premiums may increase over time according to applicable policy terms and state insurance regulations.

What Does Medicare Supplement Insurance Cover?

The benefits depend on the standardized Medigap plan you select.

Depending on the plan, coverage may include:

• Medicare Part A Hospital Coinsurance: Helps pay eligible hospital coinsurance expenses and provides up to 365 additional hospital days after Medicare hospital benefits are exhausted.
• Medicare Part B Coinsurance or Copayments: Helps pay certain remaining costs for covered physician and outpatient medical services.
• Medicare Part A Deductible: Certain Medigap plans help pay all or part of the Medicare Part A hospital deductible.
• Skilled Nursing Facility Coinsurance: Certain plans help pay eligible coinsurance expenses for Medicare-covered skilled nursing facility care.
• Hospice Care Coinsurance: Helps pay eligible Part A hospice coinsurance or copayments.
• Blood: Helps cover the cost of the first three pints of blood when needed for a covered medical procedure.
• Foreign Travel Emergency Coverage: Certain plans provide limited emergency medical coverage while traveling outside the United States, subject to plan requirements and limits.

Not every Medicare Supplement plan covers all these expenses. Benefits depend on the standardized plan selected.

What Medicare Supplement Insurance Generally Does Not Cover

Medigap policies are designed primarily to help pay certain costs associated with Original Medicare.

They generally do not provide coverage for:

• Outpatient Prescription Drugs: Most beneficiaries who want prescription drug coverage purchase a separate Medicare Part D plan.
• Routine Dental Care: Such as routine examinations, cleanings, and other dental services.
• Routine Vision Care: Including eye examinations for glasses and eyeglasses.
• Hearing Aids: And routine hearing aid services.
• Long-Term Custodial Care: Such as assistance with bathing, dressing, and other daily activities.
• Private-Duty Nursing: Independent nursing services not covered by Original Medicare.

Beneficiaries interested in these services may wish to explore separate insurance or benefit options.

Understanding Medicare Supplement Plan Options

Medicare Supplement insurance is available through different standardized plans identified by letters.

In Florida, these generally include Plans A, B, D, G, K, L, M, and N. Plans C and F may also be available to individuals who became eligible for Medicare before January 1, 2020.

Two commonly considered options are:

Medicare Supplement Plan G

Plan G provides extensive coverage of many Original Medicare out-of-pocket expenses, including Part A hospital deductibles and Part B coinsurance.

However, Plan G does not pay the annual Medicare Part B deductible.

Medicare Supplement Plan N

Plan N also provides substantial coverage, but beneficiaries may be responsible for certain office visit and emergency room copayments.

Plan N does not cover the Medicare Part B deductible or Part B excess charges.

The best option depends on your healthcare needs, budget, eligibility, and personal preferences.

We will explain the standardized plan differences in greater detail in our section on Comparing Medicare Supplement Plans Side by Side.

When Can You Enroll in Medicare Supplement Insurance?

One of the most important considerations is your Medicare Supplement enrollment period.

Your federal Medigap Open Enrollment Period is a six-month period that generally begins the first month you are both age 65 or older and enrolled in Medicare Part B.

During this period, insurance companies generally cannot deny you a Medigap policy or charge you more because of preexisting health conditions.

Outside this enrollment period, insurance companies may use medical underwriting, unless you qualify for a guaranteed-issue right or another applicable protection.

Understanding your enrollment rights can be important when selecting Medicare Supplement coverage.

Medicare Supplement vs. Medicare Advantage

Medicare Supplement and Medicare Advantage are different types of private insurance coverage.

Feature

Medicare Supplement (Medigap)

Medicare Advantage (Part C)

Relationship to Original Medicare

Works alongside Original Medicare

Provides Part A and Part B benefits through a private plan

Doctor and hospital choice

Generally any provider nationwide who accepts Medicare

Provider networks and coverage rules vary by plan

Out-of-pocket medical expenses

Helps pay eligible Original Medicare costs according to the policy

Deductibles, copayments, and coinsurance vary by plan

Prescription drug coverage

Generally requires a separate Part D plan

Most plans include Part D

Monthly premiums

Separate Medigap premium, in addition to Part B

Varies; some plans have a $0 additional monthly premium

Additional benefits

Generally does not include routine dental, vision, or hearing benefits

May include additional dental, vision, hearing, or wellness benefits

Important: Medicare Supplement insurance cannot be used to pay Medicare Advantage plan deductibles, copayments, or coinsurance.

Making an Informed Medicare Supplement Decision

Choosing a Medicare Supplement policy involves more than comparing monthly premiums.

It is important to consider the benefits provided by each standardized plan, your expected healthcare expenses, your enrollment eligibility, and the financial protection you want.

At My Health Insurance Spot, our licensed insurance professionals can help you understand Medicare Supplement options, compare available policies, and explain how different plans work with Original Medicare.

Our goal is to provide the information and personal assistance you need to make a confident, informed decision.

Personal Service. Professional Guidance. Your Peace of Mind.

My Health Insurance Spot is a brand of The Insurance Spot, Inc., a Florida-licensed insurance agency. We are not affiliated with or endorsed by the U.S. government or the federal Medicare program.