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Medicare Supplement Plans

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A Medicare supplement (also known as Medigap) insurance plan is a private form of medical insurance that covers the gaps left by Medicare. These gaps include payment of some of your Medicare health care costs like copayments, coinsurance, and deductibles.

Similar to other supplemental insurance plans Medigap aims to reduce your out-of- pocket expenses and works hand-in-hand with your Original Medicare to pay its own share of covered healthcare costs. A Medigap policy is quite different from a Medicare Advantage Plan. Medicare Advantage plans are used as ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. When you buy a Medigap policy, you have up to 10 plan options to choose from in most states. (While other states have different options). Medigap Policy plans can be purchased from private insurance companies like Fulmer Insurance Group, not the federal government. The Various Medigap plans are Plans A, B, C, D, F, G, K, L, M, and N. They all have different combinations of coverage for medicare expenses and do affect your choices based on your needs.

Expenses covered by Medigap include:
1) Part A hospital care co-insurance
2) Part A hospice care co-insurance or co-payment
3) Part B co-insurance or co-payment
4) First 3 pints of blood
5) Part A deductible
6) Part B deductible
7) Part B excess charges
8) Skilled nursing care
9) Foreign travel emergency care

The first four items in the list are the expenses covered by all Medigap plans. The other items (called optional benefits) may or may not be covered, depending on which plan option you choose. Since each plan is different, it’s important to understand which benefits are included in the Medigap policy you plan to buy.

To be eligible for Medicare Supplement insurance, you must be:

1) Enrolled in Medicare Parts A & B (Original Medicare)
2) 65 or older, or have a disability
3) You can also buy a policy if you are 65 or older, have Part A, and are enrolling in Part B.

You cannot buy a Medicare Supplement policy if you have a Medicare Advantage Plan. These two types of coverage are incompatible. If you want to switch from a Medicare Advantage Plan to a Medicare Supplement policy, you must first disenroll from the Medicare Advantage policy before your Medicare Supplement Policy begins.

Your health history could also affect your ability to buy coverage. It’s always advisable to apply for a policy during the open enrollment period. That’s because, during this period, insurers are not allowed to deny you a policy or raise your rates because of past health problems. If you buy outside of the open enrollment period, this protection may not be there, because insurers may raise your rates or choose to not offer you a policy because of your past health problems.

If you’re eligible and planning on purchasing a policy, you should do it during your Medigap open enrollment period. Your open enrollment period starts the day you are both 65 years old and enrolled in Original Medicare (both Parts A and B). If you only bought Part A when you turned 65, the 6-month period starts the day you buy Part B.If you buy during this period, you can buy any Medigap policy, even if you have health problems, for the same price as people with good health.Other benefits of buying during the open enrollment period are:1) Insurers cannot deny you coverage
2) Insurers cannot increase prices due to health issues
3) You are able to switch plans within your 6-month open enrollment period
4) You do not have to wait for coverage to begin

Technically, you can still buy Medicare Supplement insurance after your open enrollment period ends, but your health history can affect your options. It’s not a guarantee that you can buy a policy, therefore insurers can charge you higher rates because of your health history. That’s because after open enrollment, insurers are allowed to use underwriting to determine your eligibility. Underwriting lets them raise your rates or deny you coverage based on your medical history.

Monthly PremiumYou pay your private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.Insurance AgenciesYou can buy a Medigap policy from any insurance company that’s licensed in your state to sell one. Give us a call to know if we operate in your state.Guaranteed RenewableAny standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.Prescription Drug PlansMedigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D) or switch to a Medicare Advantage plan (included in some medicare advantage plans.Illegal PracticesIt ‘s illegal for anyone to sell you a Medigap policy if you have a medicare advantage plan or current medigap policy (some exclusions apply). It is also illegal for anyone to claim that medigap is part of the medicare program, be misleading or provide any false information to you. If anyone appears guilty of these practices, you can contact your Inspector General.
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