How Do the Plans Work?
Medicare Supplement plans work by filling in the gaps in the coverage provided by Original Medicare, or Medicare Part A and B. Coverage will vary between Medigap plans, but for the most part, your Medicare Supplement plan will cover out-of-pocket expenses you get stuck with.
Do You Need Original Medicare–Part A and B?
It is required that you have Original Medicare for both plans A and B. This is required by Federal Law.
Are Plans Identical?
Each of the plans available has been designed by the CMS Centers for Medicare and Medicaid Services, an agency of the Department of Health and Human Services. The chart below will show all the plans available and standardized. Please note, the only difference that an insurance company is allowed to change from plan to plan is the premium charged. We have seen drastic price differences from company to company so please consult with a properly licensed agent to make your choice.
* Plans F and G also offer a high-deductible plan in some states (Plan F isn’t available to people new to Medicare on or after January 1, 2020.) If you get the high-deductible option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 in 2021 before your policy pays anything, and you must also pay a separate deductible ($250 per year) for foreign travel emergency services.
**Plans K and L show how much they’ll pay for approved services before you meet your out-of-pocket yearly limit and your Part B deductible ($203 in 2021). After you meet these amounts, the plan will pay 100% of your costs for approved services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
What Is Not Covered Under Medigap Insurance?
After 2006, Medicare supplemental insurance no longer offered prescription coverage because of the federal Medicare Part D program which offered prescription coverage to all Medicare participants.
Medical Savings Accounts are not legally eligible to purchase or obtain Medigap or Medicare Supplement Insurance.
There is also no coverage for dental, vision, hearing aids, private nursing care either in the home or at a senior living facility.
Can You Switch Your Medicare Supplemental Insurance Plan?
Once you have decided to purchase a Medigap or Medicare Supplement plan, you are in most circumstances locked in. The only time you can get out of a plan is during the annual open enrollment period from 15 October until 7 December each year. At that time you may cancel your plan and change to either Original Medicare only, Original Medicare with a Part D (Prescription Drug Plan), or Part C Medicare Advantage Plan.
There are some exceptions for switching plans available:
- Moved out of the area (Example moved from SC to Texas)
- Another Supplement Policy is now offered with benefits not previously offered or in your existing plan
- You are still in the AEP (Annual Open Enrollment) or initial open enrollment (3 months prior to age 65 and 3 months after)