Plans Offered by Private Providers

medicare supplement plans

If you have Original Medicare there will be some gaps in your coverage. Original Medicare does not cover everything. You also have deductibles and copayments for many services under Original Medicare and Medicare supplement plans are a viable way of helping with these costs. Supplemental insurance, or Medigap, is offered by private health insurance providers and regulated by Medicare. Before purchasing Medigap coverage you should do a Medicare plan comparison. Find out what coverage you already have, how much you pay, and what is missing. You should also take into account any employer or union coverage you might have. All of this will help you determine if Medigap coverage is right for you or not.

Look into whether Original Medicare with a Medigap plan makes more sense for you than a Medicare Advantage Plan alone. This depends not only on what coverage the plans offer but any medical conditions you have. You can also compare the various Medigap plans and the private health insurers that provide those plans. While comparing the plans and coverage also consider the company offering the coverage. Ask around about them both from official sources and people you know and trust.

There are many insurers that offer Medigap plans. While the coverage will be identical for each lettered plan, costs may not be. You will want to find out a few things out about insurers before signing up for a Medigap plan:

Does the insurer offer coverage in your state or area?
Does the insurer offer Medigap coverage at all? (not all insurers do).
Does the insurer offer any additional benefits over and above what is required?
Check out the insurer with your state insurance department, friends, and other organizations.
Call a number of different insurers to compare their rates and coverage (including any cost breaks they may have).

Note that Medigap policies are regulated by both the Federal and state governments. There are rules that will differ for companies depending on where you live. But there are some obligations all companies have to meet. There are some things insurers should never do:

Pressure you into buying a policy.
Misleading you into changing insurer or policy
Try to sell you a Medigap plan when you have one already, unless you inform them in writing that you plan to get rid of your policy.
Try to sell you a Medigap plan when you have a Medicare Advantage Plan (unless your Advantage Plan ends before the Medigap plan begins).
Insinuate or state that a Medigap plan is part of Medicare or other government program (the government does not sell Medigap policies).
Insinuate or state that their Medigap plan is endorsed by any government agency.
Insurers must clearly identify their policy as “Medicare Supplemental Insurance” on the front of the policy.

In most cases an insurer should not try to sell you a Medigap policy if you have Medicaid. There are, however, exceptions to this. Remember, if you want to stay in Original Medicare and buy a Medigap policy you should not sign up for a Medicare Advantage Plan. You cannot have a Medicare Advantage Plan and purchase a new Medigap plan at the same time. If you do sign up for an Advantage Plan you will be disenrolled in Original Medicare. It is also important to note that a Medigap plan only covers one person. You can, however, ask the company if they will give a discount if you and your spouse both take out a Medigap policy with their company.

Private health care providers have to offer specific coverage for each of the lettered plans, A through N. Plans E, H, I and J are no longer offered but those who purchased them before June 1, 2010 can keep their plans if they desire. Health care providers can offer additional coverage as part of Medigap policies under Federal law. This law says that insurers can offer “new and innovative” coverage in a Medigap policy provide the other mandated coverage is also available. What the terms “new and innovative” mean are not specifically defined. You can feel free to ask prospective insurers if they offer any “new and innovative” coverage.

There are three states that do not use the standard lettering for Medigap policies: Massachusetts, Minnesota, and Wisconsin. Therefore private health insurers offering Medigap plans in those states operate under separate and distinct rules. Each state has its own standardization. Many of the benefits are similar but you will need to contact your state insurance department.

If you go to see your physician or specialists often there are Medigap plans that can help cover copayments/coinsurance and deductibles (or part of them). Again, you have to make sure you get the right plan because some pay a portion of copayments and others pay only a portion. Not all types of copayments and coinsurance are covered.

There are numerous supplemental insurance plans you can choose. Without careful comparisons you can wind up paying a good deal more for a plan with similar benefits to a less expensive plan (or even the same plan from a different insurer). Medigap plans also are helpful with paying for costs of preventative care beyond what Original Medicare covers.

Inoculations for flu, pneumonia and Hepatitis B are all covered. Likewise are a number of screenings and tests including (but not limited to): Diabetes, Breast Cancer (mammograms), Colon Cancer, Glaucoma, HIV and more. Other preventive care is also covered including, Pap Tests/Pelvic Exams, Bone Mass Measurements, Medical Nutrition Therapy Services, Diabetes Self-Management Training, smoking cessation and more. Be sure to talk to your insurance company about any other areas of care or preventative care that concern you