10 Things to Know |

10 Things to Know

1. Definition of Medicare Supplement (Medigap) Insurance:

Medicare Supplement Insurance is a private health insurance policy commonly referred to as “Medicare Supplement Insurance.”
Medigap policies are designed to help pay some or all of the costs that are not covered by Medicare Insurance Parts A and B.

2. What Medicare Supplemental Insurance Policies Cover:

Medicare Supplement Policies cover medical procedures approved by Medicare and are performed at or by a Medicare Provider.
Procedures not approved by Medicare are normally not covered by Medicare Supplement Insurance.
Some Medicare Supplement policies offer limited benefits for expenses not covered by Medicare such as at home recovery.

3. Eligibility for Medicare Supplement Insurance:

Anyone who is covered under both Medicare parts A and B is eligible for Medigap Coverage.
Insurance Companies reserve the right to set further qualification criteria beyond Medicare Eligibility at their own discretion but can not exclude any person who is in an Open Enrollment or Guaranteed Issue situation. See Medigap Eligibility>>>

4. Available Medicare Supplement Plans

Insurance companies can only sell “standardized” Medigap policies. There are 12 different standardized policies—Plans A through L. Not all companies offer all plans in all states.

Any company offering coverage is required to offer the base plan (Plan A) and any other combination of plans B-L at their discretion. See Medigap Plans>>

5. Plan Differences Between Companies

The coverage between companies for doctor and hospital visits is exactly the same for the same standardized policy.
- For instance, a Plan F with one insurance company will pay exactly the same as a plan F with any other company.
- Companies may choose which standardized Medicare Supplement Policies they wish to offer but all must at least offer Plan A.

6. Pre-Existing Conditions:

Some Medicare Supplement Insurance Companies may have a pre-existing conditions provision that limits their liability on previous medical problems for a pre-defined period of time after the issue date of the policy. Some companies will not exercise this option.
If you were covered under an employer sponsored health plan or another Medigap policy the pre-existing condition limitation may not apply,

7. Pricing Differences:

Medicare Supplement Insurance prices vary from company to company, from plan to plan and from area to area.
There is no standardization of pricing for Medigap Insurance.
You could pay substantially more for the exact same coverage if you do not shop around for the best rate for your particular situation.

8. Choice of Doctors and Hospitals

Medicare Supplement Insurance does not limit you on the doctors or hospitals that you may choose.
There are no restrictive networks.
You simply choose any provider that accepts Medicare and your Medicare Supplement will pay that provider as stated in your policy.

9. Claims:

Medicare Supplement Insurance has a very easy and mostly automated claims process.
For Medicare Part B claims each Medicare Supplement Insurance company is linked directly to Medicare. Medicare will send a copy of the claim and how they paid (known as a Medicare Explanation of Benefits or MEOB) to your Medicare Supplement provider each time they pay a claim. This is the information that the insurance companies use to determine how to pay your claim.
Because the claims come directly from Medicare, there is rarely a need for you or your doctor to file a claim for outpatient services.

10. Bottom Line:

Medicare Supplement Insurance is very important and can provide you the peace of mind of knowing that you will not be burdened by the gaps in health coverage left by Medicare Parts A and B.
It is important to compare plans and rates to make sure that you find the policy that is best for you.
As Medicare Supplement Coverage is standardized in most states and the coverage is the same from company to company, it is very important to shop around to find the best available price.