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Medicare Options Education

Medicare Supplement plans are also known as Medigap policies. In 1982 Medicare and the NAIC Standardized plans. Private insurance companies offer Medigap insurance. Medicare pays no contribution to the plans operation.

All 11 standard policies may not be offered where you live. If a Medigap insurer offers a plan in your state and county they must offer at least plan A and C and F plan.

The table of plans below are the 11 Standardized Medicare Supplement (also known by the acronym Medigap) plans that can be offered by authorized Medicare insurance companies. Medicare Supplement insurance companies may choose to offer all or only selected plans in any state or county, but if a Medicare Supplement chooses to offer plans in any state or county they must offer, at a minimum, plans A, C, and F.

Plan F presently has two versions.
The standard priced and most popular plan is the traditional F plan.

How the traditional plan F works.
In exchange for a monthly premium you receive benefits and you don’t pay any deductibles, copayments, or coinsurance when you utilize a benefit.

*Plan F also has an option called a high deductible plan F.
This high deductible plan pays the same benefits as Plan F after one has paid a calendar year deductible set by Medicare each year. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.

Plan G (Also created by MARCA)
Medicare Supplement Plan G

Medigap Plan G offers all of the benefits of Plan F, with the exception of the Part B deductible. If you choose Plan G, you’ll need to pay the standard annual Medicare Part B deductible out of pocket. Plan F and Plan G cover Medicare Part B excess charges, and they are the only Medicare Supplement plans to do so. Excess charges are the difference in cost between what a non-participating doctor or health-care provider charges for a medical service and the Medicare-approved amount. If you see a non-participating provider, he or she can charge up to 15% above what Medicare has approved for a covered service, which you’ll normally be responsible for paying.

Cost Sharing Plans K & L
In 2005, two new Medigap policies designated by the letters K and L were added to Medigap standardized plans. Plans E, H, I, & J were removed due to redundancy and because Medicare began offering the Medicare Prescription Drug plans in 2008.

How do Cost Sharing Plans K & L work?
K and L have higher out-of-pocket amounts and lower premiums than some plans. Plans K and L have different benefits. Benefit amounts are cost shared between you and the plan. Once you have met your portion of the deductible then the plan pays 100% after the limit is reached for the balance of the contract year. Please refer to the Benefits Guide above.

Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you’re comparing the same policy (for example, compare a plan A from one company with Plan A from another company).** The benefits do not vary from company to company as all Medicare Supplement plans are standardized, but the price may vary and you should investigate costs over a lifetime.

Plan N
Medigap Plan N covers all the same benefits as Plan F with the exceptions of the:

  • Medicare Part B deductible
  • Medicare Part B excess charges
You would need to pay these cost differences out of pocket. Plan N is also a little different from Plan F because although it pays for 100% of the Part B coinsurance in most cases, there are exceptions: You’ll need to pay up to $20 for certain office visits and up to a $50 copayment for emergency room visits that do not result in an inpatient admission.

What else do I need to know about Medigap Plan F, Plan G, and Plan N?
If you’re thinking of signing up for Medigap insurance, a good time to enroll is during the Medicare Supplement Open Enrollment Period, which starts when you have Part B and are 65 or older. During this six-month period, you have a special right to join any Medigap plan offered by any insurance company in your service area with “guaranteed issue “; in other words, you can’t be turned down for health reasons or charged a higher premium if you have pre-existing conditions. After your Medigap Open Enrollment Period is over, it may be harder to enroll in a plan or switch plans if you don’t have guaranteed-issue rights. Medigap insurance companies can require medical underwriting or deny you coverage, especially if you have health problems.

Please note that a Medigap plan won’t work with a Medicare Advantage plan and can’t be used to pay for Medicare Part C costs. In most cases, you can’t be enrolled in both a Medicare Advantage plan and a Medigap plan, and it’s illegal for anyone to sell you a Medigap policy if they know you have a Medicare Advantage plan (unless you’re switching back to Original Medicare coverage). Also, Medigap plans don’t include prescription drug coverage, and if you’d like prescription drug benefits in addition to your Original Medicare coverage, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan.

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