Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. provides health insurance coverage for your major healthcare services. Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. is your hospital insurance and Part B is your medical insurance. But, there are huge gaps in the amount the Medicare program covers.
These coverage gaps, which include deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. are a financial risk that you can limit with Medicare Supplement InsuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. (Medigap policy).
In this article, we’ll walk you through how to choose a Medicare Supplement plan by assessing your personal situation. When you do, then you can choose the best Medigap plan for your needs.
- Original Medicare covers about 80% of all Medicare-approved costs.
- The 20% that Medicare does not cover are out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. that must be paid by the Medicare beneficiaryA person who has health care insurance through the Medicare or Medicaid programs., or through additional coverage.
- Original Medicare does not have an annual limit on out-of-pocket costs.
- Benefits that work with Medicare coverage to help cover a beneficiary’s out-of-pocket expenses include federal and railroad retiree health benefits, TRICARE, VA health benefits, and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..
- Medigap policies are available for beneficiaries who do not have other coverage benefits.
- You can get any plan you want during your Medigap Open Enrollment PeriodUpon initial enrollment in Medicare Part A and Part B, beneficiaries have a one-time, six-month period to buy a Medicare supplement policy with guaranteed issue rights. This is the Medigap Open Enrollment Period., even if you have pre-existing conditionsA pre-existing condition is any health problem that occurred before enrolling in a health plan. The Affordable Care Act law made it illegal for health plans to or charge more due to a pre-existing condition.....
Assess Your Situation
As Americans, we all understand our healthcare system is the most expensive in the world. So, it goes without saying that not having additional coverage with our Medicare benefits could put us in a world of hurt, financially.
But, how much additional coverage is enough? And, what is the best Medigap plan?
Those are good questions, but the answer is different for everyone. There are so many different factors, including:
- Where you live
- Your age
- Your health, including your use of outpatient, inpatient, and skilled nursing facility care
- Your finances and financial goals
- Your use of tobacco
- How frequently you have doctor office visits
- Your potential to have a foreign travel emergency
Let’s talk about some plans and the reasons you might choose one over another to supplement your basic benefits.
Hi there. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. offers a 100% FREE Medigap Rate Comparison Service. It will arm you with all of the information you need to make an informed decision.
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We are retired seniors, not insurance agents. Our goal is to help folks, just like you, by making sure you have access to rates from all carriers without a sales pitch. No Calls. No Email Spam. No Kidding!
When “Best Plan” = “Most Coverage”
For some people, the question of best means having the most coverage.
Medigap Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services. offers the most coverage possible.
It covers all of the out-of-pocket costs in Medicare Parts A and B.
Unfortunately, this plan is no longer available to new Medicare beneficiaries. Congress put the kibosh on coverage of the Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. deductible. As a result, Plan G is the next best policy available.
Fortunately, the overall cost of a Plan G policy + the annual Part B deductible makes Plan G a better deal anyway. The following Medicare Supplement Plans Comparison Chart offers you a visual way to compare what each lettered plan covers:
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When “Best Plan” = “Good Coverage with Some Out-of-Pocket Costs”
As retirees, most of us find ourselves on a fixed budget. We may be healthy or have a minor health condition that’s easily managed through prescription drug coverage.
If this is your situation, a Plan F or G policy might be too costly or wasteful. In this case, a Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... could be an excellent option to consider.
In most areas, Plan N monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. are 20-30% less than Plan G. Even more when compared to a Plan F. If you are healthy, the monthly premium difference really adds up.
The monthly Plan N premium is so much lower than Plans F and G because you take on some of the costs. For example, with a Plan N policy, you pay up to $20 when you see your doctor and up to $50 to use the emergency room.
But, because you’re healthy, your copayments vs. lower monthly premiums is a reasonable tradeoff.
Plus, don’t forget that your annual wellness exam is excluded. This doctor visit is covered 100% by Medicare.
If you have a chronic condition that you and your primary care physician are managing through medication, Plan N may or may not work. It all depends on how frequently you see your doctor and whether you pay Excess ChargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment..
Part B Excess Charges are additional fees (up to 15%) that doctors may charge if they do not accept Medicare’s standard rates. Medigap Plan N does not cover Excess Charges, whereas Plan G does.
If you are not in this situation with your doctor, that’s another plus in the Plan N column.
If a small copay and not having coverage for Excess Charges works for you, put Plan N on your shortlist, or ask us for a free rate comparison.
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When “Best Plan” = “Lower Monthly Cost + Risk Protection”
One aspect of Medicare Supplement coverage that needs to be pointed out is how it compares to Medicare Advantage (Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all...). With so many Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). having a zero-dollar monthly premium, these private insurance plans are hard to ignore.
To understand how a Medicare Advantage (MA) plan might be a benefit, you need to look at total cost vs. risk. Lower premiums may not result in lower healthcare costs.
With a Medigap policy, you pay most costs in advance through monthly premiums. With a Medicare Advantage plan, you pay most costs when you use healthcare services through copays.
This fundamental difference lulls some people into a false sense of lower cost with an MA plan. Only two types of people lower costs with MA plans:
- Healthy people who rarely use Part A and Part B services, but take advantage of a plan’s extra benefits;
- And people who qualify for a dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... Medicare Advantage Special Needs Plan (D-SNP).
However, there is one feature in Medicare Advantage plans that’s very beneficial. It’s the maximum out-of-pocket (MOOP) limit, and it applies to Medicare Part A and Part B copays and coinsurance.
With MA plans, you are protected by an annual MOOP, which is currently no more than per year (in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get...).
That’s a scary number, but you need to consider that Original Medicare has no limit at all.
None. Nada. Zip!
So, that brings us to Medigap Plan KMedicare Supplement Plan K is one of two unique Medicare supplements with shared-cost coverage and an annual out-of-pocket limit. This is a plan that works for people looking for help with certain Original Medicare costs....
Like Plan N, with Plan K you share some of the costs (see the chart above). But, unlike Plan N, there’s an annual limit on your out-of-pocket costs with Plan K (currently ).
When you hit the MOOP with Plan K, all Medicare Part A and Part B coinsurance charges are paid for you at 100% for the remainder of the year.
To see your Plan K rates, be sure to click “Best Plans on a Budget” on our form.
When “Best Plan” = “Rock Bottom + Risk Protection”
Years ago my father taught me a good way to save money on my auto insurance policy. He told me to take the highest deductible possible and be a good driver.
So far, this strategy has saved me thousands of dollars on my auto insurance. I rarely make a claimA request for payment that you submit to Medicare or other health insurance when you get items and services that you think are covered., so why pay higher premiums?
A growing number of people are starting to look at their healthcare needs the same way. If you rarely make a claim, do you really need one of the best Medicare Supplement insurance plans?
Both Medigap Plan F and Plan G have a high deductible option. Once you pay the deductible amount towards your Part A and Part B covered services, the policy takes over and pays 100% of your health coverage.
Here’s what I’m doing, and it has worked out pretty well so far.
I opened a new savings account that I only use for healthcare-related costs. Each month I deposit the cost difference between a regular Plan G and a high deductible Plan GThe high deductible version of Medicare Supplement Plan G has the same coverage benefits as the regular Medigap Plan G, but you pay all costs until your Medicare-approved costs reach the annual deductible. High Deductible.... For me, that’s about $100 per month.
After four years of doing this, my account was up to about $3,800. Then I dropped my Harley-Davidson on myself and needed stitches and X-rays for my ribs. The emergency room bill came to just over $4,100.
After paying the deductible, my USAA Medigap policy kicked in and paid the rest. My healthcare savings are down, but not depleted.
Will this strategy work for you? I suggest talking it over with your insurance agent.
If you want to see rates, use our free quote service and ask for “Lowest Cost Plans”.
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The Best Time To Enroll
It breaks my heart when someone tells me they can’t get a Medigap policy because they didn’t enroll on time.
How does that happen?
Unlike Medicare Advantage and Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans (prescription drug plan), Medigap does not have an open enrollment periodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31. at a set time each year. Your enrollment period is specific to you.
So, a lot of people miss out on their Medigap protections (guaranteed issue rightGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting.) because they didn’t understand how critical it is to use their Medigap Open EnrollmentIn health insurance, open enrollment is a period during which a person may enroll in or change their selection of health plan benefits. Health plan enrollment is ordinarily subject to restrictions. Period.
Your personal Medigap Open Enrollment Period begins when you first enroll in Medicare Part B. It starts automatically and lasts for six months.
During this time you can buy any plan from any carrier you choose. So, if you want a Plan G policy from UnitedHealthcare, they can’t turn you down, even if you have pre-existing conditions.
There are two situations that can change things up a little. The first is if you have creditable coverageCreditable coverage refers to health insurance or prescription drug benefits that meet Medicare's minimum qualifications necessary to avoid a penalty. through an employer. If you’re still working when you turn age 65, be sure to call Medicare and discuss delaying Part B enrollment.
The other situation is if you decide to join a Medicare Advantage plan as soon as you get your Medicare benefits. If you do, you have a trial right, which allows you to switch back to Original Medicare with your Medigap protections.
Your trial right only lasts 12 months, and you can only use it once.
Call 1-855-728-0510 (TTY 711) for plan assistance.
If you qualify for Medicare and don't know where to start, MedicareEnrollment.com, an independent HealthCompare insurance broker, has licensed agents who can help you with your Medicare enrollment options.
Medicare Supplement Plan Rate Increases
When you have matched your needs with a plan you can start shopping. You’ll see the monthly premiums first, but don’t immediately latch on to a policy with the lowest rate.
There’s another factor to consider.
Ask your agent to show you the rate increase history on all of the policies presented. When you do, you’ll clearly see that companies don’t all raise their rates at the same time or at the same pace. This is important.
Medicare Supplement insurance carriers use three common methods to determine rates and rate increases. They include:
- Attained-age rated
- Issue-age rated
Most experts agree that you should ask your agent to explain the pricing system of each policy they present. You have a right to know if your rates will increase as you age or with the community of policyholders
Also, don’t be shy about picking up the phone to get help.
By law, insurance agents and brokers can’t increase rates. You’ll pay the exact same premium going through an agent or broker as you will going direct.
However, if you go direct, you’ll only see rates from the insurance company you call.
If you don’t already have an agent, call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency.
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Citations and References
- How to compare Medigap policies | Medicarehttps://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
- What’s Medicare Supplement Insurance (Medigap)? | Medicarehttps://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
- Explore your Medicare coverage optionshttps://www.medicare.gov/plan-compare/