UNDERSTANDING ABOUT MEDICARE
Medicare

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

Medigap

Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments

  • Coinsurance

  • Deductibles

When an American citizen turns 65 years of age, they have the option to enroll in Medicare (they may also qualify before the age of 65 if they are eligible for disability benefits). Basic Medicare, which includes Parts A and B, cover most of your basic hospital and doctor expenses, respectively. Unfortunately, "most" does not mean "all". The expenses which Medicare does not cover - sometimes referred to as "gaps" in coverage - are what Medicare Supplement insurance protects you from. It is a private plan designed to cover the medical expenses where Traditional Medicare falls short of the mark. Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here's what happens:

  • Medicare will pay its share of the Medicare-approved amount for covered health care costs.

  • Then, your Medigap policy pays its share.

Who purchases Medigap?

It doesn't matter whether you're struggling to get by, on a fixed income, or enjoying incredible wealth in your golden years - all seniors from all walks of life can benefit from a Medicare supplement insurance policy. Medicare provides standard coverage to every beneficiary, regardless of income. What it does not provide, however, is 100% coverage of your medical costs. Therefore, the more vulnerable you are to the gaps in Medicare coverage, the more you can benefit from the protection of a Medigap policy.

When can you sign up for Medigap?

Based on the convoluted rules of Medicare enrollment, many seniors mistakenly believe that signing up for Medicare Supplement is similarly complicated. The good news is that you can sign up for Medigap insurance at any time. However, there are some "sweet spot" time frames which, if you apply during those opportunities, will make the process much easier:

  • The Initial Enrollment Period. During your first 6 months of Part B coverage, your acceptance is guaranteed, regardless of your current level of health

  • The "Guaranteed Issue" Period. If you are on the verge of losing coverage through an employer, you will have a "guaranteed issue" period lasting 63 days where you can purchase any Medicare supplement policy with no health questions asked.

If you apply for Medicare supplement at any point outside of these time frames, you will likely have to go through the complicated process of medical underwriting and answering lots of invasive health questions. To learn more, and to get help going through the process, call us today at (833) 997-1330.

Things you need to know about Medigap
  • You must have Medicare Part A and Part B.

  • A Medigap policy is different from a Medicare Advantage Plan.  Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

  • You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

  • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

  • You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

  • Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

  • It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.

  • Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.