Medicare Supplement Plans
Medigap is Medicare Supplement Insurance will help 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:
- Copayment
- Coinsurance
- Deductibles
Some Medigap policies also cover services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. Before you travel outside the U.S., talk with your Medigap plan or insurance agent to get more information about your Medigap coverage while traveling.
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.
Nevada Birthday Month Rule started 1/1/22
Allows existing Medicare Supplement policyholders to have a new open enrollment period starting on the first day of their birthday month and extending for at least 60 days after.
During this time, these policyholders may purchase a new Medicare Supplement plan (with the same or lesser benefits) from their existing carrier or a new carrier without underwriting.
Innovative benefits must not be considered when determining whether a Medicare Supplement policy has the same or lesser benefits than another policy.
8 THINGS TO KNOW ABOUT MEDIGAP OR MEDICARE SUPPLEMENT
1. You must have Medicare Part A and Part B.
2. 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.
3. 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.
4. 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). If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments.
- 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 DON'T COVER EVERYTHING
Medigap policies generally do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
You also need a separate Prescription Plan.
INSURANCE PLANS THAT ARE NOT MEDIGAP
Some types of insurance aren’t Medigap plans, they include:
- Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
- Medicare Prescription Drug Plans
- Medicaid
- Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
- Tricare
- Veterans’ benefits
- Long-term care insurance policies
- Indian Health Service, Tribal, and Urban Indian Health plans
You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage. If you decide to drop your entire Medigap policy, you need to be careful about the timing.
Prescription Drug Plans
Part D covers prescription drug benefits (for self-administered drugs, such as those picked up at a pharmacy and taken at home) and regulates Medicare prescription drug plans.
You musts be entitled to Part A and/or enrolled in Part B; and reside in the Part D plan’s service area.
In selecting a Part D plan, beneficiaries should consider expected premiums and cost sharing, formulary, and network pharmacies among other factors.
What is Credible Coverage
Non-Medicare insurers (including Medigap plans) are required to notify beneficiaries annually whether or not the prescription drug coverage they have is credible (coverage that expects to pay, on average, at least as much as Medicare’s standard Part D coverage expects to pay).
All beneficiaries who do not maintain credible coverage and are informed that their non-Medicare drug coverage is no longer credible will have a special enrollment period to enroll in a Part D plan without the obligation to pay a Part D late enrollment penalty.
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