Original Medicare and Medigap coverage feature completely different benefits. In the third part of eHealthMedicare’s ongoing Medicare Vs. Series, we examine what that means for you.
As previously discussed, Original Medicare is made up of Medicare Part A and Part B. Part A is hospital insurance, while Part B is doctor’s services and outpatient hospital stays. Original Medicare doesn’t cover everything and so there are bound to be gaps in its coverage. This is where Medicare Supplement Insurance (Medigap or MedSup) comes in. This insurance doesn’t provide complete coverage on its own; instead, it is designed to supplement Original Medicare coverage.
Original Medicare at a glance
Medicare Part A is the coverage of hospital care, skilled nursing facility stays, short-term nursing home care, hospice care, and some home health services. With Medicare Part B, doctor’s visits are covered in addition to ambulance services, durable medical equipment and mental health care and counseling.
Medicare Supplement Insurance
Medicare Supplement insurance is purchased in addition to Original Medicare — it does not replace it. It covers expenses not covered by Original Medicare, such as the Part A and/or Part B deductible cost, foreign travel emergency coverage, or co-insurances. These plans are sometimes referred to as Medigap or MedSup plans; however, when shopping for a supplemental policy, insurance companies are legally required to identify these plans as Medicare Supplement Insurance.
10 Types of Medicare Supplement Plans
There are ten types of Medicare Supplement Insurance. These plans sold by private insurance companies and not every carrier will offer each plan. However, if a company is going to offer Medigap coverage, they are legally required to offer Medicare Supplement Plan A. This is a basic Medigap plan. If a company would like to sell more than Plan A, then they must offer either Plan C or Plan F, which are two of the most robust plan types.
While not every company sells each plan, it is important to note that in 47 of the United States, plan details will never change. They have been standardized, meaning that details of Plan A in Vermont will be exactly the same as Plan A’s offered in Oregon.
The states of Massachusetts, Minnesota and Wisconsin provide their own version of Medicare Supplement Insurance, which include a specific network of doctors that must be used.
Other Medicare Supplement Information
Medicare Supplement plans only cover the individual enrolling in the policy. Joint plans are unavailable. In order to join a Medicare Supplement plan, you must already be enrolled in Original Medicare, or you must join at the time you are enrolling in Original Medicare. If you have a Medicare Advantage plan, you must switch back to Original Medicare before joining a Medicare Supplement plan.
Unlike Medicare Advantage and Medicare Part D, which have the same enrollment period called the Annual Enrollment Period (from October 15 to December 7 each year), Medicare Supplement Insurance has its own enrollment period. It spans six months and begins the month that you turn 65 and have Medicare Part B. This is the optimal time to join a plan because you do not have to submit to Medical Underwriting, which is when your medical history is reviewed and you can be charged more for insurance or even be declined coverage.
Once the Medicare Supplement Insurance enrollment period passes, you can still join a plan at any point throughout the year, but you do so at the risk of paying higher premiums or being refused coverage.
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