Medigap (Medicare Supplement Plans)
These plans are designed to work with Original Medicare (Parts A & B) and are federally standardized, meaning they contain the same benefits based on the cover letter of the plan you select. This means there is no difference in coverage between a Plan G Supplement with Cigna and a Plan G Supplement with Mutual of Omaha. Currently, there are 11 different Medicare Supplement plans approved by the Centers for Medicare. However, the most popular options are Plans F, G, N, and sometimes HDF (High Deductible Plan F), depending on where you reside. Medigap plans are commonly referred to as Medicare Supplement plans, and vice versa, but both terms denote the same coverage.
Medicare Supplement Insurance (Medigap) Plan Benefits
| Benefits | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Medicare Part A coinsurance and hospital cost (up to an additional 365 days after Medicare benefits are used) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Medicare Part B coinsurance or copayment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Blood (first 3 pints) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A hospice care coinsurance or copayment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Skilled nursing facility care coinsurance | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | ||
| Part A deductible | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ | ||
| Part B deductible | ✓ | ✓ | ||||||||
| Part B excess charges | ✓ | ✓ | ||||||||
| Foreign travel emergency (up to plan limits) | 80% | 80% | 80% | 80% | 80% | 80% |
Since the Medigap plan is secondary to Medicare, it means that Original Medicare is the primary, and the Supplement is required by federal law to pay all Medicare-approved charges. It also means that as long as your doctor or hospital accepts Original Medicare, they are required to get your Medicare Supplement plan, regardless of the company name. Medigap coverage provides true peace of mind as it offers the most robust benefits and flexibility to see any provider of your choice. Medigap does not cover prescription drug benefits, so you will want to choose a different Part D drug plan (PDP) if you enroll in a Medigap plan. See the Prescription Drug Plan section below for details.
Prescription Drug Plans (PDP)
Also known as PDP, or Part D, a Prescription Drug Plan is a separate insurance policy designed to cover your medications specifically. Many of the same insurance carriers that offer Medigap and Medicare Advantage also provide prescription drug coverage. Drug Plan formularies and copays can vary significantly among insurance companies, so choosing the right plan is critical. Our consultation will thoroughly analyze your medications and help you choose the right drug plan.
Medicare Advantage (Part C of Medicare)
Medigap (AKA-Medicare Supplement) plans truly “supplement” your Medicare; Medicare Advantage plans replace Medicare with a private health plan option typically denoted as either an HMO or PPO. An HMO is a health maintenance organization, and a PPO is a preferred provider organization. This means your health care is derived from a more restrictive “Network” of doctors and hospitals, sometimes even down to the state or county you reside in. Also, you will be responsible for a larger share of copays, deductibles, and out-of-pocket charges that can range to as high as $7500 per calendar year. While these plans sacrifice coverage, benefits, and network access, they generally include prescription drug coverage and ancillary benefits such as dental, vision, hearing, gym memberships, transportation to medical providers, etc. Medicare Advantage plans are generally cheaper than Medicare Supplements, sometimes even offering a “zero dollar” monthly premium.
Conclusion
There is no right or wrong answer on which plan is best as it ultimately depends on several factors and each person’s unique situation. The plan that works best for someone in Florida may be entirely different for someone in another state. The plans that work best for someone in Florida may be entirely different for someone in an other form. For a free comparison, give us a call at 1-800-414-2044 or send us an email at info@themedicarehelpdesk.com.