Medicare is an important federal health insurance program for people 65 years and older, regardless of their health status, income or medical history. The government program pays for many services such as physician visits, prescription drugs, hospital stays, home health, skilled nursing facility costs and preventive services.
There are many programs or individual needs that may not be covered by Medicare. Medicare Supplement Plans, also known as Medigap, are a series of additional standardized, private insurance options to fill in the coverage gaps and medical expenses that Medicare Parts A and B do not cover.
What does a Medicare Supplement plan cover?
Medicare Supplement plans, also known as Medigap plans, can cover copayments, deductibles and coinsurance of the basic Medicare coverage that would otherwise be an individual’s responsibility to pay out of pocket. Some Medicare Supplement plans have additional benefits, such as coverage for skilled nursing and overseas emergency medical care.
What is the difference between Medicare Supplement Insurance and Medicare Advantage?
Medigap insurance plans help patients pay Medicare-related deductibles, co-pays and other expenses. These Medicare Supplement Plans are designed to minimize the out-of-pocket costs patients may experience to keep health care costs predictable and stable. Medigap policies are offered by private insurance companies that are not involved in the details of managing individual care.
Medicare Advantage Plans manage individual care options and solutions, similar to HMO or PPO health insurance plans offered by employers. Insurance companies that offer Medicare Advantage contract with Medicare to deliver benefits. Some of these plans offer low premiums, but often have limitations on how patients can receive care such as network restrictions, authorization requirements for specialized care, and steep out-of-pocket costs for urgent or emergency care.
Do I need Medicare Supplement Insurance?
Many people choose to purchase a Medicare Supplement to protect their savings and assets. Since traditional Medicare has significant gaps in coverage and no annual out-of-pocket limits, personal medical bills can still escalate into surprisingly large sums for a senior’s budget. Supplemental insurance can help cover these costs and keep personal health care spending more stable.
What is underwriting and how does it lead to Medigap savings?
Individuals are guaranteed the right to purchase a Medicare Supplement under certain circumstances. Individuals in open enrollment or guaranteed issue periods, including the six months after turning 65 years old, may obtain a Medicare Supplement policy without medical underwriting. After that point, different plans may have different requirements for underwriting considerations and individual eligibility.
Medical underwriting is the process by which insurance companies use health and medical information about potential applicants to match them with variable risk profiles and individualized rates. Certain pre-existing conditions — such as heart disease, diabetes or cancers — discovered in this process could result in application decline or increased premiums. Some companies have built expansions to those traditional underwriting protocols to add more dynamic rates. Health IQ rewards clients for the proactive efforts they take to stay healthy, like exercising regularly and eating a healthy diet, and offers premium discounts where state regulations allow.
How much does a Medicare Supplement plan typically cost?
The goal of a Medigap policy is to help limit the out-of-pocket costs by covering some of the costs for deductibles, coinsurance or some copayments. Individuals pay for these plan benefits with a monthly premium, for which the Medicare Supplement plan prices vary on several factors. There are a variety of Medigap plans available — A, B, C, D, F, G, K, L, M and N. The Medigap plans with more coverage will be more expensive. These plan benefits are standardized, but the prices are not uniform as they vary state by state. Age is also a factor in the pricing structure for some Medigap plans, so to find the plan that is the most affordable and best fit for an individual’s needs, work with a locally appointed specialist.
What do I need to qualify for a supplemental Medigap plan?
During the initial six-month period after you qualify for original Medicare AND sign up for Medicare Part B, you cannot legally be denied a policy or have rates raised due to pre-existing conditions. After this non-renewable period has passed, most insurance companies will likely require some medical underwriting in order to qualify for Medigap coverage. Other open enrollment and “guaranteed issue” periods do occur throughout the year, during which individuals have the right to purchase a Medigap policy regardless of health status.
Beyond the open enrollment or guaranteed issue periods, insurance companies use medical underwriting to evaluate an applicant’s health status when deciding whether to approve a Medigap coverage application and at what rates the individual will qualify for. This process can include answering personal health history questions and may include a standard physical exam. Insurance companies like Health IQ work to use an expanded underwriting process to reward the proactive steps some individuals take to remain healthy through the years to provide reduced premiums for those applying for a Medigap plan outside of individual open enrollment periods. These premium rewards can be offered for healthy lifestyle activities and choices such as following a specific nutrition protocol (such as a plant-based, paleo or Mediterranean diet), exercising regularly and maintaining a high health literacy score.
Can Medicare Supplement plans be denied?
Outside of open enrollment or guaranteed issue periods, insurance companies are allowed to require individuals to undergo a medical underwriting process. The health information gathered in this process — which includes past and present health conditions — can be used to decline an application for coverage or to charge individuals higher premiums based on perceived risk. The good news is that individuals that are in generally good health with no serious pre-existing conditions have a strong likelihood of obtaining Medicare supplement insurance without issue.
What is the open enrollment period? If I miss open enrollment, can I still get a Medicare Supplement plan?
Different states have different rules regarding open enrollment. In general, the open enrollment period is a governmental protection put in place to ensure that all Medicare recipients, regardless of health status, have access to reasonably priced Medicare Supplement insurance. This six-month period usually starts when an individual turns 65 years old and has enrolled in Medicare Part B. During this period, insurance companies are not allowed to require medical underwriting or deny coverage for any Medicare Supplement plan. They are also required to offer you the most preferred rates during this period. If an individual’s six month open enrollment window has passed, the insurance company will most likely require the medical underwriting process as part of the Medigap application process, and the offered coverage will be based on those results.
Depending on which state you’re in, there may be other open enrollment periods, as well as guaranteed issue periods, during which you have the right to obtain any policy without medical underwriting.
Is there anything a Medicare supplement plan doesn’t cover?
Medicare Supplement insurance plans cover care not authorized by Medicare. This includes a variety of non-emergency benefits not covered by Medicare Part A or Medicare Part B such as dental and eye care, prescription drugs (except in an inpatient setting), hearing aids, eyeglasses, long term custodial care, dentures, cosmetic surgery, routine foot care, etc. Most companies with Medigap coverage options will also have options for dental and vision care as well since those services are not covered by Medicare.
What happens to my Medicare Supplement plan if I move to another state or location?
If you move to a new location within the same state, Medicare Supplemental Insurance will not be impacted and you will still be able to access any provider that accepts Medicare. If you move to a different state, you may be able to keep the same plan because Medicare Supplement plans are standardized in most states, but this is an important consideration to research beforehand. Call your insurance agent or insurance company to notify them about an upcoming move and to inquire about any changes to coverage or care that may come as a result of your move, based on the specifics of your Medigap policy.
What is special about Health IQ’s Medicare Supplement options?
Health IQ is a company on a mission to provide special, lower rates on insurance for people living healthy lifestyles because hard work and health literacy deserve a financial reward. We believe that people living healthy lifestyles are overpaying for Medicare Supplement insurance, and we have negotiated with top insurance companies to offer these special, reduced rates directly to consumers living in many states where these plans are available.