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Buckeye Senior Benefits Agency

Medigap or Medicare Supplemental Health Insurance

What Is a Medigap or Medicare Supplement Insurance Plan?


Medigap or Medicare Supplemental Insurance, as the name indicates is a plan that fills in the gaps left over by Medicare Part A and Part B. This private health plan is offered by various State approved Medicare insurance companies such as Aetna, Medico, Anthem Blue Cross & Blue Shield,  Philadelphia American (New Era), CIGNA and Mutual of Omaha among others.


Who is Eligible For a Medicare Supplemental Insurance Policy?


  • You need to be enrolled with Medicare Plan A and Part B*. 
  • You need to be age 65 or older
  • You have to answer the health questions on the application (unless it's open enrollment for turning 65 or coming off of group health coverage) and pass the companies underwriting guidelines
  • You cannot have BOTH a Medigap plan and a Medicare Advantage plan, you can only have one.


Why is a Medigap Plan Good For You?


  • Guaranteed acceptance  when you enroll during the ‘open enrollment’ all health insurance providers are bound to accept you regardless of any pre-existing health conditions you might have/ had.
  •  Guaranteed renewable the insurance company has to renew your Medicare Supplement policy  and cannot discontinue it for any reason unless you are not paying the monthly premium.
  •  No hidden out-of-pocket expenses – Medicare Advantage policies are low cost (some have $0 per month plans) but many times have hidden out-of-pocket expenses like doctor copays, a deductible  or coinsurance.  Medigap plans often have no out of pocket fees like deductibles (unless you have plan G or N), or copays (Plan N), of course that's if you have the most popular supplement in America, a plan F, which covers all Medicare approved expenses aka the "Cadillac Plan" of Medicare supplements.
  •  Doctor and Hospital Choice – there are no limitations of pre-approved networks. You can visit any doctor or hospital in the USA that accepts Medicare.
  •  Zero co-insurance for hospital stay – you can avail up to 365 days of hospital stay at zero co-insurance.
  •  Zero physician co-insurance and co-payment – offered by most plans except Plan N and G


What Influences The Price Of Medicare Supplement Insurance Policy?


Factors such as age, tobacco usage, zip code (state where you live) and gender are among the most critical health plan price determinants. Besides these, the Medicare Supplement Companies use the following three methods to set their pricing:

 1. Attained Age

  •  The cost of the health coverage insurance is indirectly proportional to your age. The older you get, the higher the premiums.
  •  Increase in premiums is done over periods of one year/ three years/ five years. Unfortunately, the premiums reach their peak when the retiree needs it most and affords it in the least, i.e. at 80-90 years of age.

 2. Issue Age

  •  Premium of the insurance policy is calculated based upon the age at which you are purchasing it.
  • The premium would not be increased as you age*.

 3. Community-based

  •  Price is calculates as per the demographic data available with Medicare.


Which is the Best Medicare Supplement Plan?

Federal Government regulates what Medigap Insurance policies cover. This is why all the 12 policies provide the same coverage within a plan, without regard to what company provides it.  Here are the most popular Medicare Supplement plans and the reasons why they are popular.


Medicare Supplement Plan F is the most popular for it offers the most and best benefits for senior people. Some of the best features of this plan are:
  1. Never see a hospital bill
  2. Usually Guaranteed Issue when coming off group health insurance or turning 65
  3. Just pay your premium and forget about extra bills like copays and coinsurance

Medicare Supplement Plan G is the best value in my opinion because it offers almost the same exact benefits as Plan F, except that the senior has to pay an annual deductible of $147 (2015). After the senior pays the deductible, the plan for all intents and purposes is a plan F. Additional benefits of a this plan are:

  1. Lower rates than a plan F
  2. Lower rate increases because people have to qualify medically (answer health questions) to obtain it
  3. Sometimes seniors see rate decreases due to the amount of healthy people signed up

Medicare Supplement Plan N is the most competitively priced Medicare Supplement (besides Hi Deductible plan F). It offers a lower rate than plan G, and that's because the senior will be responsible for doctor (up to $20) and ER ($50) copays. For those seniors coming off of group coverage, this will be the most similar option to your group coverage out of all Medigap plans.