A Medicare supplement is a type of insurance that covers some of the out-of-pocket costs associated with Original Medicare. Also called Medigap, Medicare supplements are standardized plans offered by private insurers. These standardized policies must follow federal and state laws designed to protect you. Find out more about how Medicare supplements can help cover expenses not paid by Original Medicare and ensure you have the protection you need.
Medicare supplements may not charge more than the Medicare-approved amount for covered services, and they must clearly describe the benefits and premiums on their advertisements. The insurance company is legally required to give you at least 60 days notice of any increase in premiums or change to your policy. Medicare beneficiaries may file a complaint with the Texas Department of Insurance (TDI) if their insurance company fails to pay claims promptly.
The best time to buy a Medicare supplement is during the one-time, six-month Medicare supplement open enrollment period that starts when you enroll in Medicare Part B at age 65 or older. During this six-month window, the insurance company cannot ask you any health questions or turn you down for a policy. After that, you can still purchase a Medicare supplement plan, but you may have to answer medical questions and/or be subject to underwriting.
In general, the more comprehensive a Medicare supplement is, the higher the premium will be. Plans F and G offer the most comprehensive coverage, but they come with the highest premiums of all standardized Medicare supplement plans. Plans K and L provide less comprehensive coverage, but they have lower premiums than Plan F or G.
You can also consider a Medicare Advantage plan, which has network and out-of-network benefits. Most Medicare Advantage plans are now offering supplemental benefits not available in Original Medicare.
Most Medicare Supplement plans can be changed any time you want, but after your open enrollment window, you’ll have to answer medical questions and the insurance company can decline you if you have preexisting conditions or medications.
There are ten standardized Medicare Supplement insurance plans: Plan A, B, C, D, F, G, K, L, and N. These plans all offer the same core benefits, but some of them have unique additional features.
Some Medicare Advantage plans require you to use doctors and hospitals within a certain network to receive benefits. In those cases, a Medicare Supplement can help you see non-network doctors while maintaining your coverage.
A Medicare supplement can cover doctor and hospital visit copayments, the Medicare Part B deductible, and excess charges, which are amounts that doctors and hospitals bill for more than Medicare’s approved amount. Excess charges are usually no more than 15% above the Medicare-approved amount. Plans F and G cover these charges; Plan C does not.
In some cases, if you have group coverage through your job or union and lose it, you may be eligible to purchase a Medicare Supplement within 63 days of losing that coverage. Your insurance agent can explain your Medicare supplement guaranteed issue rights to you. You must be enrolled in Medicare Part A and Part B to qualify for this special benefit.