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Medicare Supplements Insurance (MEDIGAP)
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Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
• Copayments
• Coinsurance
• Deductibles
Note
Note: Medigap plans sold to people who are newly eligible for Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F aren’t available to people newly eligible for Medicare on or after January 1, 2020. If you already have or were covered by Plan C or F (or the Plan F high deductible version) before January 1, 2020, you can keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans that cover the Part B deductible.
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
• Medicare will pay its share of the Medicare-approved amount for covered health care costs.
• Then, your Medigap policy pays its share.
8 Things To Know About Medigap Policies
1. You must have Medicare Part A and Part B.
2. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D). If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.
8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.
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Medicare Options
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HMO (Health Maintenance Organization)
You usually have to use the doctors and other providers in the plan’s network. In an HMO with point-of-service option (HMOPOS), you may be able to go out-of-network for certain services. If you want drug coverage, the HMO Plan you join must include drug coverage.
PPO (Preferred Provider Organization)
These plans have a network of doctors and other providers, but you can use providers outside their network. You’ll usually pay less if you get services from in-network providers. If you want drug coverage, the PPO Plan you join must include drug coverage.
PFFS (Private Fee-for-service)
You can see any doctor or other provider that accepts the plan’s payment terms and agrees to treat you. Not all providers will, even if you’ve seen them before. If you join a PFFS Plan that doesn’t include drug coverage, you can also join a separate Medicare drug plan (Part D).
MSA (Medical Savings Account)
These are high-deductible plans that deposit money into a savings account that you can use to pay health care costs before you meet the deductible. You can see any doctor or provider. Once you’ve used the amount of money in the account, you’ll pay all costs until you meet the deductible. These plans don’t include drug coverage, but you can also join a separate Medicare drug plan.
Cost Plan
These plans are only available in some states. You can see any doctor or other provider that works with Medicare. If you go to a provider outside the network, Original Medicare covers those services. You’ll pay the Part A and Part B deductibles and coinsurance, usually 20% of the Medicare-approved amount, for those services.
You can join a Cost Plan without drug coverage anytime the plan’s accepting new members. You can also join a separate Medicare drug plan during an enrollment period.
If you want to join a Cost Plan with drug coverage, you can only join during an enrollment period.
MMP (Medicare-Medicaid Plan)
These plans are only in some states. You can join if you have Medicare, are getting full Medicaid benefits, and meet other criteria by the state. All MMPs include drug coverage.
Special Needs Plans
You can join this type of plan if you:
• Have both Medicare and Medicaid
• Have a specific disease or condition (like diabetes)
• Live in an institution (like a nursing home)
These plans tailor their benefits, provider network, and drug formularies to best meet the needs of the people they serve. All SNP Plans include drug coverage.
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