Who is Eligible for Medicare Supplement Insurance?

  • You are currently covered under Medicare Parts A & B
  • You are within 6 months of turning 65
  • You are within 6 months of receiving Part B coverage
  • If you are about to lose your group health insurance plan
Please be aware that even if you qualify for Medicare Supplement Insurance, you may be required to answer some questions regarding your medical history. To learn more, or if you have any questions regarding Medical Supplement Insurance eligibility, please contact us 866-611-0519.

When Can I Sign Up for Medicare Supplement Insurance?

  1. The Initial Enrollment Period
    During the first six months of your Medicare Part B coverage, you’re guaranteed Medigap acceptance regardless of your current medical standing.
  2. “Guaranteed Issue” Period
    If you’re in danger of losing medical coverage through your employer, Medigap offers a “guaranteed issue” period lasting 63 days where you’re able to purchase the Medicare Supplement Policy of your choice.
  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care
Discover If Medicare Covers What You Need Please speak to your doctor or health care provider to learn more about certain services and supplies, and if Medicare will cover them. Typically the standard Medicare plan will cover whatever you need, however there may be certain items/procedures that are currently not covered. Medicare Coverage Is Based On Three Main Factors
  1. Federal and state laws
  2. National coverage decisions made by Medicare about whether something is covered
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area
WHAT DOES PART B COVER? Depending on your Medicare plan, your coverage may differ depending on the rules associated with it. Nonetheless, each plan still provides the same essential coverage as the standardized Medicare plan. Part B Covers Two Types Of Services
  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best
You pay nothing for most preventive services if you receive these services from a health care provider who accepts assignment. Part B Covers:
  • Clinical Research
  • Ambulance Services
  • Durable Medical Equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial Hospitalization
  • Surgical Second Opinions
  • Limited Outpatient Prescription Drugs
PRESCRIPTION DRUG COVERAGE UNDER PART C & D With Medicare, you receive prescription drug coverage as an optional benefit under parts C and D, respectively. By knowing exactly what type of prescription drugs you need on a daily basis, you’re able to get the exact plan you need.

By not obtaining Medicare drug coverage when you first sign up for your Medicare plan, you’ll likely end up paying a late enrollment fee. There are several Medicare plans which offer prescription drug coverage, each of which varies in both cost and drugs covered.

Two Ways To Qualify For Prescription Drug Coverage
  • Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
  • Medicare Prescription Drug Plan (Part D) . These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
WHAT IS THE DIFFERENCE BETWEEN MEDICARE SUPPLEMENT INSURANCE PLANS F, G, AND N? Medicare Supplement (or Medigap) insurance plans are standardized across the nation, except in Massachusetts, Minnesota, and Wisconsin. Each of the 10 plans is denoted by a letter, and the currently available plans are A, B, C, D, F, G, K, L, M, and N. These plans are provided through private insurance companies, but plan type with the same letter must offer the same set of basic benefits regardless of location.

Medigap Plan F is considered one of the most popular plans because it offers the most comprehensive coverage of certain health care costs, including:
  • Medicare Part A coinsurance and hospice care coinsurance
  • Medicare Part A deductible
  • Medicare Part B coinsurance or copayment
  • Medicare Part B deductible
  • Part B excess charges
  • First three pints of blood used in a procedure
  • Skilled nursing facility (SNF) care coinsurance
  • Coverage outside of the United States (up to plan limits)
Medigap Plan G offers all of the same benefits as Plan F except for the Part B deductible. Medigap Plan N covers the same benefits as Plan F except the Part B deductible and Part B excess charges. Also, it covers the Medicare Part A deductible at 50% versus 100%. Medigap Plan N pays for 100% of the Part B coinsurance, except for copayments of up to $20 for certain office visits and up to a $50 for emergency room visits that do not result in an inpatient admission.

Medicare Supplement insurance plans Medicare Supplement insurance, also known as Medigap or MedSup, is also sold through private insurance companies, but it is not comprehensive medical coverage. Instead, Medigap functions as supplemental coverage to Original Medicare. Current Medigap plans don’t include prescription drug coverage.

Medigap plans may cover costs like Medicare coinsurance and copayments, deductibles, and emergency medical care while traveling outside of the United States. There are 10 standardized plan types in 47 states, each given a lettered designation (Plan G, for example). Plans of the same letter offer the same benefits regardless of where you purchase your plan. Massachusetts, Minnesota, and Wisconsin offer their own standardized Medigap plans.

The standardized Medigap plans each cover certain Medicare out-of-pocket costs to at least some degree. Every Medigap plan covers up to one year of Medicare Part A coinsurance and hospital costs after Medicare benefits are used up. But, for example, Medigap Plan G plans don’t cover your Medicare Part B deductible, while Medigap Plan C plans do. So, if you’d like to enroll in a Medicare Supplement insurance plan, you might want to compare the Medigap policies carefully.

While benefits are standardized, the costs are not, meaning they could fluctuate depending on the insurance company offering the plan and location. That is, while Medigap Plan G includes the same coverage no matter where you buy it, the premium for this plan can vary. Also, not every standardized lettered plan is offered in every state.

Is Medicare Part D optional? You’re not required to enroll into a Medicare Part D Prescription Drug Plan. However, if you go without creditable prescription drug coverage for 63 or more days in a row after you’re first eligible , you may have to pay a late-enrollment penalty if you enroll into a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan later.