This post discusses Medicare Supplements in detail, including the pros and cons.

Medicare Supplement Plans (MediGap)

People who are tired of networks and bureaucracy and just want freedom in their health care might really appreciate a Medicare Supplement policy, which is sometimes called MediGap. (I’ll use these words interchangeably throughout this article). MediGap is not to be confused with Medicare Advantage, which is also called Part C. Medicare Supplements and Medicare Advantage plans are both solutions to limit your financial risk with Medicare, but they approach that from very different directions. To enroll in either one, Medicare regulations require that you have both Medicare Parts A and B. Also, you must choose either Medicare Supplement OR Medicare Advantage. You may not be enrolled in both of them at the same time. Learn about Medicare Advantage.

If you choose Medicare Supplement, your solution will look something like this. Medicare will pay about 80% of your medical costs. Instead of you paying the other 20% your MediGap insurance company will pay that 20% for you. In exchange, you’ll pay a flat monthly fee to them month in and month out whether you’re sick or healthy. MediGap plans never include Part D for prescription drugs, so you’ll need to buy that separately, and you’ll also need to buy your dental, vision, and hearing plans separately.

There is no provider network for Medicare Supplement plans—you’re free to use any provider in the United States as long as that provider accepts Medicare. You’ll also have no primary care physician, no referrals needed, no claims to worry about. When you get medical care, your provider will bill Medicare directly. After Medicare pays their 80%, they’ll forward the bill to your Medicare Supplement company who will have to pay your remaining 20%. This is important: your MediGap company has NO SAY over whether they play that claim or not. They must pay the claim. If Medicare pays their 80%, the Medicare Supplement company must pay their 20%.

Pros of Medicare Supplements

  • Fixed monthly payment, so budgeting is easy.
  • No provider networks. Use any provider in the U.S. who accepts Medicare.
  • No primary care physician.
  • No referrals needed for a specialist.
  • No claims paperwork.
  • No date restrictions. Add or drop a policy at any time of year if you’re healthy enough to qualify.
  • Benefits remain the same from year to year (but price will usually increase).

Cons of Medicare Supplements

  • Monthly payment usually increases each year as you age.
  • Most people must qualify by being healthy (some exceptions).
  • Your drug plan and dental plan must be purchased separately.
  • Not good for people under 65 years old in most states.
  • Not subsidized by Medicaid for low income Americans.

Health Matters . . . Usually

Because Medicare Supplement companies are required to pay your claims, they’re very strict about who they allow to enroll in their plans. They don’t want sick people. (See below for exceptions during the Open Enrollment Window and a Guaranteed Issue window.)

The Kaiser foundation published a list of medical conditions that are likely to be problematic when trying to medically qualify for a MediGap policy. Underwriting varies a little from company to company and sometimes from state to state, but here is a general idea of the kinds of conditions that most companies will decline. We can usually determine which company is most likely to approve you before we apply.

Open Enrollment Period

Normally an application involves many health questions and a full underwriting review of your health history and prescriptions. However, every consumer will have at least one open enrollment period during which time you can enroll in a MediGap plan with no medical questions. That window of opportunity is six months from your Part B start date. For example, if you’re due to start Part B on June 1st, then June through November will be your open enrollment window to apply with no medical questions. Most companies will allow us to apply several months in advance so you can get approved to start the same day you start Part B.

Problematic Health Conditions*

  • ALS (Lou Gehrig’s Disease)
  • Alcohol/drug abuse
  • Alzheimer’s disease or other dementia
  • Chronic lung or pulmonary disorders (chronic bronchitis, COPD, cystic fibrosis)
  • Cirrhosis
  • Congestive heart failure
  • Diabetes (insulin dependent)
  • Emphysema
  • End Stage Renal Disease (ESRD)
  • Fibromyalgia
  • Heart Disease
  • Hepatitis
  • Immune disorders (RA, MS, Lupus, AIDS)
  • Kidney disease requiring dialysis
  • Mental/nervous disorder
  • Myasthenia gravis
  • Organ transplant
  • Osteoporosis (if severe/disabling)
  • Stroke
  • Advised by physician to have surgery, medical test, treatment, or therapy
  • Implantable cardiac defibrillator
  • Use of supplemental oxygen
  • Use of nebulizer
  • Asthma requiring continuous use of 3+ medications including inhalers

*Underwriting guidelines vary from company to company.

Guaranteed Issue Window

Some people start Medicare when they turn 65 but continue with group health insurance for many months or years, so they don’t look for a MediGap policy until much later. These people will have a 63-day window following the loss of group coverage to “guarantee issue” into a Medicare Supplement Plan. Those who guarantee issue into a plan must enroll in the plan letter that is mandated by Medicare (currently Plan G). Those who are healthy enough to qualify medically and pass underwriting can enroll in any plan, so we recommend qualifying medically when possible, even if you have a guaranteed issue window. Because those who can’t pass underwriting enroll in Plan G, Plan G ends up with a larger number of people with high medical costs. There is anecdotal evidence that suggests annual rates are rising at a higher percentage for Plan G than for Plan N.

Good to Know

No Date Restrictions.

You can add a Medicare Supplement policy or switch to a different MediGap policy any time you’re healthy enough to qualify. There are no date restrictions for MediGap; however, there are date restrictions for the Part D prescription drug plan that you must buy separately. We will review your Part D plan each fall between October 15 and December 7 and change as needed for a January 1 start date.

Best for 65 and up.

If you are disabled and started Medicare at an age younger than 65, most Medicare Supplement companies will either not sell you a policy or it is so outrageously priced—sometimes literally 10 times higher for a 64-year-old than it is for a 65 year old. So if you’re younger than 65, I encourage you to choose Medicare Advantage. However, the open enrollment period for you will be the six months following your 65th birthday. This is the only time you will be able to get a Medicare Supplement policy without answering medical questions.

Medicare Supplement Plan Choices

The Medicare department of our government publishes a book each year on MediGap policies explaining how they work and how to choose one. This is a 128-page book for 2022 that you can get HERE. On page 76 of this book, there is a chart that outlines the various Medicare supplement plans that are available. Highlighted in blue are the most popular plans today, so we’ll take a closer look at how those plans differ from one another.

Some of these plans have been discontinued, and others don’t provide enough benefit
so they are unpopular. The most common plans today are Plan F, Plan G, and Plan N.

Most Common Plans: F, G, N

Plan F, Plan G, and Plan N all cover the same healthcare benefits and services. They differ only in what YOU are required to pay.

  • Plan F – you pay the monthly premium only; no copays, coinsurance, or deductibles for any service. Plan F is being discontinued, so it’s not available to anyone who started Medicare in 2020 or later. It is still available to those who started Medicare before 2020.
  • Plan G – you pay the monthly premium plus an annual Part B deductible ($203 in 2021) as services are received.
  • Plan N – you pay the monthly premium, Part B deductible, and possible copays of up to $20 for doctor visits and up to $50 for emergency room visits. In addition, most states will allow doctors to bill “excess charges” on Plan N, also called “balance billing.” Learn about excess charges.

Premiums for Plan N are always lower than for Plan G but if you go to the doctor a lot, then Plan N is probably not a good choice for you. If you are healthy and you have infrequent visits to the doctor, you can save money with Plan N.

Just to be clear, all of these plans cover the same exact Medicare-approved services. There’s not a scenario where one plan will pay for your hip replacement and a different plan won’t. They all pay for whatever Medicare approves. The difference is the degree of cost sharing that is borne by you. There will be more cost sharing with plan N than with Plan G, but Plan G has a higher monthly premium.

Standardization

Decades ago, the Medicare department standardized MediGap policies plan types so that they would be exactly the same from company to company. This is something that most Medicare beneficiaries do not understand—even those who have been on Medicare for a long time, so I’m going to explain it using an analogy.

I buy my toothpaste at Costco, but I could buy that same toothpaste at any drugstore, grocery store, convenience store, even airports and hotels.  No matter where I buy it, the toothpaste inside the tube is exactly the same. The merchants who choose to carry my brand don’t have any say whatsoever about the recipe or the ingredients used inside the tube. They can decide whether they want to sell it in their store, and they can also decide how much to charge. They have some degree of control over who they let in their store to buy it. For example, at Costco a membership is required to enter the store; at an airport, only ticketed passengers can access the stores.

This is exactly how MediGap plans work. Medicare defined what each plan covers, and how much cost sharing will be borne by consumers (copays, deductibles, etc.) Insurance companies who want to offer MediGap plans are free to charge whatever monthly premium they want, but they are not free to decide what medical services are covered and which are not. Insurance companies can not change consumer cost sharing amounts that are established by Medicare. Insurance companies can choose only what to charge for the monthly premium and, to a degree, whom to accept into the plan.

The reason I say that a lot of people misunderstand this is because they will tell me “I love my insurance company, they’ve been so good to me and they pay everything.” But really, it’s Medicare that has treated them well, not the insurance company. They have no say about paying your claims; they have to pay. If you switch to a different insurance company for a Medicare Supplement plan, you should have exactly the same experience. (Note: this is NOT true for Medicare Advantage, which we will discuss in detail in another post.)  For Medicare Supplements, your Plan G or your Plan N should be exactly the same no matter which company you choose. When the price takes a big jump, we comparison shop to see if we can find a company selling it for less.

Monthly Premiums

Rate Increases

You can keep your Medicare Supplement plan for as long as you like (without needing to renew it each year), but you should expect the monthly premium to increase annually. These increases are usually a nominal amount, but if you get a large increase, you should call so we can shop for another plan that costs less. If you’re healthy enough to qualify, we will find another plan of your same plan type that is exactly like the one you have, except for the price.

Location Matters

Medicare Supplement prices vary greatly, according to where you live. In some states, the imposed regulations are so substantial that insurance companies have had to dramatically increase their prices to even do business. In those states, Medicare Supplements are just too expensive for many people to afford. In other regions, Medicare Supplements are very affordably priced.

I did a very random analysis in 2021 that illustrates differences that still apply: I picked nine cities throughout the country that start with the letter “A.” Some of these are densely populated, others are sparsely populated, and some are in between. I ran quotes for Plan G and Plan N for 65-year-old females and 65-year-old males, non tobacco. These are the prices showing that day.

  • The pink and blue represent female versus male prices.
  • In Anaheim, California, and in Albany, New York, the lowest priced Plan G and Plan N charges the male price for both males and females.
  • The lowest prices across the board were in Abilene, Texas.
  • High priced cities are sometimes twice the price or more than the low priced cities.

Prices change all the time, but the point I’m making here is that where you live matters. Even if you think Medicare Supplement is the thing that would fit your lifestyle the best, it may be cost prohibitive in your region.

You can only buy a policy based on your resident address (no post office boxes). If you have multiple residences, then we’ll comparison shop and get it from the cheapest one. You can’t use a business, vacation, or family member’s address.

State Exceptions: Connecticut, Maine, Massachusetts and New York have more lenient consumer protection laws with respect to guaranteed issue rules, so prices are usually higher in these states. Massachusetts, Wisconsin and Minnesota each have their own programs for Medicare beneficiaries, so Medicare Supplements work a little bit differently in those states. Other states stick to the federal guidelines with few exceptions.

MediGap Costs

All Medicare Supplement policies have a monthly premium, unlike Medicare Advantage plans, many of which have a $0 monthly premium. In addition to the MediGap premium, most people pay $0 premium for Part A and $170.10 premium for Part B (2022 price). If your adjusted gross income two years ago was higher than $91,000 for single and $182,000 for married, then you will pay more than the $170.10. Learn about extra costs for high income earners.

In addition to the Part B premium and the MediGap premium, you’ll pay a monthly premium for your Part D prescription drug plan. The national average in 2022 for this is in the $35 per month range, but that’s just for the monthly premium and does not include any of the costs of drugs. If you have a complicated pharmaceutical profile, the cost of your medications will be your biggest concern. Those with minimal needs can sometimes get a drug plan in the $7-10 a month range, that will prevent you from getting charged the late enrollment penalty. There will also be a premium for your dental, vision, and hearing policy. Lock in lower rates for life by getting this when you’re 64 instead of waiting until you’re 65.

My experience talking with people who have Medicare Supplements is that they love them. As they age, the price gets a little bit high, so cost will sometimes drive people to another solution, but it’s not because they’re dissatisfied with MediGap; it’s because it got too expensive for them.

Conclusion

The Medicare Supplement program is great—offering freedom, flexibility and convenience that most American just aren’t used to. If you’re willing to pay for a MediGap plan, you’ll probably be very happy with your healthcare. If the Medicare Supplement prices are concerning to you, then watch my Medicare Advantage video.

Medicare Advantage programs are also great, but they approach limiting your financial risk from an entirely different perspective. If you are healthy, you could spend very little on your health care—close to zero sometimes. In addition, the Medicare Advantage companies throw in all kinds of freebies to entice you to sign up with them.

Help is free!

I’m Laraine Sookhoo and I’m passionate about helping you understand your Medicare options so you can get the most out of your Medicare benefits. My help is free, so book an appointment to get started!

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