Medicare PLUS Medigap

If you’re about to turn 65, you should be shopping for a health plan that covers the costs that traditional Medicare doesn’t. If you already have a Medigap plan, it's always wise to shop around and confirm you are still in the best plan at the lowest price. There is no "annual enrollment period" with Medigap plans, so don't wait.

As welcome as Medicare’s health care coverage is, it does have its gaps. The traditional fee-for-service program generally pays 80 percent of the medical bills, which means the remaining 20 percent becomes the responsibility of beneficiaries. Here’s an example. With the average hospital stay costing about $30,000… your 20 percent would be $6000. Now, imagine if you needed major surgery. For example, Heart Bypass surgery which typically cost between $70,000 & $200,000. Now you’re looking at between $14,000 & $40,000 out of pocket. You can see how the 20 percent you’re responsible for could quickly get out of hand.

To protect themselves, many people buy supplemental coverage from private insurers. Medicare Supplement or “Medigap” insurance, as it’s called, helps fill the gaps that deductibles, copayments and coinsurance leave. It makes out-of-pocket costs more manageable.

Not everyone should consider a Medigap policy. You don’t need to supplement your Medicare coverage if you’re on Medicaid or enrolled in a group health plan through an employer or former employer. Also, you have the option to sign up for a private Medicare Advantage plan. If you choose that option, you are not allowed to enroll in a Medigap plan. It's one or the other. But there are numerous opportunities to switch. As a side note; please keep in mind, with Medicare Advantage plans and most employer group health plans, you are still responsible for deductibles, copayments and coinsurance... AND, you are required to use a network of doctors and hospitals the insurance carrier contracts with to manage your care. If you go "out of network", it may not be covered. For those reasons, Medicare Advantage plans typically have a much lower premium than Medigap plans. If this is your preference, Senior Benefits Network can help find the plan that's right for you.

The combination of traditional Medicare coverage and a Medigap plan makes good sense for beneficiaries who prefer a broad choice of doctors, hospitals and other health care providers but still want to limit their out-of-pocket expenses. There is no “network” of doctors and hospitals you are required to adhere to. If they accept Medicare, they accept Medigap. It’s that simple.

The best time to buy a Medigap plan is within six months of turning 65 and enrolling in Medicare’s Part B medical insurance. During that period, insurers can not refuse to sell you a policy, or charge you more than other people because of a health problem or pre-existing condition. If you try to buy after those six months, there’s no guarantee an insurer will cover you. If they do cover you, the premium could be substantially higher. You can enroll up to 6 months prior to your 65th birthday to lock in the lowest possible rate.

As explained on page 100 of the 2016 Medicare & You Handbook, “Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs.”

Visit and click on “Supplements and Other Insurance” to find out more about each of the 10 available kinds of plans. Or click this link to view a Medigap chart showing the basic information about the different benefits that Medigap policies cover.

All 10 standardized plans cover these basic benefits: the coinsurance for extended hospital stays, the coinsurance for doctor visits and outpatient services, the coinsurance for hospice care, and the cost of the first three pints of any blood you might need. Beyond that, different Medigap plans cover additional out-of-pocket expenses, such as the hospital deductible, the outpatient deductible, the coinsurance for skilled nursing care, and the cost of medical emergencies while traveling outside the country.

You’ll pay the insurer a monthly premium for your Medigap policy in addition to the monthly premium you’ll pay Medicare for Part B. Although insurers must offer the same benefits within each kind of plan, their premiums can vary widely, So shop around. Of course, I recommend contacting Senior Benefits Network. (Yeah, I’m a little bias.)

It’s also wise to find out how often an insurer has raised premiums. It’s not just the initial price, but what happens year to year. An insurance broker will have that information.

One note of caution: Medigap insurance doesn’t plug all the holes. It’s not a way to pay for long-term custodial care, dental care, eyeglasses or hearing aids. Also, it only covers things that are “medically necessary.” For example, cosmetic surgery isn’t covered. It won’t pay for your tummy tuck or that facelift you’ve been considering. Also, new Medigap policyholders need to buy separate drug coverage under Medicare’s Part D if they want it. Same as original Medicare.

If you’re interested in supplemental insurance, here are four steps to follow:

• First, decide which benefits you want and which standardized Medigap plan best meets your needs.

• Next, find out which insurers sell Medigap policies in your area.

• Then, do some research on the insurers that interest you. Besides comparing premiums and annual rate increases, check the companies’ customer service. The State Department of Insurance will have a record of consumer complaints against particular insurers.

• Finally, pick the policy that best fits your specific needs and budget. Once your application has been accepted, you can’t be canceled for any reason. You can keep your insurance as long as you pay the premiums.

You can do all this on your own. But if you want to save yourself the headaches and 2 or 3 weeks of stress, then call an insurance broker that represents ALL the top insurers in your area so they can do the heavy lifting for you.

Senior Benefits Network is great choice. Based out of Bryan/College Station Texas, Senior Benefits Network Insurance Services is dedicated to providing unbiased help on selecting a Medicare Supplement. As Brokers, we can shop ALL of the Top Rated insurance carriers. We don't work for them. We work for you. We have the tools and the experience to find the products that meet your specific needs. This service is FREE and could save you $1000 per year or more off your premiums.

Senior Benefits Network is your leading source for Senior Health Products. We specialize in Medicare Supplements and ancillary Health Products. Please surf, research and investigate our website at for everything on Medicare for your current or upcoming decisions. We're available to answer any questions you may have.

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