After learning about the basics of Medicare Supplement Insurance policies in our Part 1 blog, it’s now time to break it down a bit more and learn about the plans and benefits offered with Medicare Supplement policies. Read on to learn much more about these plans, how they work, and what is usually included.
Medicare Supplement Insurance Policies
Medicare Supplement policies offer a range of plans. These plans are identified by a letter range as plans A-N. The plans are standardized with primary benefits. This means that no matter what insurance carrier you choose to buy the Medicare supplement coverage from, the benefits will be the same carrier to carrier, according to the letter chosen.
Each identified letter plan has a different benefit and cost-sharing structure. Some plans have been discontinued like the I and J plans. Other plans offered, such as the C and F plans, require a person to be eligible for Medicare before January 1, 2020, to enroll in the plan. Today, the most popular Medicare Supplement plans offered on the marketplace are the F, G, and N plans.
All supplement plans include
- Part A coinsurance/copayment, plus 365 days after Medicare benefits are used up
- Part A hospice coinsurance/copayment
- First three pints of blood
- Part B coinsurance
Coverage for other costs not paid for by Medicare, such as deductibles, excess charges, and skilled nursing facility coverage varies by plan.
Each plan will consist of a cost-sharing responsibility unique to the specific plan that is chosen. The plan will pay their share of the cost of a covered health event after Medicare, and the policyholder pays for their share of the costs. The cost-sharing responsibility of a policyholder is typically very low once Medicare and the Medicare Supplement plan pay their portion.
How Medicare Supplement Insurance Plans Work
Here is a breakdown of the general rules of how a Medicare Supplement policy is configured:
- There are no pre-existing condition limitations (except in New York).
- Those insured with a Medicare Supplement policy can choose any licensed doctor or hospital that accepts Medicare patients. There are no network constraints.
- There is direct access to a specialist doctor without a referral requirement from your primary care physician.
- The plans are medically underwritten unless the Medicare beneficiary meets Open Enrollment or Guaranteed Issue requirements.
- The plans offer guaranteed renewable coverage, which means the plan cannot be canceled by the insurance carrier as long are premiums are paid when they are due.
- There is no change in coverage when a policyholder relocates within the United States.
- Electronic claims cross over for Medicare Part A and Part B, so members do not have to submit claims to the insurance carrier.
- Medicare Supplement plans do not have a set enrollment period and can be applied for throughout the year.
When Is The Time To Apply for a Medicare Supplement Policy?
Medicare Supplement policies can be applied for throughout the year, and have no set enrollment period. If a Medicare beneficiary applies when they are first eligible for Medicare Part A, there will be an open enrollment period. In this period, the plans will be required to accept the Medicare beneficiary no matter their health condition. This open enrollment will span six months, including the month of their eligibility. Also, if an individual has a guaranteed issue period, (Example: did not take Medicare Part B when first eligible, because still had employer group health coverage and still working) they would qualify for a Medicare Supplement plan, in the period of guarantee, without a medical underwriting requirement.
Outside of open enrollment and guaranteed issues, any other enrollment application for a Medicare Supplement policy will be medically underwritten. This means that health conditions are considered in the application process. If the insurance carrier decides that the medical condition does not qualify the applicant according to underwriting guidelines for a policy, the company can deny the application.
What Isn’t Included in a Medicare Supplement Policy?
While Medicare Supplement coverage is full of great benefits, there is still some essential coverage not covered. Medicare Supplement only includes the coverage that Original Medicare covers. Dental, vision, hearing, and prescription drugs are benefits that neither Medicare nor Medicare Supplement coverage offers and will need to be purchased separately.
Remember that a Medicare Advantage plan and a Medicare Supplement plan do not work together. A Medicare beneficiary can only have one or the other.
We at Healthcare American offer and can help you apply for most Medicare Supplement Insurance carriers and products available on the market. For more information on Medicare Supplement Insurance and for help finding the correct company for your individual needs, give the insurance brokers from Healthcare American a call today!
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