Blog

As Medicare beneficiaries consider supplemental coverage to fill the gaps left by Original Medicare (Parts A and B), many turn to Medigap plans. Among them, The HDG (High Deductible Plan G) stands out for the comprehensive benefits it provides at a lower monthly premium, but with a catch: a high annual deductible. If your client is considering a HDG Plan, understanding the pros and cons of HDG Plans will help them make an informed decision.

What Is HDG

HDG or High Deductible Plan G provides the same benefits as standard Medigap Plan G; one of the most comprehensive Medigap options, but only after the beneficiary meets an annual deductible. Each year, CMS decided what that deductible amount will be; in 2025, the deductible is $2,800.

Once the beneficiary pays the deductible for the year, the plan pays 100% of covered Medicare expenses, just like a standard Plan G.

Pros of HDG

1. Low Monthly Premiums

The biggest selling point of the HDG plans is their affordability upfront. The premiums for HDG Plans is typically much lower than standard Plan G, in some cases, less than 1/3 of the price, making this a great option for healthy enrollees or individuals living on a fixed income who want to be prepared for unexpected health issues.

2. Full Coverage

Once the beneficiary meets the annual deductible, HDG covers:

• Part A coinsurance and hospital costs
• Part B coinsurance/copays
• Blood (first 3 pints)
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance/copays
• Medicare Part A deductible
• Part B excess charges
• Foreign travel emergency care (up to plan limits)

3. Good Option for Health Individuals

Those who rarely seek medical care may not reach the annual deductible; in other words, out-of-pocket spending could stay well below the cost of a standard Plan G’s premium.

4. Standard Benefits

Just like all other Medicare Supplement plans; HDG is standardized. Therefore, after the deductible is met, the benefits are the same regardless of insurer. The only thing to compare are the premiums and service quality, not the coverage.

Cons of HDG

1. High Upfront Costs

Individuals who require frequent care (doctor visits, outpatient services, hospital stays) pay out-of-pocket until they reach the $2,800 (in 2025) deductible. For some, this could all happen early in the year, and the savings from lower premiums may not offset that.

2. Not Ideal for Some Budgets

For individuals on a tight or fixed income, facing unexpected out-of-pocket expenses could be difficult to manage before the deductible is met, even if the plan is technically cost-effective over time.

3. Premiums Aren’t Fixed

Although the premiums are much lower than standard Plan G, HDG premiums (like all Medigap plans) can still increase annually, leading to less savings over time. It may be a good idea to check the rate history of the insurer before choosing a plan.

4. Deductible Increases

Each year, CMS sets the annual deductible and it usually has a slight increase each year. This unpredictability can cause some issues with long-term budgeting when compared to standard plans.

Who May Be a Good Fit For HDG

• Healthy individuals with few healthcare needs
• Younger Medicare beneficiaries (e.g., age 65-70) not expecting major procedures
• Those comfortable with financial risk with the means to pay the deductible if necessary
• Budget-conscious individuals looking for low monthly expenses

Medicare HDG provides similar peace of mind to regular Plan G. It is just delayed until after the deductible is met. It’s a good option for those who can afford some out-of-pocket risk in exchange for lower premiums. As with all coverage options, it’s not a one-size-fits-all solution.

A licensed Medicare agent can help run the numbers and explore quotes tailored to an individual’s specific needs.

As an agent, helping clients navigate Medicare Supplement (Medigap) insurance can be both rewarding and challenging. One key aspect agents must understand and be able to explain to clients is what is Medicare supplement underwriting. Although Medigap plans offer standardized benefits, getting approved for coverage; especially outside of guaranteed issue periods, often depends on the underwriting process. Here’s what you need to know to guide your clients effectively.

Medicare Supplement Underwriting

Underwriting for Medicare Supplement plans refers to the process insurers use to evaluate an applicant’s health history before they issue a policy. This process determines whether an applicant qualifies for coverage and, in some cases, what premium they’ll pay. It typically includes a health questionnaire and a review of the applicant’s prescrption medications and medical history.

When Underwriting Is Required

Underwriting is generally required when a client applies for a Medigap plan outside of their open enrollment period or a guaranteed issue period. Here’s a breakdown:

Medigap Open Enrollment Period (OEP): This is a six-month window that starts the first month a client is 65 or older and enrolled in Medicare Part B. During this time, carriers must accept the applicant regardless of health status; CMS does not permit underwriting.

Guaranteed Issue Rights: These occur in specific situations (such as losing employer coverage or moving out of a Medicare Advantage plan’s service area). During this time, the client can enroll in certain Medigap plans without having to go through medical underwriting.

Learn more about Guaranteed Issue Rights

Unfortunately, outside of these periods, applicants are typically subject to underwriting and can be denied coverage based on pre-existing conditions.

Common Health Conditions That Affect Underwriting

While each carrier has it’s own underwriting criteria, common disqualifying conditions include:

• Congestive heart failure
• Insulin-dependent diabetes with complications
• Chronic obstructive pulmonary disease (COPD)
• Cancer within the past two years
• Alzheimer’s or dementia
• End-stage renal disease (ESRD)

In addition; some carriers may impose a waiting period for pre-existing conditions or adjust premiums based on health history.

Watch a quick YouTube video on Medicare Supplement underwriting

Navigating Medicare Supplement Underwriting

• Timing is everything: Try and encourage clients to apply during their OEP or another guaranteed issue window to avoid underwriting altogether.
• Pre-Qualify Applicants: Ask clients key health questions before submitting applications to avoid the disappointment of unnecessary declines.
• Know the Carriers: Different insurers have different underwriting guidelines. It is a good idea to familiarize yourself with each carrier you represent’s underwriting grids and health questions.
• Explore Alternatives: In the event the plan declines a client, they can opt for a plan that does not require underwriting, such as Medicare Advantage or other coverage options.

Understanding Medicare Supplement underwriting is essential to provide viable options to your clients. By staying informed about carrier guidelines and knowing how to time applications correctly, you can help clients get the coverage they need with fewer issues.

Need a SCOPE; click here

Because there are so many regulations for Medicare sales, agents need to constantly be learning. That is why we will discuss Medigap Guaranteed Issue Rights in this post. This is a subject that is crucial to understand but often misunderstood.

Medigap Guaranteed Issue Rights

Guaranteed Issue (GI) Rights are protections under federal law that provide beneficiaries the right to purchase certain Medigap (Medicare Supplement) policies without having to go through medical underwriting. That means insurance companies can’t:

• Deny the beneficiary enrollment in a policy
• Charge enrollees more based on health
• Impose waiting periods for pre-existing conditions (in most cases)

These rights kick in during specific situations, often tied to changes in your health coverage or life circumstances.

When Guaranteed Issue Rights Apply

Here are some common scenarios that trigger GI rights:

Turning 65

Anyone who turns 65 has a 6 month period where they can enroll in a Medigap plan without having to go through underwriting.

Loss of Employer or Union Coverage

Individuals that have health coverage through an employer or union (including COBRA) that ends have 63 days from the end of that coverage to buy a Medigap policy using GI rights.

Medicare Advantage Plan Leaves a service Area

If a Medicare Advantage (MA) plan no longer provides service the enrollee’s area, is terminated, or they move out of the plan’s service area, they can return to Original Medicare and buy a Medigap policy under GI protections.

Beneficiary Tries a Medicare Advantage Plan for the First Time

Those who joined an MA plan when they were first eligible for Medicare at 65 and switch back to Original Medicare within the first 12 months can buy any Medigap policy offered in their state.

Medigap Insurance Company Goes Bankrupt or Misleads You

If the Medigap insurer goes out of business or the beneficiary is misled into buying a policy, they have GI rights to purchase another policy.

Trial Rights

In some cases, beneficiaries have “trial rights” that allow them to try out an MA plan and return to a Medigap plan under GI protections. This typically applies if they dropped a Medigap policy for an MA plan and want to switch back within 12 months.

Rules and Timelines

• Typically individuals have a 63-day window from the date previous coverage ends to use their GI rights.
• The plans that are guaranteed issue depend on eligibility and location. The standard Medigap plans are Plans A, B, C, F, K, or L.
• The federal government mandates guaranteed issue rights, although some states offer broader protections. It is important to check the rules for each state.

Watch a YouTube video on Medicare Supplement Underwriting GI & non-GI states

Why Guaranteed Issue Rights Matter

Without GI rights, applying for Medigap outside the initial enrollment period often means going through medical underwriting. Those who have pre-existing conditions could be denied coverage or charged more.

GI rights are a safeguard. They ensure that when life throws a curveball like; losing coverage, moving, or simply changing your mind, beneficiaries can access supplemental coverage without penalty.

Birthday Rule

There are 6 states that allow beneficiaries to change Medigap plans without underwriting during a specific period before/after their birthday each year on a GI basis. The states that have this rule are: CA, ID, IL,KY, LA, MD, NV, OK & OR. Each of these states has it’s own specific rules for this.

Important:

Some states allow beneficiaries to change Medigap plans any time or at specific times without undergoing medical underwriting. These states are: CT, NY, MA & ME.

In CT & NY enrollees change Medigap plans anytime of the year without underwriting. Massachusetts offers an annual open enrollment where beneficiaries do not have to go through underwriting. In Maine there is an open enrollment in June where Medicare Supplement enrollees can switch to a similar or lower benefit plan without underwriting.

Anyone applying under GI rights; insurance companies may request documentation (like letters from the former insurer). Keeping all notices and paperwork handy makes the application process smoother.

Medigap Guaranteed Issue Rights are an important part of the Medicare landscape, especially for those navigating transitions. Understanding when and how they apply allows you to help clients make informed choices and avoid gaps in healthcare coverage.

Physicians Mutual Preventive Benefits are part of their Medicare Supplement plans designed to enhance Original Medicare by covering additional healthcare expenses. Notably, certain plans include coverage for preventive health care services and may offer access to fitness programs like Silver&Fit.​

Preventive Health Care

Preventive health care is essential for early detection and management of health conditions. Because of this, Physicians Mutual provides benefits for preventive services in most of their Medicare Supplement plans, excluding Plan A. These benefits are not subject to high deductibles, ensuring that policyholders can access necessary preventive services without significant out-of-pocket costs.

The Preventive Benefits Rider

This Medicare Supplement portfolio is unique to the market. It offers a Preventive Benefits Rider that not only covers preventive care but adds the Silver & Fit program as well.
This wellness combination is not available from any other insurance carrier.

The rider offers extra benefits for physical exams, health screenings and routine blood work not covered by Orignal Medicare.

The Silver & Fit Program

This program provides useful benefits such as; memberships at one of thousands of participating fitness centers as well as discounts at premium fitness centers. Additionally they provide each member with a choice of one home fitness kit per year and assces to thousands of on-demand workout videos.

Watch our YouTube video for all the details

Silver&Fit Fitness Program

Staying active is vital for overall health, especially for seniors. The Silver&Fit program offers access to a network of fitness centers and resources to help seniors stay fit. While Original Medicare does not cover Silver&Fit, some Medicare Supplement and Medicare Advantage plans include similar programs. Physicians Mutual offers Silver&Fit benefits in specific states, often as part of their preventive benefits rider. Availability and terms can vary, so it’s important to review plan materials or consult with a licensed agent to determine if Silver&Fit is included in your area.

Considerations For Choosing a Plan

When selecting a Medicare Supplement plan with Physicians Mutual, consider the following:

• Plan Availability: Physicians Mutual offers various plans, including Plan A and Plan G. They also offer Innovative Plan G options which feature lower premiums with a deductible for the initial years.
• Preventive Benefits: Confirm whether the plan includes preventive health care services and understand any associated costs or limitations.​
• Fitness Programs: If access to fitness programs like Silver&Fit is important to you, verify the availability within your chosen plan and state.​Medicare Plan Finder
• Discounts: Physicians Mutual may offer discounts for non-tobacco users, automatic bank withdrawals, or household discounts when another adult aged 60 or older resides with you.

For personalized information and to explore plan options that best suit your healthcare needs and lifestyle, consider contacting a licensed Medicare agent.

If you are an agent who woul dlike to offer these plans; click here for online contract and become part of the Crowe team!

Unfortunately, as people age, the risk for chronic conditions like heart disease, diabetes, and cancer increases. Although with the right preventive measures in place, many of these conditions can be delayed, managed effectively, or even avoided. That is why we will go over the importance of preventative services for Medicare beneficiaries.

Preventive Healthcare

The objective of Preventive healthcare is to maintain wellness and discover health issues before they become serious. It includes regular checkups, screenings, immunizations, counseling, and lifestyle intervention. These services are all designed to detect potential health problems early or prevent them from happening.

Why Preventative Service for Medicare Beneficiaries Matters

Early Detection

Some serious conditions, such as colorectal cancer or high blood pressure, may not show symptoms until they’ve progressed. That is why routine screenings are important. They can catch these conidtions early, when they’re easier to treat. This helps the beneficiary have a better qualityof life and save money on treatments.

Managing Chronic Conditions

Due to the fact that, over two-thirds of Medicare beneficiaries suffer from multiple chronic conditions, preventative care is essential. Preventive care helps manage these illnesses more effectively, avoiding emergency visits, hospitalizations, and complications. Annual wellness visits give beneficiaries an opportunity to review medications, coordinate care, and update personalized prevention plans.

Immunizations

Keep in mind; Flu shots, shingles vaccines, and COVID-19 boosters can be life-saving for older adults whose immune systems may not be as strong as younger individuals. Medicare Part B covers many of these vaccines. Staying up-to-date with immunizations can help prevent avoidable illness and hospital stays.

Mental and Cognitive Health

Preventive care also includes screenings for depression and cognitive impairment that are critical as people age. These services allow early interventions that can improve quality of life and help individuals maintain independence.

Health Education and Lifestyle Support

Through programs like smoking cessation counseling and diabetes self-management training, Medicare supports healthier living. Lifestyle changes such as, eating healthier foods, excercising or quitting smoking can dramatically reduce the risk of future health problems.

Overcoming Barriers to Access

Despite the clear benefits, many beneficiaries don’t fully utilize preventive services. Reasons include lack of awareness, confusion about coverage, transportation challenges, or simply not knowing what’s available to them. That’s why education and outreach; especially from healthcare providers, caregivers, and community organization are so crucial.

In the event a client wants to have better coverage for an illness, agents should understand the benefitof ancillary products to avoid gaps in coverage.

Agents: Watch a quick YouTube video on why and how to sell ancillary products

Preventive healthcare isn’t just about avoiding illness. It’s about living better, longer, and keeping your independence. For Medicare beneficiaries, taking advantage of all the preventive services Mediare covers is one of the smartest health decisions they can make.

Medicare provides essential health coverage for seniors and certain disabled individuals, but it doesn’t cover everything. That’s where Medicare Supplement plan (Medigap) come in. These policies help cover out-of-pocket costs like copays, coinsurance, and deductibles. Is a Medicare Supplement enrollment right for you? We will discuss who might be a good fit for one.

Medicare Supplements

Medicare Supplement policies are insurance plans provided by private insurance companies, designed to work with Original Medicare. They help cover the “gaps” in Medicare coverage, making healthcare costs manageable. However, beneficiaries cannot have a Medicare Advantage with a Supplement. Individuals must have Original Medicare to enroll in a supplement plan.

Who should consider a Medicare Supplement

Medicare Supplement plans are a great option for individuals who want more comprehensive coverage and predictable healthcare costs. Here are some reasons individuals may benefit from enrolling in a Medicare Supplement plan:

Lower Out-of-Pocket Costs

Original Medicare beneficiaries pay coinsurance, copays, and deductibles for medical services, which can add up. For those who prefer to minimize these expenses, a Medicare Supplement plan can significantly reduce out-of-pocket costs, providing greater financial security and predictable expenses.

Frequent Healthcare Users

For individuals with chronic conditions who require frequent doctor visits, or need ongoing medical treatments, Medicare Supplement can be an cost saving option. It covers costs that would otherwise be paid out-of-pocket, making medical expenses more manageable.

Travelers and Snowbirds

Unlike the network restrictions of Medicare Advantage plans, Supplement plans provide nationwide coverage. Some plans even offer foreign travel emergency coverage, making them ideal for those who travel frequently or live in multiple states throughout the year.

Flexibility in provider choice

Medicare Supplement plans allow enrollees to see any doctor or specialist who accepts Medicare assignment. There is no need for referrals or network restrictions. This is very attractive to those who want more freedom in their healthcare options.

Individuals who can afford the premiums

While Medicare Supplement plans reduce out-of-pocket costs, they come with monthly premiums in addition to the Medicare Part B premium. For individuals who can comfortably afford the premiums, a Supplement plan can provide peace of mind and financial protection against unexpected medical expenses.

New Medicare Enrollees

For most beneficiaries, the best time to enroll in a Medicare Supplement plan is during the six-month Medicare Supplement Open Enrollment Period, which begins when beneficiaries first enroll in Medicare Part B. During this time, beneficiaries have guaranteed issue rights. This means they can enroll in any Medicare Supplement policy available in their state without medical underwriting. Those who apply outside this period, may be subject to higher premiums or even denial based on health conditions. Please note; underwriting does not apply to those who live in one of the 4 guarantee issue states.

Who might not want a Medicare Supplement

Although Medicare Supplements are beneficial for many, they may not be a good choice for everyone. Those who might not benefit from a Medicare Supplement are:

• Enrolled in a Medicare Advantage Plan: Medicare Supplement cannot be used with Medicare Advantage.
• Individuals with employer or retiree coverage: Some employer-sponsored plans provide secondary coverage to Original Medicare, making a Medicare Supplement unnecessary.
• Those who rarely use medical services: Healthy individuals who don’t visit the doctor often may find the cost of a Medicare Supplement premium outweighs the benefit.

Watch a quick YouTube video Medicare Advantage vs Medicare Supplement

Beneficiaries should seek the advice of a licensed Medicare agent before enrolling in a plan. They can help compare plan option to ensure they make the best choice for the individual situation. Understanding healthcare needs and financial situation can help determine if a Medicare Supplement is the best plan choice.

Choosing the right Medicare Supplement (Medigap) plan is an important decision for individuals managing healthcare costs. In this post, we will answer the question; why enroll in a Plan N.

Medicare Supplement Plan N can be a great plan option due to its balance of affordability and comprehensive coverage. Individuals considering their Medicare Supplement options may find the Plan N is the perfect fit for their healthcare needs.

Lower monthly premiums

One of the biggest advantages of Plan N is its cost-effectiveness. Although Plan N provides many of the same benefits as other Medigap plans, its premiums are generally lower than Plan G. This makes it a good option for individuals who want solid coverage without paying a high premium for benefits they may not use too often.

Comprehensive coverage

Plan N covers many out-of-pocket costs that Original Medicare does not, including:

• Medicare Part A hospital coinsurance and hospital costs for up to 365 days after Medicare benefits are exhausted
• Medicare Part B coinsurance (except for small copays)once the annual Part B deductible is paid
• First three pints of blood
• Part A hospice care coinsurance
• Skilled nursing facility (SNF) care coinsurance
• Limited foreign travel emergency coverage (80% up to plan limits)

Out-of-Pocket costs

Plan N offers lower premiums in exchange for reasonable cost-sharing amounts. This includes:

• Up to a $20 copay for doctors visits
• Up to a $50 copay for emergency room visits (this copay is waived if the enrollee is admitted)

These low out of pocket amounts costs are predictable and manageable.

Please note: Unlike Plan G, Plan N does not cover Medicare Part B excess charges. Although, this is usually not an issue for beneficiaries who visit doctors that accept Medicare assignment, as they agree to charge only the Medicare-approved amount.

Plan N is a great choice for individuals who:

• Want the freedom to use any provider that accepts Medicare assignment
• Want to save on monthly premiums and still have great coverage
• Do not mind paying a nominal copay for medical services

Freedom to choose any provider that accepts Medicare assignment

Unlike Medicare Advantage plans, which have network restrictions, Medigap Plan N allows beneficiaries to see any doctor who accepts Medicare assignment. This is beneficial for individuals who seek care in more than 1 state and want greater flexibility in choosing healthcare providers. This is especially helpful if the individual uses several providers to treat medical conditions or illnesses.

Medicare agents; subscribe to our YouTube channel for free informational and training videos

Protection from high hospital costs

Hospital stays can be expensive, but Plan N covers Part A coinsurance and hospital costs beyond Medicare’s limits. This ensures that beneficiaries do not face excessive out-of-pocket costs for extended hospital stays allowing beneficiaries to focus on recovery.

Alternative to more expensive Medigap plans

For those who want comprehensive coverage without the higher Plan G premiums, Plan N provides a good balance between affordability and comprehensive coverage.

Why enroll in Plan N

Medicare Plan N is a good choice for:

• Individuals who want lower monthly premiums
• Those who are comfortable with small copays for doctor and ER visits
• Beneficiaries who may use more than one Medicare-approved provider
• People looking for nationwide coverage without restrictive networks

Medicare Supplement Plan N is a great choice for those who want a balance of affordability and comprehensive coverage. With lower premiums, predictable cost-sharing, and strong hospital coverage, it offers a practical solution for many Medicare beneficiaries. Beneficiaries should consult with a licensed Medicare agent before enrolling in any Medicare Plan to ensure the plan aligns with healthcare and financial needs.

Because diabetes affects millions of Americans, understanding Medicare diabetes coverage is extremely important to both agents and those affected by diabetes. For diabetics, proper management and access to supplies is essential to maintaining health and quality of life. Fortunately, Medicare provides comprehensive coverage for diabetes-related services and supplies. It’s important to understand what Medicare covers and how to maximize benefits.

Medicare Part B

Medicare Part B covers a variety of diabetes-related supplies and services, including:

Blood Sugar Testing Supplies – This includes blood glucose monitors, test strips, lancets, and control solutions. Medicare generally covers up to 300 test strips and lancets every three months for insulin-dependent beneficiaries and up to 100 for non-insulin users.

Continuous Glucose Monitors (CGMs) – Medicare covers therapeutic CGMs and related supplies for qualifying individuals who meet specific criteria.

Insulin Pumps and Insulin for Pumps – Medicare covers insulin pumps as durable medical equipment (DME) and the insulin used in these pumps.

Medical Nutrition Therapy (MNT) – Beneficiaries with diabetes may receive MNT services, including nutritional assessment and counseling.

Diabetes Screenings – Medicare covers two diabetes screenings per year for beneficiaries at risk of developing diabetes.

Diabetes Self-Management Training (DSMT) – A critical education service that helps patients learn how to manage their diabetes effectively.

Medicare Part D: Prescription Drug Coverage

While Medicare Part B covers insulin used in pumps, Medicare Part D (Prescription Drug Plans) covers most other types of insulin, as well as oral diabetes medications, needles, syringes, and certain related supplies. Coverage may vary based on the specific Part D plan, so it’s important to review formulary lists and copayment amounts before enrolling in a plan.

Medicare Advantage (Part C) and Supplemental Coverage

Medicare Advantage (MA) plans must cover everything Original Medicare (Part A and Part B) covers but often include additional benefits, such as expanded prescription drug coverage, wellness programs, and cost-sharing assistance for diabetes management. Some plans may also offer broad access to CGMs and other advanced diabetes care.

How to get Medicare covered diabetes supplies

It is important to always use suppliers and pharmacies that are part of your Medicare plan’s network. Check with the plan provider for specific requirements and preferred providers. Beneficiaries must obtain a prescription from their doctor for blood sugar testing supplies.

Click here to download Medicare coverage of diabetes supplies, services & prevention programs

Medicare provides extensive support for individuals with diabetes, but navigating coverage details can be complex. Understanding what’s included under Medicare Part B, Part D, and Medicare Advantage plans helps beneficiaries make informed decisions and access necessary supplies for effective diabetes management.

To answer the question; what is the Medicare GEP; The Medicare GEP is an opportunity for individuals who missed their initial chance to sign up for Medicare Part A and/or Part B to enroll. It runs from January 1 to March 31 each year. This allows eligible individuals to enroll in Medicare coverage, though late penalties may apply.

Who needs the GEP

The GEP is for individuals who did not sign up for Medicare during their IEP (Initial Enrollment Period) and do not qualify for an SEP (Special Enrollment Period).

When does coverage begin

As of 2023, individuals who enroll in Medicare during the GEP will have their coverage begin the month after they enroll. Prior to 2023, coverage did not begin until July 1, which led to significant delays in accessing benefits.

Late enrollment penalties

Individuals who sign up during the GEP may have to pay an LEP (late enrollment penalty). This can increase monthly Medicare costs:

Part A penalty

For those who must pay a premium for Part A, the monthly premium could increase by 10%. This will be in place for twice the number of years they were eligible but didn’t sign up.

Part B Penalty

The monthly Part B premium will increase by 10% for each full 12-month period the beneficiary was eligible but didn’t enroll. This penalty is permanent and remains in place for as long as they have Part B.

Medicare Advantage, Part D and Supplement enrollment

If an individual enrolls in Medicare during the GEP, they can sign up for a Medicare Advantage (Part C) or a Medicare Part D prescription drug plan at this time. Coverage for these plans begins on the month following the enrollment. Although late enrollment in Part D or Medicare Advantage plans that include prescription drug coverage may include a lifelong penalty.

Medicare supplements can be a little more difficult to get after the individual’s Medigap open enrollment has passed. When this is the case, some states require enrollees to undergo underwriting which can lead to denial or higher premiums.

Avoiding the need for the GEP

Beneficiaries can avoid using the GEP (General Enrollment Period) and getting potential LEPs:

Sign up for Medicare during the Initial Enrollment Period, which starts three months before the 65th birthday and ends three months after.

Those who have employer-sponsored coverage should confirm whether they qualify for a Special Enrollment Period (SEP) when that coverage ends. If they do, be sure to enroll before the SEP ends.

The Medicare GEP is an important opportunity for those who miss their initial chance to enroll in Medicare. However, because of potential late penalties and delays in coverage, it’s best to sign up during the Initial Enrollment Period or a Special Enrollment Period when possible. Understanding enrollment deadlines helps ensure that beneficiaries get the healthcare coverage they need and avoid unnecessary costs.

Medicare Supplements, also called Medigap plans, are insurance policies private insurance companies offer to fill the “gaps” after Original Medicare pays it’s portion of approved medical expenses. Understanding what Medicare Supplements cover is essential for Medicare agents and anyone considering enrollment in a Medigap plan to reduce healthcare costs and enhance Medicare benefits.

Medicare Supplement plan overview

Medicare Supplement plans are standardized by the federal government, meaning the coverage provided by each plan of the same name (Ex. all Plan Ns) is the same across all insurance carriers. However, premiums vary based on provider and service area. There are 10 standard Medigap plans available in many states, labeled A, B, C, D, F, G, K, L, M, and N. Each plan letter provides a different level of coverage to meet varying healthcare needs and budgets.

Learn about Medicare premiums & deductibles

What Medicare Supplements cover

Medicare Supplement plans provide coverage once Original Medicare pays its portion of the cost for approved healthcare costs. See below for what Medicare supplements cover:

Medicare Part A coinsurance for hospital costs

All Medigap plans cover the coinsurance for hospital costs under Medicare Part A for up to an additional 365 days after Medicare benefits are exhausted.

Medicare Part B Coinsurance or Copays

Many Medigap plans cover the 20% coinsurance for outpatient services under Medicare Part B. Plan K and Plan L provide partial coverage, while Plan N may require a small copay.

Blood (First 3 Pints)

Original Medicare does not cover the first three pints of blood needed for some medical procedures. Medigap plans cover this expense.

Part A Hospice Care Coinsurance

Hospice care is covered by Medicare, but beneficiaries may have to pay coinsurance for certain medications and respite care. Medigap plans cover these costs.

Skilled Nursing Facility (SNF) Coinsurance

After 20 days in a skilled nursing facility, Medicare requires a daily coinsurance payment. Most Medigap plans cover this expense.

Medicare Part A Deductible

The Part A deductible for hospital stays can be substantial. Many Medigap plans, including Plans B, C, D, F, G, and N, cover this deductible.

Medicare Part B Deductible (Only for Plans C and F)

Plans C and F cover the Medicare Part B deductible; however, these plans are only available to beneficiaries who were eligible for Medicare before January 1, 2020.

Medicare Part B Excess Charges

If a healthcare provider does not accept Medicare’s approved amount as full payment, they may charge an additional amount of up to 15%. Plans F and G cover these excess charges.

Foreign Travel Emergency Care

Some Medigap plans (C, D, F, G, M, and N) provide coverage for emergency medical care during international travel, up to plan limits.

What Medicare Supplements don’t cover

Although Medigap plans cover many out-of-pocket expenses, there are some services they do not cover:

Prescription Drugs

Medigap plans do not include drug coverage. Beneficiaries must enroll in a Medicare Part D plan for prescription drugs.

Long-Term Care

Supplements do not cover services like custodial care in a nursing home or assisted living facility.

Dental, Vision, and Hearing

Routine dental, vision, and hearing services are not included in Medigap coverage.

Private-Duty Nursing

Typically, these services are not covered.

Watch a YouTube video on Medicare enrollment periods

What to consider when choosing a supplement

It is important to evaluate current healthcare needs and potential medical expenses to help determine the level of coverage needed. Budget is another big consideration before choosing a plan. One more important factor before enrollment is eligibility. Some plans require underwriting for anyone who is outside a guaranteed issue period. There are plans (C & F) that are no longer available to anyone who turned 65 after Jan 1, 2020.

Medicare Supplements provide invaluable financial protection by covering the out-of-pocket expenses left by Original Medicare. By understanding what these plans cover and how they work, you can make an informed decision that ensures peace of mind and comprehensive healthcare coverage. For those considering enrollment in a Medigap plan, a licensed Medicare agent can help provide guidance and compare options to find the plan that best meets coverage needs.