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This year many agents are wondering what to do about lost PDP commissions. We are offering a few solutions to help supplement the loss of commissions. Please note there are still many opportunities to earn income in the field of Medicare sales.

The first thing you need to remember is that clients rely on your assistance to find the best plan options each year. Stay with us for a few suggestions to help raise your income.

Look at your client’s current PDP plan

Although your client’s current PDP plan may not be commissionable, it may still be the best option for them. Remember they have other plans with you, and you must make sure they know they can rely on your guidance. When clients see that you are willing to help them without a commission, it may lead to increased trust and a boost to your reputation. This can even lead to more client referrals in the long run.

Although we understand this will not pay your bills, if you do not want to provide assistance, someone else might. A smart agent knows, there are plenty of opportunities to assist clients with other commissionable products.

Watch a quick video on the prescription payment program

It is also important to know; some carriers are still paying commissions on PDP sales. Be sure you are contracted with a variety of carriers and plans in your service area. The best choice for the client may be a commissionable plan and, in that case, it’s a win for you both.

Click here to add carriers to your current Crowe contract or start a new contract request

Look at making a Medicare Supplement plan change

As you know, clients who are enrolled in a standalone PDP plan are usually enrolled in a Medicare Supplement plan. Many clients do not think about changing their Medicare Supplement coverage. The plan just renews each year and goes unnoticed.

In some instances, the Medicare Supplement plan carrier may have raised the plan cost over the year, and clients may not realize it. This provides an opportunity to find them a savings opportunity with the same coverage at a better rate from a competitive carrier. Keep in mind, some states may require underwriting to make a Medicare Supplement change. If you are lucky enough to be selling in a GI state, changing plans is as easy as writing an app.

A MAPD plan could be an option

Clients may want to give a Medicare Advantage plan a try. For some enrollees, this a great way to save money and still receive the protection of comprehensive medical coverage. MAPD plans are a very popular choice and can add to your bottom line. MAPD plans pay a generous commission rate for both new and renewal business.

Click here to learn about 2025 Medicare commissions

If you offer PDP plans, you already need to complete your AHIP, so there’s no reason not to add MAPD plans to your business.

Having a variety of product offerings help protect your income stream and gives clients a greater choice of coverage options.

Offer other needs-based products

Before you meet with each client, you should conduct a thorough needs-based assessment. This often leads to cross-selling opportunities. Clients may want to purchase insurance that fills a specific coverage gap. If you plan to discuss these coverage options, be sure your SOA includes ancillary products. In some cases, you may need to collect an additional SOA and make a subsequent appointment.

Ancillary products such as dental, vision, hospital indemnity, critical illness, cancer, heart attack and stroke or even long- and short-term care or life insurance are a few options. These products can provide necessary coverage for your clients and a supplement to your income as well. These products can more than make up for lost PDP commissions.

Learn more about why you should add ancillary products

What qualifies as preventative under Medicare and how do you ensure you take full advantage of these benefits? Because preventive care is an essential part of staying healthy and managing potential health risks before they become serious, Medicare recognizes the importance of preventive care and offers a range of services to help beneficiaries maintain their health.

What Is Preventive Care

Preventive care refers to medical services that aim to prevent illness, detect conditions early, or promote overall good health. These services can include screenings, vaccines, counseling, and much more. By focusing on prevention, Medicare helps beneficiaries proactively manage their health and reduce the need for more costly treatments in the future.

Click here to download a copy of a comprehensive list or covered preventative services

Medicare Coverage for Preventive Services

Medicare provides a wide array of preventive services under Part B (Medical Insurance). Many of these services are available to beneficiaries at no cost. These services may help detect health problems early when treatment is sometimes more effective and less expensive.

Some common types of preventive care Medicare covers:

Wellness Visits

Within the first 12 months a beneficiary enrolls in Medicare Part B, they are entitled to a “Welcome to Medicare” preventive visit. This one-time visit includes a review of your medical and family history, as well as basic measurements like height, weight, and blood pressure.

After your initial visit, Medicare covers an annual wellness visit each year. This can help create or update a personalized prevention plan. This plan can help beneficiaries stay on top of their health by identifying risk factors and setting health goals.

Vaccinations and Immunizations

Medicare covers vaccines that help prevent serious illnesses, including:

1. Flu Shot (Influenza): Covered once per flu season, typically every fall or winter.

2. Pneumococcal Vaccines: Medicare covers two different pneumococcal shots. The initial shot as well as a second shot a year later if appropriate.

3. Hepatitis B Vaccine: Available to those at medium or high risk for Hepatitis B.

4. COVID-19 Vaccines and Boosters: Medicare covers COVID-19 vaccines and booster shots as recommended by health authorities.

5. The Shingles Vaccine: This vaccine is administered in two doses. The second dose is given two to six months after the first. Medicare covers the cost of both doses.

Read more about Medicare coverage of vaccines

Screenings and Tests

Medicare offers a variety of preventive screenings and tests to help detect health issues early, including:

1. Mammograms: Medicare covers mammograms for the purpose of screening once every 12 months for women aged 40 and older. Medicare may also cover diagnostic mammograms if medically necessary.

2. Colon Cancer Screenings: Medicare covers multiple types of colon cancer screenings, including fecal occult blood tests, multi-target stool DNA tests (like Cologuard), flexible sigmoidoscopy, and colonoscopy. The frequency of these tests depends on the specific test and risk factors.

3. Bone Density Tests: Covered once every two years (or more often if medically necessary) for individuals at risk for osteoporosis.

4. Diabetes Screenings: Medicare covers up to two diabetes screenings per year for individuals at risk. This includes those with a history of high blood pressure, high cholesterol, obesity, or a family history of diabetes.

5. Cardiovascular Screenings: Medicare covers a screening blood test every five years to check for conditions like high cholesterol and triglyceride levels.

Cancer Screenings

Because early detection of cancer can lead to better treatment outcomes. Medicare covers:

1. Cervical and Vaginal Cancer Screenings: Medicare covers pap tests and pelvic exams are once every two years, or every year for women at high risk

2. Prostate Cancer Screenings: Annual prostate-specific antigen (PSA) tests and digital rectal exams for men aged 50 and older.

3. Lung Cancer Screenings: Low-dose CT scans are covered annually for individuals at high risk, particularly heavy smokers or those who have quit smoking within the past 15 years.

Cardiovascular Health

Medicare covers several services to help maintain cardiovascular health, including:

1.Cardiovascular Behavioral Therapy: This includes counseling on diet and exercise to help reduce the risk of heart disease.

2. Blood Pressure Screenings: These are typically part of your annual wellness visit.

Diabetes Prevention Program

The Medicare Diabetes Prevention Program offers lifestyle coaching and resources to help beneficiaries at risk for diabetes prevent the onset of the disease. The program is designed to encourage weight loss, healthy eating, and regular physical activity.

Mental Health and Wellness

Medicare also covers preventive services aimed at mental health, including:

1. Depression Screenings: Medicare includes an annual screening for depression as part of the yearly wellness visit.

2. Alcohol Misuse Counseling: Medicare covers counseling for beneficiaries who are screened and found to have alcohol misuse issues.

3. Smoking Cessation Programs: Medicare covers up to eight counseling sessions per year to help beneficiaries quit smoking.

Obesity Screening and Counseling

For individuals with a body mass index (BMI) of 30 or higher, Medicare covers counseling sessions to help promote weight loss and healthy living. This coverage includes regular face-to-face meetings with a healthcare provider.

Screenings for Infectious Diseases

Medicare also offers coverage for screenings to detect infectious diseases, including:

1. HIV Screenings: Covered once every 12 months, or more frequently for individuals at higher risk.

2. Hepatitis C Screenings: Covered once if born between 1945 and 1965, or annually for those at high risk.

3. Sexually Transmitted Infections (STIs): Medicare covers both screenings and counseling sessions annually for individuals at risk.

Make the Most of Medicare Preventive Services

1. Schedule an annual wellness visit: This visit is a great opportunity to discuss overall health and get a personalized prevention plan. It’s also a good time to make sure you’re up to date on all the preventive services you’re eligible for.
2. Know What Medicare Covers: Familiarize yourself with the list of preventive services Medicare covers and discuss these options with your healthcare provider. They can help determine which screenings and vaccines are appropriate for you.
3. Keep Track of When You’re Eligible: Medicare covers some services once a year or every few years. Make a note of when you’re eligible for your next screening or vaccination.

Preventive care is an important part of Medicare coverage and can help you stay healthier, detect potential problems early, and avoid costly treatments. Whether it’s a simple flu shot, a cancer screening, or an annual wellness visit, Medicare makes it easy for beneficiaries to access a wide range of preventive services. Understanding what’s covered and taking advantage of these benefits can play a key role in maintaining health and well-being.

If you need help choosing a Medicare plan, click here to learn why you should use a licensed Medicare agent

SEPs are important for both agents and beneficiaries to understand. Missing an SEP can cause a beneficiary to pay more for their medical care then necessary. We will discuss the disaster/emergency SEP requirements to make sure your plan is approved without delays.

It is important to note; disasters or emergency SEPs that are declared by a government entity are only applicable to beneficiaries who were unable to complete an enrollment during a valid election period that took place during the emergency or disaster. CMS has clear guidelines when beneficiaries can use this SEP.

How to qualify for this SEP

The beneficiary has to have missed a valid election period when the declared disaster or emergency occurred. They have to have been unable to make the desired plan change during the specified time period. SEPs for disasters or emergencies are only applicable to those who live in the affected area during the emergency.

CMS also states; beneficiaries who rely on the help of individuals who reside in an area where the disaster or emergency occurs for health care decisions, may also be eligible for the SEP

Some reasons for not using this SEP

This SEP is not valid in cases when the beneficiary has already used another valid election period during the time the SEP begins. This is the case when the disaster SEP occurs during another valid election period. For instance, if the disaster SEP begins at some point during the AEP and the beneficiary uses the AEP election period, they are not eligible to use the SEP. This is because they have already used an election period. Thye are now ineligible to switch plans again.

Watch a quick YouTube video on SEP Changes for Dual, Partial Dual and LIS members in 2025

Learn more about SEPs – click here to watch a video

How long does the SEP last 

SEPs last for either at least 2 months after the end of the emergency or disaster or when the end of the incident is stated, the rules follow whatever date is later.

Here’s an example:

On August 8th through August 15th there is a wildfire that causes FEMA to declare a disaster/emergency in two counties. FEMA declares the SEP on August 20th; this means the start of the SEP is August 8th. This SEP would end two full months after the SEP is announced on August 20th. In other words, the end of the SEP would be October 20th because this is the later date.

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Because many people on Medicare require additional help at some point it is important to understand Medicare and home healthcare coverage. The main goal of home healthcare is help individuals recover from an illness or injury and regain independence.

Eligibility

In order for a beneficiary to qualify for home healthcare services under Medicare, the following criteria must be met:

1. A doctor or another licensed healthcare provider must have a face-to-face meeting with the beneficiary and certify that they require home health services.
2. The beneficiary must require part-time/intermittent skilled nursing care, physical therapy, occupational therapy or speech-language pathology services.
3. Patients must be homebound. In other words, it is difficult for them to leave the house without help due to their condition.
4. A Medicare certified home healthcare agency must provide the care.

Services Medicare covers

Once the eligibility criteria are met, Medicare covers many home health care services, including:

• Skilled Nursing Care: Provided on a part-time or intermittent basis.
• Therapy Services: Physical, occupational, and speech-language therapy to aid in recovery and rehabilitation.
• Home Health Aide Services: Assistance with personal care on a part-time basis if the patient is also receiving skilled care.
• Medical Social Services: Counseling and help finding community resources.
• Medical Supplies: Certain medical supplies like wound dressings.
• Durable Medical Equipment (DME): This includes equipment such as walkers or wheelchairs.

Services Medicare does not cover

• Full-time care: 24-hour-a-day care at home.
• Meals: Meals delivered to the home.
• Homemaker services: Medicare dose not cover services such as; shopping, cooking or cleaning if they are the only services needed.
• Personal care: If this is the only care required, Medicare will not pay a home health aide to provide basic personal care services such as bathing, dressing or using the bathroom (activities of daily living).

How to set up home healthcare services under Medicare

1. Make an appointment with your doctor or healthcare provider to go over your health needs and establish if home health care is a good choice.
2. Be sure you see your doctor face-to-face as required by Medicare.
3. Ask your doctor or insurance provider to help you find a Select a home health agency that is certified by Medicare.
4. Work with your doctor and the home health agency to develop a plan of care to fit your specific needs.

How Original Medicare covers home healthcare costs

In most cases, individuals enrolled in original Medicare pay nothing for covered home healthcare services. Although, there is a cost for DME durable medical equipment. In general, Medicare covers 80% of the approved amount while the individual is responsible for the remaining 20%.

Part A: Typically covers home health care services after the beneficiary has been in the hospital for a period of 3 days or more.

Part B: Covers home health services without the requirement of a prior hospital stay.

Watch a YouTube video the difference between Medicare Supplements and Medicare Advantage

Medicare Advantage Plans and Home Health Care

Medicare Advantage plans (Medicare Part C), are an alternative to Original Medicare. Private insurance companies that are approved by Medicare offer these plans. They must provide the same benefits as Medicare Part A and Part B. Many Medicare advantage plans also offer additional benefits that original Medicare does not cover, such as vision, dental, wellness programs, OTC as well as rides to medical appointments.

How Medicare Advantage plans cover home healthcare costs

Although Medicare Advantage plans must cover at least the same level of home health care services as Original Medicare, there are a few things you should know:

1. Network Restrictions: Unlike Original Medicare, Medicare Advantage plans often have network restrictions. Beneficiaries of most plans need to use home health agencies that are in the plan’s network.
2. Prior Authorization: Some Medicare Advantage plans require prior authorization for home health services. In other words, beneficiaries need approval from the plan before they receive certain services.
3. Additional Benefits: Many MA plans offer extra benefits beyond what Original Medicare provides. These could include additional support services, like caregiver support, home modifications, or wellness programs.
4. Cost Structure: Although Medicare Advantage plans must cover home health care at least as well as Original Medicare, the cost structure (copays, coinsurance, and deductibles) may be different. It’s important to understand your plan’s specific costs.

Find out how to cover the gaps left by Medicare advantage plans

Medicare’s home health care coverage can significantly benefit those who need medical care in the comfort of their own home. Understanding the eligibility criteria, the types of services covered, and how to initiate these services ensures that beneficiaries receive the appropriate care while minimizing out-of-pocket expenses.

Please note: before choosing a Medicare plan, it is best to consult a licensed healthcare agent to get accurate, personalized plan information.

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Because agents need to present all options to their clients, they need to be able to answer the question; why choose a Medicare Supplement. This is especially true due to Medicare Advantage plan changes scheduled to take place in 2025. Some of these changes will include discontinuing some added benefits and higher co-pays for some services. For this reason as well as some we list below, clients may be more inclined to enroll in a Medicare Supplement plan

Click here to watch a video on the MA plan changes for 2025

Reasons to choose a Medicare Supplement

Due to the fact that as people age their health care needs tend to grow, most individuals require more comprehensive healthcare coverage. For many people Medicare is the cornerstone of their healthcare plan. However, while Medicare offers substantial coverage, there are gaps that can leave individuals with unexpected medical expenses. This is where Medicare supplement (Medigap) plans, come into play. Here are some good reasons your clients might opt for a Medicare supplement plan.

Fill the Coverage Gaps

Medicare Parts A and B provide coverage for hospital stays, doctor visits, and approved medical services. However, they don’t cover everything. Because things like deductibles, coinsurance, and copays can quickly add up, Medicare supplement plans are designed to fill these gaps. They help cover expenses such as copays, coinsurance, and deductibles, thereby reducing out-of-pocket costs for beneficiaries.

Freedom to choose healthcare providers

One of the best benefits of a Medicare supplement plan is the freedom to choose your healthcare providers. Unlike Medicare Advantage plans that require enrollees to use only in-network providers or pay a higher price, Medicare Supplement plans allow enrollees to use any doctor or hospital that accepts Medicare assignment. In other words, they can use any healthcare provider they need without worrying about network restrictions.

Medical coverage while traveling abroad

Medicare supplement plans provide coverage for emergency medical expenses enrollees incur while traveling abroad. While Original Medicare typically does not cover healthcare services outside of the United States (with a few exceptions), certain Medicare Supplement plans provide coverage for emergency care during foreign travel. This is an important benefit for seniors who enjoy traveling or have family members living abroad.

Predictable costs

Because Medical expenses can be unpredictable, it can be a challenge to budget for healthcare costs, especially during retirement. With a Medicare supplement, enrollees know exactly what their monthly premium is, as well as any out-of-pocket costs for covered services. This predictability can provide peace of mind and financial stability, allowing you to focus on enjoying your retirement years.

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Guaranteed renewable

Medicare supplement plans are guaranteed renewable. This means the insurance company cannot cancel coverage as long as premiums are paid on time. This reassures that enrollees have continuous coverage, regardless of changes in health or medical history. Additionally, once enrolled in a Medicare supplement plan, beneficiaries have certain rights and protections, including the ability to switch plans without being subject to medical underwriting.

Find out about Medicare Supplement Guaranteed issue rights.

Enrolling in a Medicare supplement plan offers many benefits, including filling the coverage gaps left by Original Medicare, freedom to choose healthcare providers, emergency coverage for medical expenses while traveling abroad, predictable costs, and guaranteeing renewable coverage. By investing in a Medicare supplement plan, enrollees safeguard their health.

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Best Medicare Supplemental Insurance

Medicare Supplemental Insurance, also known as Medigap, plays an important role in filling the coverage gaps left by traditional Medicare coverage. Traditional Medicare covers about 80% of approved medical expenses, this leaves 20% for the beneficiary to pay. Because there are so many plans available, agents need to understand how to help clients choose the best Medicare supplemental insurance. In this blog, we discuss what Medicare supplements are, why they are essential, and how to find the best coverage for your client’s healthcare needs.

Understanding Medicare Supplemental Insurance

Medicare supplements are sold by private insurance companies and cover expenses that are not covered by Original Medicare.  These expenses include, copays, coinsurance, and deductibles. There are 10 plan choices available and each one offers a different level of coverage.  All the plans are standardized by CMS. This means, all plans with the same letter name must provide the same coverage.  The only difference between one plan of the same letter and another is the cost of the plan. This allows beneficiaries to choose the plan that best suits their individual healthcare needs and budget.

Find out about 2024 Medicare commissions – watch a YouTube video

Things to consider when comparing Medicare supplements

1. Different supplement plans offer varying levels of coverage. For example, Plan G provides comprehensive coverage, including all Medicare coinsurance, and copayments, while other plans may offer more limited coverage.
2. The premiums for supplement policies can vary significantly.  This depends on the plan type, location of client, and insurance company that is offering the plan. It’s essential to consider the monthly premium as well as potential out-of-pocket costs when comparing plans.
3. Unlike Medicare Advantage plans, which require enrollees to use a provider network, Medicare supplement plans allow beneficiaries to see any healthcare provider who accepts Medicare assignment. This flexibility benefits anyone who needs to see many different providers for one or more health conditions.
4. When a beneficiary chooses a Medicare supplement policy, it’s important to choose a reputable insurance company with a good financial rating. This gives the client peace of mind knowing they are dealing with a company that will pay their claims and provide reliable coverage.

Learn about Medicare supplement guaranteed issue rights

Top Medicare supplement Plans

Although the “best” Medicare supplement plan depends on individual healthcare needs and preferences, there are a few that are chosen most often by Medicare beneficiaries.

1. Supplement Plan F provides the most comprehensive coverage.  It pays all Medicare deductibles, coinsurance, and copayments.  Thus, providing beneficiaries with maximum financial protection. The premium for this plan is high, but that is based on the coverage it provides. Unfortunately, this plan is only available to those who turned 65 before January 1, 2020.
2. Plan G is the most similar to Plan F. This plan covers most Medicare expenses, except for the Part B deductible. It’s a great option for individuals who want comprehensive coverage at a slightly lower premium than Plan F.  It is available to anyone who turns 65 and is eligible for Medicare coverage.
3. Plan N is another great coverage option.  However, it requires beneficiaries to pay copays for some  services, such as some office visits and emergency room visits. Although, enrollees pay lower premiums than with Plans F or G.  To view a comparison chart of the all the supplements, click here.

Additional Information

In some states, there are high deductible options for Plans F & G.  These plans offer a low premium and full coverage once the deductible is met.

If you are a Medicare agents who wants to offer these plans; click here for online contracting

When shopping for a Medicare supplement plan, it’s important to:

1. Evaluate healthcare needs as well as budget.
2. Compare supplement plans offered by different insurance companies.
3. Consider coverage options, premiums, and company reputation.
4. Review the benefits and limitations of each plan carefully.

Medicare Supplemental Insurance provides Medicare beneficiaries a valuable coverage option. These plans offer peace of mind and financial protection against the high cost of healthcare. Consulting with a licensed insurance agent can provide valuable guidance to understand the complexities of Medicare supplement coverage and selecting the right policy.

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Medicare supplement comparison

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Pros And Cons Medicare Advantage

With the Annual Enrollment Period just around the corner, agents need to brush up on all kinds of knowledge and regulations to better serve their clients in the coming months. Let’s look at the pros and cons of Medicare Advantage plans.  Here’s a quick breakdown of the benefits and drawbacks of choosing a Medicare Advantage plan:

Pros And Cons Medicare Advantage – Pros

• Medicare Advantage plans (also known as Medicare Part C) typically have cheaper premiums than Original Medicare. This can be a good choice for beneficiaries who need lower monthly premiums or out-of-pocket costs.

• Medicare Advantage plans typically include drug coverage. This is not the case with Original Medicare.

• There is an in-network out-of-pocket maximum for plan holders, which means that a beneficiary will not pay more than $8,300 a year for healthcare.

• Medicare Advantage plans often come with perks, such as some vision, hearing, and dental services that do not come with Original Medicare plans. In some cases, they even include gym membership stipends or preventative chiropractic care.

Pros And Cons Medicare Advantage – Cons

• Because there is a network of healthcare providers for each Medicare Advantage plan, beneficiaries are limited to the providers that are in-network. This means that they can use only certain hospitals, providers, and services in their area.

• There is an approval process for some services and prescriptions, like preauthorization on seeing in-network specialists. Many services do require referrals in order to be covered by the plan. Original Medicare does not include this restriction.

• The network of providers may change throughout the beneficiary’s plan, which may lead to inconsistencies in their doctors and providers being covered.

• Costs are based on how often the beneficiary sees a doctor. The monthly premiums in Medicare Advantage plans are low or even free.  Co-pays, coinsurance, and deductibles contain most of the cost. This means that a health emergency or expensive medical care could cost the beneficiary more with a Medicare Advantage plan than with an Original Medicare plan.

With this information, agents will be able to better help their clients.    Better evaluate if a Medicare Advantage plan is right for them.

Licensed Agents –

Pros and Cons of Medicare Advantage Plans  – Click here to see what Crowe and Associates has to offer 

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Medicare Supplement Plan N

There are a large variety of Medicare Supplement plans to choose from. Medicare Supplement Plans, also known as Medigap, are plans that private insurance carriers sell to Medicare beneficiaries to remedy some of the gaps in coverage that occur in Original Medicare. Medicare supplemental plans can help pay the beneficiary’s share of out-of-pocket costs such as copays, coinsurance, or other fees. Medigap policies are named after letters of the alphabet in all but three of the continental United States.

Increasing Popularity

Medicare Supplement Plan N has become increasingly popular due to its wide range of coverage. Plan N covers 100% of the Medicare Part B coinsurance costs. Beneficiaries are left to cover a $20 copay for office visits and a $50 copay for emergency room visits. These low costs are appealing to many purchasers. Medicare Plan N also provides the following benefits:

• For hospitalization, Plan N pays for Part A (of Original Medicare) coinsurance plus coverage for an additional 365 days after Medicare benefits end. That is an entire year of additional hospitalization coverage.

• Plan N also pays for Part B’s coinsurance, excluding a $20 copay for office visits and a $50 copay for emergency rooms. Copayments for hospital outpatient services are also covered.

• The first three pints of blood each year are paid for by Plan N coverage.

• Perhaps most vitally for many seniors, Plan N covers the hospice care Part A coinsurance.

• Skilled nursing facility care is covered under Plan N.

• The Medicare Part A deductible for hospitalization is covered under these benefits.

• And, Plan N provides travel abroad medical emergency help.

There was a previously very widely used Medicare Supplement Plan called Medigap Plan F. Plan F was discontinued in 2020, and carriers were no longer allowed to enroll additional beneficiaries in Plan F. Because of this new gap where the popular plan no longer exists, Plan N is one of the Medigap plans that is growing increasingly popular because of its wide range of coverage.

Already Appointed to Sell Medicare Supplement Plan N?

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Do I Need a Medicare Supplement

Medigap is the common term for Medicare Supplement insurance. Medigap is extra insurance that beneficiaries can purchase from private insurance carriers. The purpose of Medigap is to help pay for out-of-pocket expenses that can accrue in Original Medicare coverage.  Therefore, enrollees must be enrolled in Original Medicare in order to purchase a Medigap policy.

Medigap policies are standardized. This means that, unlike Medicare Advantage and other policies, all Medigap policies offer the same basic benefits regardless of carrier or location. There are ten different types of Medigap policy and they are lettered: there are plans A through D, F, G, and K through N. This is how companies distinguish which benefits and prices a plan has.  Price is the only difference between plans from different insurance carriers with the same letter. However, in Massachusetts, Minnesota, and Wisconsin, standardizes Medigap policies differently. All other states use the alphabet system.

 Original Medicare with a Medicare Supplement

There are many healthcare services that Original Medicare does not cover because it is not a blanket insurance policy. An example of where Medigap policies can be helpful is with copays and deductibles. Let’s say a beneficiary becomes ill enough that they need a say in the hospital. With Original Medicare, that hospital stay (bed and board) is 100% covered.   Keep in mind the Part A deductible applies. However,  the beneficiary may still owe up to 20% of other costs. An example is anesthesiologist fees. Those bills can be significant. Medigap policies can help with that coverage.

Do I Example

Here is an example.  If a beneficiary is in the hospital for 60 days, they will be paying $400 a day, and there are similar copayments for nursing homes and other facilities. Those numbers can quickly add up to prohibitive costs, particularly for seniors on a fixed income or who are struggling with their health in their increasing age.

For anyone who wants an increased coverage for copays, fees, and deductibles, Medicare supplement insurance policies can be a reasonable way to mitigate possible costs.

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