What is a Medicare Supplement Plan or Medigap?
Medicare Supplement (Medigap) – A Medicare Supplement Plan is a health insurance policy sold by private insurance companies that is designed to “fill” in the gaps of Original Medicare (Parts A & B). Also referred to as Medigap policies– they are exactly the same thing. Medicare Supplement Plans help pay some of the health care costs that Original Medicare doesn’t cover. To be more specific, Medicare Supplement insurance follows Medicare as the secondary insurance policy. For example, Medicare Supplement Plan G is secondary to the primary insurance, Medicare. Think of Medicare as the “truck” or “decision maker” for your coverage, and the Medicare Supplement Plan as the “trailer” or the secondary policy following Medicare wherever you go for medical care.
Medicare Supplement Plans are the same as Medigap policies.
There are two terminologies used for these plans: Medigap and Medicare Supplement plans. They are exactly the same thing. Medicare Supplement Plans are standardized plans that have specific benefits based on their corresponding plan letter. The level of coverage you will receive depends on the plan you select (ie. Plan G, N or F if grandfathered), NOT the insurance company that is offering the plan).
Compare the benefits of each Medicare Supplement Plan letter to figure out which plan you want as your secondary coverage. Furthermore, they are all standardized regardless of the insurance carrier and follow Medicare as the secondary policy. This means they don’t decide what it covered, Medicare, the primary, does. These Medigap policies then follow Medicare and pick up deductibles, copays, co-insurance, etc. Therefore, the only difference is, “What insurer is going to pay your secondary bill after Medicare has paid, and how much that insurer is going to charge you for that plan’s coverage at your age, and in your ZIP code?” Choose the best priced Medicare Supplement Plan at the best rate for your age. Yes, it’s that simple.
Medicare is primary. Medicare Supplement Plan is secondary.
You’re Medicare Supplement insurance coverage does not dictate what is covered by Medicare or how Medicare covers a medical procedure or service. It merely follows behind Medicare to pick up the additional costs when receiving medical care. This is true, regardless of the insurance company that issued the plan– they are all standardized! Medicare first– any secondary Medicare Supplement or Medigap Policy follows. Customize your coverage by selecting the Medicare Supplement Plan you want as well as the Medicare Prescription Drug Plan (Part D) that suits your prescription coverage needs.
How does Medicare Supplement insurance coordinate with your Medicare?
Keeping Original Medicare & adding to your coverage.
“There can be big differences in the premiums that different insurance companies charge for exactly the same coverage”– direct quote from Medicare’s own “Choosing a Medigap Policy” (CMS).
With that said, why would you want to pay more for something if you had options to choose an insurance carrier with a great reputation at the lowest monthly price? For example, why not compare the pricing of Medicare Supplement Plan G with 10 insurance carriers, and then decide which one you want to go with. It’s really that simple. What if the company you chose increases their rates $25-30 dollars more per month for the same coverage when you turn 67 or 69? Well, we will help you lower your rate by changing Medicare Supplement Plan insurance carriers, using the California Birthday Rule to switch carriers– with guaranteed-issue.
Now, here is some more information on how Medicare Supplement plans are priced. I will remind you that regardless of how they are priced, if they charge “X”, “X” is what you’ll pay the insurance company. So, it doesn’t really matter how they are priced as long as it’s a competitive rate, right? In other words, we want the lowest premium for the Medicare Supplement Plan letter you want, at your age and in your ZIP Code.
Mentor One Insight
Again, think of the Medicare Supplement Plan (Medigap) as the “trailer” following the “truck”, it follows Medicare wherever it goes”— the Medigap or Medicare Supplement Plan insurance policy that is second in line after Original Medicare Part A & B pay first as the primary payor for any of your Medicare billing in a physicians office, hospital, or medical provider (ie. physical therapist, chiropractor, etc.).
Keep in mind that different insurers will “frame” the same type of coverage in various ways to differentiate themselves from others selling the same plan type. For example, let’s use Plan G to clarify. An insurance company may market their Medicare Supplement Plan G to make you feel like they have the “best” Plan G. However, all Plan G’s cover you exactly the same following Part A and B of Medicare. As you’ve already seen or will see, they are not very transparent about the plans all being standardized by Medicare. Why would they? They want your business and would be happy to charge you another $30-50 more per month if their branding “made you feel” as if their product covered you better than others.
All Medicare Supplement Plan G's were created the same.
Imagine all Medicare Supplement Plan G’s are made in a make-believe “Medicare factory” somewhere. This factory stamps out thousands of plans a day– all exactly the same. More specifically, each Medicare Supplement insurance plan company then takes the pre-made standard Plan G Medigap policy and places their branded insurance sticker over the top of the plan (red, blue, green, light blue, with their insurance logo, etc). Then, they decide how much they want to charge a certain age in a certain ZIP code. Lastly, all the insurance carriers offer the Plan G, they just all charge different rates at different ages, in different ZIP codes. I’ll help you find you the plan you want at the lowest rate!
It’s seems a little ridiculous when you’re able to break through all the insurance company branding and finally see exactly how they’ve “framed” the marketing on their plans. Knowing this, we can now take advantage of knowing they are all the same and shop all the carriers to find the best rate in your ZIP code at your age. Remember, your physician doesn’t take the Medicare Supplement Plan insurance per se, they take Medicare. To review, the Medicare Supplement insurance plan always follows, regardless of the insurance logo/brand/color on it. The question to ask yourself is, what are you paying for that coverage?
Surprisingly, this is may be new to your experience as you begin shopping Medicare plans, but I’m here to share with you what other companies may not. You deserve complete transparency as well as options of which insurance carrier you would like to purchase your coverage through. For example, Plan G and Plan N, with carrier “X, Y, or Z”. Your Choice!
Plan F coverage
If you were first Medicare eligible before 01/01/20 and chose Plan F, you are able to keep the plan and/or move among Plan F carriers during your California- 60 Day birthday guaranteed issue period (ie. guaranteed to switch from Plan F to Plan F with any carrier that is charging less at your age in your ZIP code). If you were eligible after 01/01/2020, I recommend you look at Plan G or Plan N. Remember all three of these plans (F, G, N) follow your Medicare as the Supplement–second in line to your primary payor, Medicare. Your access to providers, physicians, and medical facilities is exactly the same with all three plans. The only difference is how you’d like to insure the portion of costs that Medicare does not cover. That’s it!
Plan G coverage
After 01/01/2020, Plan G became the top plan for those looking for the most comprehensive coverage when enrolling into Medicare during their initial enrollment period with guaranteed issue rights (no health questions asked). Once the annual deductible is paid, $240 for 2024, your Plan G covers all Medicare Part A and Part B expenses. This means, no co-pays or out of pocket costs for the rest of the calendar year for medical procedures once the deductible is fulfilled.
Remember, this doesn’t include prescriptions- those additional expenses would fall under your Prescription Drug Plan (Part D) that you can add to a Medicare Supplement Plan. I recommend going with the best priced Plan G for your initial enrollment. My office will check in with you every year with reminders about your options to move to any Plan G with guaranteed issue rights using the CA birthday rule. Most clients move every 2-3 years to save $300-500 a year, however, you can move each year to be sure to keep your premium as low as possible. It’s up to you!
Plan N coverage*
You would have copayment of $20 for some office visits/$50 for an emergency room visit.
Plan N does not cover excess charges*
The word “some office visits” is used by Medicare for Plan N. I would assume you will pay a co-payment for office visits as a rule of thumb. If you are not charged, great, but better to assume the $20 copayment. As for Part B excess charges, these are not common, but can be expensive in the event you see a provider that doesn’t accept medicare assignment aka “the negotiated rate Medicare is willing to pay for the service”.
Enrolling with an Independent broker vs. Direct to a Call Center
1) The cost to enroll through us is FREE – so is our independent advice!
2) You get local personalized service from your local broker as opposed to a random call center agent.
3) Your premium is paid directly to the insurer of your choice (you control your online acct., billing, etc.).
4) We are compensated by the insurance carrier you choose. The premium is exactly the same. 100%
5) You can take advantage of the added support services the insurer offers as well as us. Win-win!
Why go direct to an insurance companies call center where you are likely to be passed line to line and talk to a new representative each time to need service. Why not use a local independent broker for more personalized service at no additional cost? Let us handle the important enrollment processes for you and utilize the insurance companies service center for billing and payment services.
Get professional service from an independent Medicare Supplement broker.
Enrolling thorough us will provide you more resources for questions and concerns specific to your Medicare Supplement Plan (Medigap). In addition to having access to your personal broker, you will always have the same resources with the insurance company as you would have as going direct through their 800 numbers, online account direct, online help center, etc.
As an independent broker, I will be paid by whichever company you choose to get your Medicare Supplement insurance plan through. It’s really that simple and straightforward. And, yes, the premium for your plan of choice is exactly the same as calling the carrier and going direct.
What are Medicare Supplement insurance premiums?
Medicare Supplement premiums are what you pay directly to the insurance company to provide you with the additional costs that Medicare Part A and Part B does not cover for approved Medicare services and procedures.
Defining what a Medicare Supplement Plan premium is seems fairly straightforward, and it is. The reason I’ve chosen to break this down is because a Medicare Supplement Plan(s) are the only products that have variable premiums for exactly the same coverage– standardized coverage on a nationwide level (Yes, 100% the same coverage as they are overseen and issued by the government).
Any health insurance product that is sold on any individual/group marketplace will have different levels of coverage, different networks, different copays/co-insurance, and different ways in which the plan functions for your healthcare needs when not on Medicare with a Medicare Supplement Plan (Medigap). For example, let’s say you and a dozen of your friends (all the same age- say, 64 years old) may all have employer group plans through each of your employers prior to transitioning to Medicare (for this example, let’s assume you don’t work together under the same plan). You all likely have great coverage options, but I’d bet each and every one of the those 12 plans are structured differently, providing different networks, and costing different amounts. Not only do you pay different contributions from your pay check, but your copays/co-insurance and access to physicians is all different. Even if they seem similar, there are differences whether you know it or not. This is not the case with Medicare Supplement Plans once you’re enrolled in Medicare.
With Medicare Supplement Plans (Medigap), if you and your 12 friends all had the same plan letter Medicare Supplement Plan (say, Plan G), you would all have exactly the same coverage. You would have exactly the same access to physicians anywhere in the country, exactly the same deductible ($240 for 2024), no out-of-pocket costs for the same Medicare covered medical procedure (fully covered after the annual deductible is paid). The ONLY difference would be what you pay for that coverage based on which insurance company you choose to go with and what ZIP code you live in. We assumed you were all the same age in this example. If you were all different ages, the same principles would apply, however, the rates would be slightly more for the older members of the plan according to age brackets set by each insurer. And again, even as costs vary by age, the coverage would remain exactly the same.
We simplify the Medicare Supplement Plan process.
After we help you break down and simplify how to think about the standardized insurance plan by letter, you can then focus which plan is best for you in your ZIP code. Maybe you and your 12 friends go with the same insurance carrier? Great, you all have great coverage on Plan G with that specific insurer. Some of you will pay more than others in this scenario if you live in different parts of California. Ideally, each of you would shop all the carriers to find the best Plan G in your specific ZIP code to keep your premiums as low as possible. Regardless of what insurance company you choose, you would all be covered with the same standardized Medigap Plan G. Medicare would be primary to all Plan Gs and therefore, would give you all the same access to physicians and providers. The Medicare Supplement Plan does no dictate what is covered, Medicare does.
I hope breaking this down for you allows you to more comfortably review Medicare Supplement Plans in an objective manner. Contact my office so we can shop the carriers in your ZIP code to give you options. Shop rate and go with the carrier of your choice! Again, re-shop plans during the California Birthday Rule to keep your premium low and coverage exactly the same!
The best practices and process of changing Medicare Supplement Plans.
Medicare Supplement insurance Gym Membership?
Many carriers will include a gym membership through Silver Sneakers– which is a program that gives you gym access in your area to multiple locations depending on where you live and what gyms in your area that accept the plan. Check out the SilverSneakers program here!
Call the ask about which carriers offer this and how to search for the locations! This is considered an additional add-on and has no effect on your Medicare Supplement (Medigap) coverage.
What are the Medicare Supplement insurance premiums in California?
This should be used a guide. Although it is typical for most regions to be similar, each ZIP code will have its own pricing. I will use examples with cities in various regions. If you live near the city area, you’ll likely have a similar quote. I’ll include areas where most of my clients live so you can see the difference in pricing for the same exact Medicare Supplement products in different ZIP codes.
For a specific quote for your age and ZIP code, please fill out the Request Quote Form at the bottom of this page for a personalized quote for you in your specific ZIP code and age.
Mentor One Insight
Let’s logically break this down so you can decide between which Medicare Supplement Plan G or N that you want to start with when first enrolling into a Medicare Supplement Plan (Medigap). If you’re a current client or looking for an independent broker to work with, and you have a Plan F, feel free to shop those rates or consider moving down to a Plan G if lower premiums offset the Part B deductible and justify it.
So, why Medicare Supplement Plan G? Well at roughly $120 a month at 65 in ZIP code 95864 (Sacramento, CA), you have no medical expenses to plan for through the year, other than the annual Part B deductible of $240 (2024). I know you are used to your deductibles being ($500-$2000 +) so it may come as a shock to you that your premium of $120 a month and $240 annual deductible will be all that you’ll pay out of pocket- no-copays/no-coinsurance once the deductible is paid up (the full 20% is then covered). Welcome to Medicare with a Medicare Supplement Plan G!
Considering Plan N? At roughly $95 a month at 65 in ZIP code 77777 (Pleasanton, CA), you have the same annual deductible as Plan G (Part B deductible of $226 for 2023). Once that is fulfilled for the year (usually the first appointment or two), you’ll then have copays of $20 ($50 for emergency). See more below for a comparison of the two Plan letters.
Medicare Supplement Plan G vs Medicare Supplement Plan N
For comparative purposes, let’s use the $20 since its much more accurate to typical co-pays charged to our clients on Plan N (it states up to $20). Ok, so if the deductibles are the same for Medicare Supplement Plan G and N, then we look a premium and copays. At roughly $25-30 a month more for G than N, then it’s all in the numbers, right? 12-15 copays per year breakeven point? Let’s go with that. You have a healthy year you win with Plan N. You have a year full of medical complications, Plan G wins. With that said, there is another reason if costs are equal- meaning G and N side by side with 12-15 appointments for the year (primary/specialist/tests/chiropractor/physical therapist, etc). Now comes in the mysterious “Part B excess charges” which is something we cant predict, and is why I recommend Plan G over Plan N for this reason.
Plan G covers Part B excess charges. Check out what Medicare excess charges are here!
Plan N does not. Now, this depends on whether the physician, provider takes medicare assignment (or the balance billing /negotiated rate as acceptable payment for their service). You can be billed directly for Part B excess charges – which is up to 15% above the Medicare balance billing amount which can add up to a lot of money out-of-pocket. This is something that differs for all Medicare providers and physicians, so it depends on your physician, medical group, provider, etc. It’s not very common, but I prefer my clients to be covered in Plan G.
I recommend that you pay an extra $25-35 a month, avoid ever having to pay copays, and know that you’ll never get a Part B excess charge. Plan G > Plan N.
The last reason to go with Medicare Supplement Plan G over Plan N when you first enroll. Plan G supersedes Plan N when it come to the order in which the insurance companies rank coverage. With that in mind, you can always go down from Medicare Supplement Plan G to Plan N during your CA birthday rule if you chose to do so with guaranteed-issue rights to move from Medicare Supplement Plan G to Plan G (same coverage/lower premium) or Plan G to Plan N (lower coverage/lower premium).
However, it is NOT guaranteed-issue for you to move “up the ladder” of plans. To do so, you would have go through medical underwriting to qualify. Start higher (Plan G) “up the ladder” of plans and you can easily move down (Plan N) if you chose to do so after using the plan for a year or two. Moving to lower coverage is very uncommon once my clients realize how valuable Medicare Supplement Plan G is compared to Plan N with copays and potential Part B excess charges. I’m constantly thanked for talking my clients into the better plan. They avoid copays and have the option of moving down later (they rarely do!).
Maybe you’re interested in a Medicare Supplement Plan, and would like to compare the Pros & Cons of a Medicare Supplement Plan vs. a Medicare Advantage Plan, If so, view here.
