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Medicare Supplement FAQs

Medicare Supplement FAQ

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1. What Is A "Modernized" Medicare Supplement Plan?

Medicare Supplement plan choices changed as of June 1, 2010 and plans offered on or after that date are called "modernized" plans. Certain prior plans (E. H, I and J) were eliminated and Plans D and G were modified. These eliminated and changed plans were "grandfathered," and beneficiaries with those plans have been allowed to retain them. In most instances it's in the best interest of beneficiaries to keep their grandfathered plans rather than to purchase a "modernized" plan.

2. What Plans Are Available?

NOTE: Starting January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C, F, and Hi Deductible F are no longer available to such individuals. If you already have one of these plans as of January 1, 2020 you'll be able to keep your plan. Also, if you qualify for Medicare before January 1, 2020, but are not yet enrolled, you may be able to buy one of these plans.

The chart below shows basic information about the different benefits Medigap policies cover in 2025.

Yes = the plan covers 100% of this benefit
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable

Medigap 2024

* Plans F and G (as well as the J plan that existed prior to 2010) also offer a high-deductible plan. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,870 in 2025 before your policy pays anything. (Plans C and F aren't available to people who were newly eligible for Medicare on or after January 1, 2020 and Plan J has not been offered since 2010).

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N does not cover the Part B deductible or Part B excess changes, and there are copayments of up to $20 for some office visits and up to $50 for emergency room visits that don't result in inpatient admission.

 

You live in Massachusetts, Minnesota, or Wisconsin

If you live in one of these 3 states, Medigap policies are standardized in a different way.

3. What Providers Are Covered?

Unless an individual purchases a "SELECT" plan (see question 4), s/he is eligible for treatment by ANY provider who accepts Medicare anywhere in the U.S.

Providers who accept Medicare but don't take Medicare assignment (payment directly from Medicare), are permitted to charge up to 15% (this is called an "excess charge"). Plans F and G cover excess charges; Plans A, B, C, D, K, L, M, and N do not. Excess charges are not permitted to be assessed in Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, or Vermont.

4. What Is A Medicare SELECT Plan?

Medicare SELECT is a type of Medigap policy sold in some states that requires you to use hospitals and, in some rare cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). Any of the standardized plans (see question 2) can come in a SELECT version.

If you have a SELECT plan and don't use a Medicare SELECT hospital or doctor (if applicable) for non-emergency services, you'll have to pay some or all of what Medicare doesn't pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose provided the provider accepts Medicare.

A SELECT plan is less expensive than a standardized plan with the same letter designation.

SELECT plans are offered by only some carriers and only in certain states and zip codes. When these plans are offered, they're usually restricted to certain zip codes and plans, and only a small number of hospitals are usually included in the network.

5. Where Can I Find Available Plans?

Medicare Supplement policies can generally be purchased at any time and, unlike Medicare Advantage or Part D prescription drug plans, do not have "lock in" provisions that prevent individuals with such plans from changing plans or carriers. You cannot be charged extra or refused coverage during the Medigap Open Enrollment Period (a period that lasts 6 months and begins on the first day of the month in which the beneficiary is both 65 or older and enrolled in Medicare Part B).

Unless a beneficiary has a guaranteed issue right or buys a Medicare Supplement during the Medigap Open Enrollment Period, Medicare Supplement plans utilize medical underwriting, which means that you can be rejected or charged extra for a health condition. Individuals with Medicare Advantage plans can buy Medicare Supplement plans during the Annual Election (Enrollment) Period that runs from October 15--December 7 for a January 1 effective date, and the Medicare Supplement carrier can utilize medical underwriting unless the individual is in the Medigap Open Enrollment Period.

During the Open Enrollment Period (1/1-3/31 or during the first three months after electing a Medicare Advantage or Medicare Advantage Prescription Drug Plan at age 65 during the initial coverage election period), individuals who have Medicare Advantage or Medicare Advantage Prescription Drug plans can elect to return to Original Medicare (Parts A and B) and also purchase a Medicare Supplement and/or stand-alone Part D plan. Unless such an individual has what is called a "guaranteed issue right" (for example, what is called a Medicare "trial right"), Medicare Supplement plans bought outside of the Medigap Open Enrollment Period are subject to medical underwriting.

Medical underwriting requirements, which apply in situations other than open enrollment and guaranteed issue, differ between each carrier. However, all plans with the same letter designation provide the same level of benefits.

Eight states--California, Idaho, Illinois, Louisiana, Maryland, Nevada, Oklahoma, and Oregon---have “birthday” rules for changing Medicare Supplement plans. This is an annual protection afforded to Medicare beneficiaries that provides an open enrollment period available for a specific timeframe around the beneficiary’s birthday when purchasing a Medigap policy without underwriting or a waiting period is possible. Each state with a birthday rule has its own specific regulations and timeframes, so it’s important to check the details for your state.

Some Medicare carriers permit members to change plans with no underwriting at any time (either to any plan offered by that carrier or to a plan providing lesser benefits, depending on the carrier) and others have rules permitting members to change to certain plans (e.g., on the two-year anniversary date).

Call us at 561-734-3884 or 877-734-3884 (TTY: 711) for more information and help in enrolling in a plan.

6. What Is A "Trial Right"?

You have a guaranteed issue (i.e. a right to buy a Medicare Supplement policy with no underwriting) if:

1. You joined a Medicare Advantage plan when you were first eligible for Medicare Part A at age 65 (note that you must have enrolled as of the first of the month you were first eligible for Medicare Part A at age 65 or you don't qualify for this trial right) and within the first year of joining, you decide you want to change to Original Medicare; or

2. You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you've been in the plan less than a year, and you want to switch back.

You have different rights to buy certain Medigap policies, depending on which "trial right" you're exercising.

If you have the first trial right, you can buy any Medigap policy that's sold in your state by any insurance company.

If you have the second trial right, you have the right to buy the SAME Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the SAME insurance company you had before still sells it. If your former Medigap policy isn't available, you can buy any Medigap Plan A, B, C, F, K or L that's sold in your state by any insurance company. (Individuals not eligible to buy Plans C or F must be offered Plans D and/or G instead.)

Click here for details about trial rights.

Note: The above are minimum standards for trial right requirements and are contained in the Choosing a Medigap Policy publication. Some states have liberalized these requirements, and some carriers provide an additional 12 months under certain circumstances. Please call us at 561-734-3884 or 877-734-3884 (TTY: 711) to discuss what trial rights may apply to your particular state and situation.

7. What’s The Availability Of Plans C and F?

Here's what you need to know about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which eliminated Plans F, Hi Deductible F, and C ONLY for those with Medicare Part A effective dates on or after January 1, 2020, or those not previously eligible for Part A and were born on January 1, 1955.

  • Anyone eligible for Medicare Part A before January 1, 2020 can enroll in a Plan F, Hi Deductible F or C even after 2020 and can keep their plan as long as they choose.
  • Anyone who becomes eligible for Medicare Part A on or after January 1, 2020 will NOT be able to purchase either a Plan F, Hi Deductible Plan F, or Plan C. Plan G (the same as Plan F except the insured is responsible for the Part B deductible) will continue to be available in addition to all the other options (i.e. Plans A, B, D, G, K, L, M and N), and a new Hi Deductible Plan G will become available.
  • Insureds ALREADY enrolled in Plans F, Hi Deductible F, or C Plan do not need to take any action. Plans F, Hi Deductible F and C will still be available for consumers eligible to purchase them in 2020 and beyond.

Please see this compliance update that summarizes all of the MACRA changes that took effect January 1, 2020.

Schedule For 2025
Affordable Care Act Enrollment

Affordable Care Act open enrollment for 2025 plans began November 1, 2024 and ends January 15, 2025 on the Federal Facilitated Marketplace (https://www.healthcare.gov)

You DO NOT need a Qualifying Life Event to qualify.
There are no pre-existing condition limitations.

Call Us At 786-970-0740 (Cell)
to determine what kind of plan you may be eligible for.


2025 Annual Enrollment Period For Medicare Beneficiaries

Marketing for 2025 Medicare Advantage, Medicare Advantage Prescription Drug, and separate Medicare drug coverage (Part D) began October 1, 2024. Medicare beneficiaries can enroll in or change plans for 2025 by enrolling during the Annual Enrollment Period between October 15 and December 7 for a January 1, 2025 effective date. Individuals who want to keep their present plans, if they are available for 2025, do not need to submit enrollment applications. Individuals with terminating plans have until February 28 to enroll in a new plan but should enroll by December 31 to have a January 1, 2025 effective date. Except for individuals wishing to enroll in a Chronic Special Needs Plan, there are no health questions to qualify.

Medicare beneficiaries can enroll in a Medicare Supplement plan within 6 months of their Part A and B effective dates without answering health questions. Generally, individuals with Medicare Supplement plans can change plans at any time but in many cases will need to answer health questions to qualify. Individuals who have Medicare Advantage plans can enroll in Medicare Supplement plans during the Annual Enrollment Period but in most cases will have to answer health questions. There are special rules for individuals with “trial rights” or eligibility for guaranteed issue policies that don’t require answering health questions.

Call us at 561-734-3884 or 877-734-3884 (TTY: 711) for details.

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to individuals and families qualified to buy health (tax- and non-tax subsidized) insurance and dental/vision and/or hearing plans through the Federal marketplace (this is called buying “on-exchange” or “on-marketplace”) or directly from insurance carriers (this is referred to as buying “off-exchange or -marketplace”). Our Affordable Care Act policies comply with the Affordable Care Act and contain all of the “essential health benefits” required by that law.

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The dental/vision and/or hearing insurance

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for those who are looking for more inexpensive coverage and shorter term alternatives.

We offer Medicare Supplement, Medicare Advantage, and Part D Drug plans

to Medicare-eligibles. Our site is compliant with federal, state, and carrier guidelines in selling these policies. See the Medicare-eligibles section of this site for details.

We represent many carriers that offer supplemental benefits

to both individuals and families and Medicare beneficiaries, and the site contains information about hospital indemnity, cancer, critical illness, accident, and international medical insurance offered by many different carriers. This section of the site also contains valuable information and tools about lowering the cost of prescription medications. Call us if you want more information about or would like to enroll in one of these products.

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Finally, we have a complete array of Life, Final Expense, and Annuity products

and offer pre-need services in Florida, as we have both life insurance and pre-need licenses in that state.

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we’re paid directly from the carriers we represent, Premiums are NEVER EVER marked up to include paying us for our services: you pay the same whether you order directly from the carrier or the marketplace on your own or directly through us or from our site.

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