Special Blog: Medicare Matters


The Federal Government’s Medicare program, which most seniors over 65 enroll in, is a good Health Insurance plan, except for one very small fact. Along with various co-pays and deductibles that you need to pay along the way, Medicare only pays for 80% of your Medical bills. If you quickly do the math, and consider a possible serious medical issue or two popping up in the near and distant future, the 20% of medical bills that you are responsible for can add up to thousands of dollars!

To cover the gaps in Medicare coverage, you have two options. You can buy a Medicare Advantage plan or buy Medicare Supplemental Insurance otherwise known as “MediGap”.

The following is an introduction to Medicare Supplement (MediGap) insurance.

  1. DEFINITION: Medicare Supplement Insurance, also known as Medigap, is private Insurance that pays for the “gaps” in coverage that “Original” Medicare Parts A & B do not cover. It is not Medicare Advantage (which is typically a HMO type of Medicare Coverage).
  2. COVERAGE: Medicare Supplements cover 100% of the gaps for medical procedures and hospital costs that Medicare approves and will pay for (except the gaps). If Medicare doesn’t approve of a particular (unconventional) treatment or procedure, Medicare Supplements won’t pay as well.
  3. ELIGIBILITY: To purchase Medicare Supplements, one must have Medicare Parts A & B
  4. PLANS: There are several Medicare Supplement Plans to choose from. The features of the different Plans are standardized by the Federal Government.  Companies selling Medicare Supplements cannot deviate from the standard features. Plan “F” from one company is EXACTLY the same as Plan “F” from another company.
  5. PRICE:  Even though companies are selling the same exact plans, they can charge different prices. The Plan “F” price from one company can be different than the Plan ”F” price from another company. There is no pricing standardization. Please make it a point to shop around for the best price!
  6. PRE-EXISTING CONDITIONS: Pre-existing conditions do not matter and will NOT have an effect on pricing or your eligibility when buying a Medicare Supplement Plan if:
    a) You are new to Medicare and you sign up within the 7-month Initial Enrollment window;
    b) You were involuntarily terminated from another Medicare Plan due to the company ending their Medicare programs, etc.;
    c) You are coming off a Gov’t plan or a Group Plan from an employer. 
    Aside from these three exceptions, pre-existing conditions could factor into your pricing and/or eligibility
  7. DOCTORS & HOSPITALS: With Medicare Supplements there are NO RESTRICTIONS to what Doctors and Hospitals you choose. There are NO NETWORKS and NO REFFERALS needed for specialists, tests or procedures. You may receive medical care in any state, with NO geographical limitation
  8. CO-PAYS: With Medicare Supplements, there are NEVER ANY CO-PAYS, or OUT-OF-POCKET COSTS when receiving medical care (except for $20 per Dr. visit in the new Plan ‘N’)
  9. CLAIMS: There is coordination between Medicare, Medicare Supplement Insurers and Health Care providers so you will never receive a bill, or have to submit bills. You will only receive a “Summary of Benefits” so you can see what was paid for and by whom
  10. INTERNET & TELEPHONE: Your Medicare coverage is much too important to buy on the Internet, over the Telephone or from TV Commercials. You need someone to come to your home, and get to know you and your situation so they can provide you with the most appropriate options and recommendations. Look to work with an Insurance Professional who specializes in Medicare and who will always be available for questions and guidance… as this will provide you the best value, along with the peace of mind that you deserve!

Thanks to our guest blogger, Howard Peck, who we regularly work with and who is a Pennsylvania licensed Insurance Broker specializing in Medicare Advantage, Medigap, Part ‘D’ Drug Plans and Long Term Care Insurance. Howard represents numerous Top ‘A’ Rated Insurance Companies that allows him to offer the best plans based on his client’s needs and budget. Please contact us if you’d like to arrange for a consultation with Howard.