You may have heard the term Utah Medicare Supplement Plans before but aren’t sure what they are or how they work. Here we provide a summary for you of what a Medicare Supplement Plan (also referred to as “Medigap”) is and how it might help you with your Medicare health insurance coverage.
A Medicare Supplement Plan is a plan offered by many insurance companies. Brokerage groups such as American Senior Benefits often help Medicare Beneficiaries select between these companies and their plans. The Medicare Supplement Plans help cover health care costs Medicare does not cover, including deductibles, coinsurance, and co-pays.
Note that, like any other privately purchased Medicare insurance plan, Medicare Supplements do not provide family plans. Each plan is for individual coverage similar to how Social Security benefits are applied individually. For example, a husband and wife would each purchase their own plan. While many companies offer household discounts for having both spouses on their plans, it is sometimes in the couple’s best interest to have Medicare Supplement insurance coverage through two different insurance carriers.
Medicare Supplement policies purchased after their ‘modernization’ in 2010 are considered renewable. The insured, also known as a policy holder, does not need to re-apply or prove insurability to maintain coverage from year to year. Use of the coverage for either minor or serious health challenges does not cause an increase in premiums or jeopardize your coverage. Once you qualify for and secure your plan, so long as you pay your premiums, you are insured. This is, perhaps, the greatest strength of a Medicare Supplement – their consistency and reliability. It literally takes an act of Congress to change the coverage. As of today, this has been the most consistent form of Medicare health insurance coverage in the United States for over 50 years. To date, Congress, when they do make changes to plan benefits, has offered ‘grandfathering’ to those who already hold plans. Those folks have been able to keep their plans as they are used to. Only new buyers become immediately subject to the new terms.
To use a Medicare Supplement, beneficiaries must have what is called both Medicare Parts A & B. Part A covers services such as are incurred when admitted to a hospital or for temporary recovery for an illness or injury in a skilled nursing facility. Part B generally covers most other medical services that do not require hospital admittance, such as seeing your primary doctor, specialist visits, durable medical equipment, outpatient surgery, some injections, etc. Note that both Parts A & B of Medicare have limits to their coverage. Both have deductibles, co-insurance, and co-pays as well as upper coverage limits that may surprise some. This is why very few people retain their Medicare benefits without securing additional coverage. Traditionally, that coverage has most often been retained by holding a traditional Medicare Supplement Plan.
Medicare Beneficiaries in Utah are well served with Medicare Supplement Plans if they expect high use of medical care in the future. The consistency of coverage can provide them with one less thing to worry about. Also, people may want a Medicare Supplement Plan for its convenience, as there is no doctor or hospital network to have to abide by with most plans. A policy holder who finds out they have cancer in West Jordan, Utah can decide to receive treatment in Johns Hopkins, Maryland if they wish. The coverage will work the same in both locations.
A supplement plan may differ from state to state, so it’s important you consult your insurance brokerage offering Medicare Supplement Plans to what your state offers. There are also different levels of coverage with different plans. Similar to Medicare ‘Parts’, Medicare Supplement ‘Plans’ that differ from each other go by letters of the alphabet such as A, G, F, N, etc. Some or more popular than others and no one plan is most appropriate for everyone. Use your insurance professional to help decide on the plan that suits you best.
It’s also important to note Medicare Supplement Plans vary in cost. Some may come with higher or lower premiums. Premium – the monthly or annual payment a person makes to the insurance company to secure the coverage as a policyholder – is determined by two factors in any given state or zip code. One, the claims history of a geographic area like your zip code is used to determine the cost of the plan premium. Second, most companies raise premium based on increased age. Insurance companies cannot raise premiums on individuals for use or claims.
Ask our insurance professionals about companies with discounts for things such as early entry age or household discounts for having a partner living with you. The criteria for household discounts vary widely and can often be the biggest deciding factor in choosing between several Medicare Supplement carriers.
It is critical to remember that Medicare Supplement (or Medigap) Plans require you to be able to so no to roughly a page of questions about your health – what they call underwriting. This barrier to entry may surprise people with the Affordable Care Act being in place for about five years now. It remains one of the few health insurance plans that require relatively good health to attain. This is one method by which they keep premiums lower than they otherwise might. Of course, know that, as mentioned earlier, they cannot kick you off your plan once you do become unhealthy, injured, or sick. You got it. That’s what they’re there for.
There are exceptions to the underwriting requirement. One is aging in. While there are additions and exceptions between states, in Utah and Idaho, Medicare Supplement carriers are required to accept you when you first begin your Medicare coverage. Also, there is a provision for those who delayed Medicare coverage – perhaps because they retained employer coverage until a later age – to not have to answer any health questions if they get their new Medigap coverage soon enough upon losing the employer coverage. There are other much more specific circumstances, exceptions, and provisions as you can imagine with any large government program like Medicare or Social Security.
With that said, be aware that this article could not possibly cover everything we’d like it to without boring you to death. It should not be considered complete or comprehensive. For an excellent sleeping pill – I mean read – on the subject, crack open the 2017 booklet, “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare,” from the Center for Medicare & Medicaid Services (CMS), developed jointly with the National Association of Insurance Commissioners (NAIC). Told you.
You can also request a meeting with one of our several professionals. They will provide you with a physical copy of the booklet referenced above. They will help spell out how Medicare works in layman’s terms and point out the pro’s and cons of the many different choices you have with your Medicare insurance coverage. They can explain things like how your Medicare coverage, income, and your Social Security benefits may affect each other.
If that sounds like a wise option, you can call our team at 801-281-0066 or email us at firstname.lastname@example.org.