Get An Instant Quote Now



The First 3 Steps in Acquiring Medicare Supplement Insurance Coverage in California


Introduction

If you are to turn 65 within the next year or two, it's time to learn about your Medicare supplement insurance plan options.  A quality Medicare supplement plan is as important a piece as any, when it comes to achieving financial stability in retirement.

Let's go over the basics of Medicare supplement coverage and break down 3 tips to acquiring this insurance necessity in the state of California. 


What is Medicare Supplement Coverage (Medigap)?

Before you make the leap to acquiring a Medicare supplement plan, it's important to know what this coverage is and what it could mean for you and your family.  Simply put, Medicare supplement coverage is insurance for medical circumstances that are not covered by Medicare.  While Medicare coverage is quite extensive, it does not cover everything.  If you have the misfortune of suffering a medical incident that requires surgery, or a hospital stay, medical bills can mount rather quickly.  Most people are surprised at the costs associated with even the most modest of medical procedures.  A quality Medicare Supplement plan can be a financial lifesaver.

Medicare Supplement plans (also known as Medigap plans), are offered through private companies.  Keep in mind that Medigap plans are not the same as Medicare Advantage Plans. (For the pros and cons of Medicare Advantage plans, click here.)

Medigap coverage can only be used for one thing: circumstances where traditional Part A and Part B plans don't provide coverage.

In total, there are ten Medigap plan styles that consumers may consider.  We'll discuss these plans in more depth so that you can make the decision that's right for you. 

Good to know:  When it comes to medical services, shop around for a better deals.  Patients often think that medical fees are set, but just like any other business, costs for goods and services can vary widely.  Shop the cost of exams, tests, procedures, medications, nursing facilities, and imaging centers before non-emergency events.  The price of an MRI on one side of Main Street can be $500, and $2,500 on the other.  Healthcare pricing, as a rule, is arbitrary.  Even the pharmacy you choose can be the difference in hundred of dollars annually.


Who is Eligible for Medicare Supplement Coverage in California?


To be eligible for a Medigap plan in the state of California, you must meet certain requirements.  Let's take a look at the conditions consumers must satisfy in order to be eligible to apply for Medigap insurance.

For starters, you must be enrolled in Medicare Part A and Part B.  If you are not enrolled in Both Part A and Part B of Original Medicare, you will not be able to purchase a Medicare supplement plan.
Secondly, in almost every case, you need to be age 65 or older to be eligible for Medigap insurance.  The state of California requires Medigap insurance companies to provide at least one type of supplemental insurance to individuals who, through specific disabilities, are eligible for early Medicare.



There are a few insurance circumstances in which you cannot be covered by a Medicare supplement plan:

  • Medicare Advantage Plans  If you are covered by a Medicare HMO, PPO, or Private Fee-for-Service Advantage Plan, you are not eligible for Medigap insurance.
  • Medicaid  You cannot augment your Medicaid coverage with a Medicare supplement plan.
  • Veterans' Benefits  Like Medicaid, Veterans' benefit coverage cannot be supplemented by a Medigap plan.

If you have a Medicare Prescription Drug Plan, you will still need Original Medicare to be eligible for a Medicare supplement plan.  Medicare Prescription Drug plans, and Medicare Supplement plans are two distinctly separate coverages.  The benefits do not overlap.  Since 2006, Medigap has been barred from covering the cost of prescription drugs.


How Does Medigap Work in the State of California?

If you meet the eligibility requirements for Medigap insurance in California, you may be wondering how exactly Medigap insurance works.  Is the payment rolled up into one bulk Medicare cost, or will you be forced to pay two different premiums?  Additionally, does Medigap insurance offer spousal coverage, or is it just for one person?

Let's take a look at these questions and break down the answers.  Because Medigap plans work differently than Original Medicare, it's important you understand the differences between the two plans.

If you enroll in a Medigap plan, you will need to pay an additional premium on top of your existing Part B premium.  This premium will be paid on a monthly basis.  These plans cover only one individual.  If you are seeking supplement coverage for both you and your spouse, each member must apply for his or her own policy.

Medigap coverage is purchased through private insurance companies.  You'll find that different insurance companies have different premium structures (and therefore different prices) when it comes to their Medigap plans.

If you suffer a medical incident, you can expect Medicare to cover any medical costs according to the Medicare coverage plan benefits.  Your Medigap insurance is designed to help cover expenses not covered in your Original Medicare plan.

As long as you continue to pay your monthly Medicare supplement premiums, you are never in danger of losing your coverage.  Because Medigap is guaranteed-renewable, you can keep your coverage even if you fall ill or have a downward turn in your health.


Steps to Finding the Right Medicare Supplement Plan

Finding the right Medigap plan for your situation doesn't have to be difficult.  Though it can be overwhelming at first, by following the steps below, you should be able to painlessly find an ideal plan. 

  • Step #1: Research Medicare Supplement plan styles.

First, you'll need to research the different Medicare Supplement plans available.  Currently, there are ten different supplement plans available: A – N.


Medicare Supplement Plan Comparison

Benefits Medicare Supplement Plans
  A B C D F* G K L M N
                     
Medicare Part A Deductible No 100% 100% 100% 100% 100% 50% 75% 50% 100%
Medicare Part B Deductible No No 100% No 100% No No No No No
Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Medicare Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%**
First three pints of blood 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Medicare Part A hospice coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled Nursing Facility (SNF) coinsurance No No 100% 100% 100% 100% 50% 75% 100% 100%
Medicare Part B Excess Charges No No No No 100% 100% No No No No
Foreign Travel Emergency (Up to Plan Limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-Pocket Limit*** None None None None None None $5,240 $2,620 None None

*Plan F is also has a high-deductible option.  The F high deductible plan pays for all Medicare-covered expenses after you meet a $2240 annual deductible.
**Office copay exceptions: Some office visits may require a copayment of up to $20.  Emergency room visits may require a copayment of up to $50.
***Plan pays 100% of covered Medicare costs for the remainder of the calendar year once the out-of-Pocket limit is reached.


Good to know:  Just because a hospital or office is "in-network" doesn't mean all its doctors are.  Think you're covered because you took the time to make sure your hospital or doctor's office was approved as being in your network?  Think again.  It's just not that simple. Individual providers, labs, tests, specialists, and others that work within the facility may still be out of network.  Yes, exasperating, but true.  It's tedious but important to, when possible, ask everyone involved in your treatment if they are an "in network" provider.


  • Step #2:  Research plan pricing

Once you've chosen the plan type that fits your needs, you should begin looking at insurance companies that offer that plan.

  • Visit the California Department of Insurance.

Visit the California Department of Insurance website.  Here, you will find a wealth of information pertaining to the insurance companies who offer Medigap coverage in the state of California.  Use this resource for official, in-depth, insurance information.

  • Step #3:  Contact Insurance Companies in Your Area

Don't be afraid to make some phone calls.  Be sure to verify plan details directly with the insurance carrier, before applying for any plan.  This can prevent costly mistakes, delays, and even denials in the future.
Also, be sure ask as many questions as you need in order to feel comfortable about selecting a plan.


The Bottom Line

Educating yourself on the Medicare Supplement options that are available to you will substantially increase your chances of purchasing the ideal plan for your needs.

Newplanoptions.com is here to help.  Our insurance professionals have years of experience helping consumers find the right plan for their needs and budget.  call now.



Other articles:
Is Short-Term Health Insurance Right For You?
Resources