Medicare Supplement Plans
Medicare does not pay for everything. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, services not covered by Medicare, and excess charges when doctors do not accept assignment.
Medicare Supplement Insurance (Medigap)
Medicare Supplement insurance is also called Medigap insurance because it covers the "gaps" in Medicare benefits, such as deductibles and copayments. Medicare Supplement insurance is a private health insurance policy purchased by a Medicare beneficiary. Federal and state law regulates Medicare Supplement policies. Only a Medicare Supplement policy, or a Medigap policy, will help fill gaps in Medicare benefits. Other kinds of insurance may help you pay out-of-pocket health care costs, but they do not qualify as true Medicare Supplement insurance. For example, an employer retirement health plan may pay for prescriptions, vision and dental services, but it may not pay for Medicare deductibles and copayments.
Therefore, it is not a true Medicare Supplement policy because it does not coordinate benefits with Medicare. Do I Need a Medicare Supplement Policy? The answer to this question depends on one factor. Do you know you will always have adequate income and assets to cover all medical costs NOT covered by Medicare, such as deductibles, copayments, or non-covered services? If you are not sure the answer is yes, or if you do not want to risk it, you should explore your options for supplementing Medicare. In addition to Medicare Supplement Insurance, you will need Part D Drug Coverage.
Standard Medicare Supplement Coverage
To make it easier for you to compare one Medicare Supplement policy to another, Indiana allows 8 standard plans to be sold. The plans are labeled with a letter, A through N. Plans H, I, and J are no longer offered, and Plans C and F are only available to people who were eligible for Medicare before January, 2020. There are high deductible versions of Plans F and G..
These 8 plans (A, B, D, G, K, L, M, N) are standardized, which means that benefits will be the same no matter which company sells the policy to you. Plan A is the basic benefit package. Plan A from one company is the same as Plan A from another company. Since Medicare Supplement policies are standardized, you are free to shop for the company with the best price and customer service. To see what benefits are offered with each plan, click here.
Generally, Medicare Supplement policies pay most, if not all, Medicare copayment amounts, and policies may pay Medicare deductible amounts except for the Part B deductible. Although the benefits are the same for each standard plan, the premiums may vary greatly. Before purchasing a supplement policy, determine how the company calculates its premiums.
An insurance company can calculate premiums one of three ways.
- Issue Age: If you were 65 when you bought the policy, you will pay the same premium the company charges people who are 65 regardless of your age.
- Attained Age: The premium is based on your current age and will increase as you grow older.
- No Age Rating: Everyone pays the same premium regardless of age.
The Indiana Department of Insurance must approve premium rates for all Medicare Supplement policies. Premium increases are approved based on a loss ratio. This means that an insurance company must prove actuarially that it would experience a loss if it didn't raise its premium based on claims paid out.
Medicare SELECT Insurance Policies
Medicare SELECT policies are a type of Medicare Supplement insurance sold by a few private insurance companies. A Medicare SELECT policy is one of the 8 standardized supplement policies.
It differs from Medicare Supplement insurance because you are expected to use a network of hospitals associated with the insurance company. In return, you will usually pay lower premiums. Also, in order to enroll in a Medicare SELECT plan, you must live within the service area of a network facility.
What does Medicare Supplement insurance cover?
Medicare Supplement insurance is sold in 12 standard plans. Plans C and F are only available to people who were eligible for Medicare before January 2020.
View all plans types and the benefits they include. (updated 1/6/2020)
Every company must sell Plan A, which is the basic plan, or the "core benefit" plan. The standard plans are labeled A through L. Remember, the plans are standardized. So, Plan F from one company will be the same as Plan F from another company.
Select the supplement policy which fits your needs, and then purchase that plan from the company which offers the lowest premiums and best customer service.
Included in all plans.
- Pays Part A Hospital copayment ($371 per day for 61-90 days and $742 per day for 91-150 days in 2021)
- Pays for an additional 365 days of hospitalization after Medicare benefits end.
- Pays Part B copayment (usually 20% of the Medicare approved amount)
You will have to pay part of the cost-sharing of some covered services until you meet the annual out-of-pocket limit. Plan K has a $6,220 (2021) out-of-pocket limit. Plan L has a $3,110 out-of-pocket limit (2021). Once you meet the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. These amounts can change each year.
Part A Deductible
The initial amount Medicare does not pay for an inpatient hospital stay per benefit period ($1,484 in 2021).
Skilled Nursing Copayment
The amount Medicare does not pay for days 21-100 in a skilled nursing facility ($185.50/day in 2021).
Part B Deductible
The initial amount Medicare will not pay for covered physical or other outpatient services each calendar year ($203 in 2021). Most people will pay $148.50 (2021) each month for the Part B Premium. Due to changes that were implemented in January 2020, the Part B deductible is not covered unless you were eligible for Medicare before January 2020.
Foreign Travel Emergency
(Medicare does not pay for care received in a foreign country.) This benefit covers, after a $250 deductible per year, 80% of health expenses for emergency care received in the first 60 days of a trip to a foreign country, up to a lifetime maximum of $50,000.
At Home Recovery
(Medicare only pays for skilled nursing home health care.) This benefit covers home health visits for assistance with activities of daily living, when either Medicare home health coverage is currently being received or within eight weeks from the last Medicare home health visit, up to $1,600 per year.
Part B also covers preventive services at $0 copay and $0 deductible. These include welcome to Medicare physical exam, abdominal aortic aneurysm screening, annual wellness exam, bone mass measurement, cardiovascular disease screening, colorectal cancer screening, diabetes screening, mammogram screening, pap test/pelvic exam/clinical breast exam, vaccines, flu H1N1 flu, hepatitis B, pneumonia. Copay and deductible apply to glaucoma tests, HIV screening, Medicare nutrition therapy services, prostate cancer screening, smoking cessation counseling.
Part B Excess
Medicare does not pay excess charges above its approved amount. This benefit covers the difference between the Medicare approved amount and the limiting charge (which is no more than 15% above the Medicare approved amount). This benefit pays either 80% or 100% of the Part B excess charges.
Part D Drug Coverage
You must enroll in a Medicare Part D Drug Plan or have another drug plan that has equal or better coverage than Part D. If not, there is a 1% penalty for each month that you are not enrolled in Part D. For example, using the drug benefit from the Veterans Administration (VA) is credible coverage, and there would be no penalty. However, retiree drug coverage provided by an employer may or may not be credible. The employer is required to tell you each year if it is or is not.
There is a time period when a company must sell a Medicare Supplement policy to you. This six-month period is called Medigap Open Enrollment Period (OEP) begins when you are 65 or older and enroll in Medicare Part B.
During Medigap Open Enrollment Period (OEP), a company:
- Cannot refuse to sell you a Medicare supplement policy, regardless of your health.
- Can ask you health related questions on the application.
- Cannot charge you a higher premium because of your health history.
If you are 65 years old or older:
You can enroll in Medicare Part B when you turn 65 and our Medigap Initial Enrollment begins the day your Medicare Part B becomes effective.
If you continue to work past age 65 (to any age) and delay enrolling in Medicare Part B, you "trigger" your Open Enrollment period by enrolling in Medicare Part B. It begins the day your Medicare Part B becomes effective.
If you are 65 or older and delayed enrolling in Medicare Part B because you were covered by your working spouse's employer group health plan, you "trigger" your Open Enrollment period by enrolling in Medicare Part B. It begins the day your Medicare Part B becomes effective.
If you are under 65 and receive Medicare due to disability:
Currently, there is no Initial Enrollment period for disabled Medicare beneficiaries until they are 65. However, as of July 1st, 2020 a new law (SEA 392, also known as "tammy's law") requires all Medigap companies that sell policies to individuals over the age of 65 MUST also make available Plan A to individuals under the age of 65.
There are other options for those who are under 65 and disabled:
Medicare Advantage Plans cannot turn you down if you have Medicare due to a disability and are under age 65. As of January 2021, you cannot be excluded from enrolling in a Medicare Advantage Plan due to End State Renal Disease (ESRD).
Some companies accept applications for other Medicare Supplement policies from those under 65 and disabled. However, there is no guarantee that they will sell a policy to you.
If you are under 65 and receive Medicare due to a disability, you trigger your Initial Enrollment period when you turn 65. When you turn 65, your Medicare is due to age and no longer due to disability. A company must then sell you any plan it offers.
If I am still working and have Medicare due to disability, can my employer group health plan turn me down? That depends on the size of your employer.
- If your company employs 100 or more employees and:
- You work full time and your employer group health plan offers coverage to other full-time employees, they cannot turn you down, or charge you premiums which are higher than other employee premiums.
- You work part time and your employer group health plan offers coverage to other part-time employees, they cannot turn you down or charge you premiums which are higher than other employee premiums.
- If your company employs fewer than 100 employees, Medicare would be your primary insurance.
Can my working spouse's employer group plan turn me down? That depends on the size of the employer.
Your working spouse's employer group health plan can only turn you down if the company has fewer than 100 employees. They have to cover you the same as any other spouse. They cannot give you less coverage or charge you a higher premium.
If your working spouse's employer has less than 100 employees, Medicare would be your primary insurance.
Companies must be approved by IDOI in order to sell Medicare Supplement policies. All of the companies listed below have been approved by the state. The plans are labeled with a letter, A through J. Not all companies sell all ten plans. Following each company name and phone number, we have listed the Medicare Supplement plans sold by that company based on the following categories:
- Medicare Supplements for Persons 65 and Older
- Medicare Supplements for Persons Under 65 and Disabled
- Medicare SELECT Insurance Companies