A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
Medigap policies do not cover everything!
Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
FOR 2024: The Following Deductibles and/or Co-Pays apply:
PART “A” (HOSPITAL)
Inpatient Hospital Stay –You Pay…(benefit period ends 60 days after release fromcare) Deductible: $1,632 per benefit period
- Coinsurance (days 1-60): $0 per day of each benefit period
- Coinsurance (days 61-90): $408 per day of each benefit period
- Coinsurance (60 lifetime reserve days):$816per day after day 90 of each benefit period
Skilled Nursing Facility Stay–You Pay…(3-dayinpatient hospital stay required first)
- Coinsurance (days 1-20): $0 per day of each benefit period
- Coinsurance (days 21-100): $204 per day of each benefit period
PART “B” (MEDICAL):
- Part B Deductible–You Pay… $240 per calendar year
- Part B Coverage–You Pay…Generally 20%, after $240 deductible is met
Part B Premium (including high income Part B & Part D) [paid to Medicare]
- Those enrolled in Part B will pay at least the standard $174.70/mo. premium(based on income).
- Higher income earners will pay a Part B IRMAA (Income Related Monthly Adjustment Amount)in addition to the $174.70/mo. standard premium.
- Higher income earners who are enrolled in Part D Prescription Drug coverage also pay a Part D IRMAA in addition to the monthly insurance premium for a Part D prescription drug plan or Medicare Advantage plan that includes Part D coverage. (For this information – Please Call me)
PART "D" - Prescription Drug Plans (PDP)*
- Annual Deductible for 2024 is $545.00 for Most Plans – Several Plans offer a Zero Deductible, but the premiums are higher, but also the cost of drugs “MAY” be lower overall.
- Most Plans in 2024 will offer the “Insulin Savings Program” where your Insulin is limited to only a $35.00 maximum charge per Insulin Drug per month.
- Initial Coverage Limit or Threshold = $5,030 (Now you are in the Donut Hole or Coverage Gap) – You are now responsible for 25% of the retail cost of your drugs until you have spent $8,000
- Once you reach the $8,000 of out of pocket expenses – you are finished for that calendar year.
- There are approximately 25 Available Drug Plans in South Florida for 2024 and they vary in premium from approx. $0.00 per month to about $175.00 per month. Average is about $35.00 per mo.
*Subject to change
IMPORTANT: DO NOT PICK A PLAN THAT HAS LESS THAN A 3 STAR RATING OR IS LISTED AS “TOO NEW TO BE MEASURED” AS IT IS NOT RECOMMENDED.
BE AWARE THAT SOME OF THE PLANS LISTED ARE DIRECT TO CONSUMER PRODUCTS AND AN AGENT CANNOT SELL IT.
Insurance plans that aren't Medigap or Medicare Supplements:
Some types of insurance aren't Medigap or Medicare Supplement plans, they include:
- Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
- Medicare Prescription Drug Plans
- Medicaid
- Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
- TRICARE
- Veterans' benefits
- Long-term care insurance policies
- Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap or Medicare Supplement policy (not just the drug coverage)
If you decide to drop the entire Medigap or Medicare Supplement policy, you need to be careful about the timing. For example, you may want a completely different Medigap or Medicare Supplement policy (not just your old Medigap or Medicare Supplement policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
If you drop your entire Medigap or Medicare Supplement policy and the drug coverage wasn't creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.
