Medicare Supplement (Medigap)

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Medicare Supplement plans, also known as Medigap plans, are insurance policies sold by private companies to help cover some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn't cover. These plans are designed to supplement OriginaMedicare, not replace it.

Minnesota is one of three states (along with Massachusetts and Wisconsin) that standardize their Medicare Supplement plans differently from the rest of the country. In Minnesota, there are two main types of Medicare Supplement plans: the Basic Plan and the Extended Basic Plan.

Basic Plan:

The Basic Plan is designed to cover essential out-of-pocket costs that Original Medicare (Part A and Part B) doesn't fully cover. This plan includes:

• Part A and B coinsurance and copayments: The Basic Plan covers the coinsurance and copayments for Medicare-covered services, such as hospital stays, doctor visits, and preventive care.
• First three pints of blood: Medicare only covers the fourth pint of blood and beyond. The Basic Plan covers the first three pints.
• 50% of the Part A inpatient hospital deductible: In 2024, the Part A deductible is $1,632 per benefit period. The Basic Plan covers half of this deductible.
• 50% of Part B excess charges: If a provider does not accept Medicare assignment and charges more than the Medicare-approved amount, the Basic Plan will cover 50% of these excess charges.
• 80% of foreign travel emergency care: The Basic Plan covers 80% of emergency care received outside the U.S., up to plan limits.
• 100 days of skilled nursing facility care. 
• State-mandated benefits (diabetic equipment and supplies routine cancer screening, reconstructive surgery, and immunizations)

Basic Plan Doesn’t Cover

• Part A: inpatient hospital deductible
• Usual and customary fees (Part B Excess Charges)
• Part B: deductible

        If you enroll in the Basic plan, you can add riders to customize coverage.

Optional Riders for the Basic Plan:

Minnesota allows insurance companies to offer additional benefits to the Basic and Extended Basic Plans as optional riders. These riders may include:

• Part A deductible coverage
• Part B deductible coverage (only available to beneficiaries on Medicare before 1/1/2020) 
• Part B Excess Charge
• Preventive care coverage

        Each rider's cost will either be added to or subtracted from the basic plan's base cost. 

Extended Basic Plan:

The Extended Basic Plan includes all the benefits of the Basic Plan, plus additional coverage:

• 100% of the Part A inpatient hospital deductible: The Extended Basic Plan covers the full Part A deductible.
• 100% of Part B excess charges: If a provider charges more than the Medicare-approved amount, the Extended Basic Plan will cover all of these excess charges.
• 120 days of skilled nursing facility care.
• 80% coverage while in a foreign county, pays 100% after you spend $250 out of pocket  for emergency medical situations..

Choosing a Medicare Supplement Plan in Minnesota:

When selecting a Medicare Supplement plan in Minnesota, it's essential to consider your specific healthcare needs, budget, and the benefits most important to you. If you choose a Medicare Supplement Plan, you will also need to enroll in a Medicare Part D Plan for prescription drug coverage. Factors to consider include:

• Current and future healthcare needs
• Monthly premium costs
• Out-of-pocket expenses, such as deductibles and copayments
• Provider network and accessibility
• Additional benefits offered through optional riders

At Lakes Health Insurance, I'm committed to helping you navigate the Medicare Supplement options available in Minnesota. I will work with you to assess your unique situation, compare plans from various insurance companies, and recommend the plan that best aligns with your needs and budget.

It's important to note that the best time to enroll in a Medicare Supplement plan is during your Initial Open Enrollment Period, which begins three months before your 65th birthday, includes the month you turn 65 and ends three months after that birthday. During this time, you have a "guaranteed issue right," meaning insurance companies can't deny you coverage or charge you more based on your health status.
 

• Medicare Supplements help pay for remaining out-of-pocket expenses, such as deductibles and coinsurance.
• There are nine standardized plans in Minnesota, with Basic, Extended Basic, and N being the most popular.
• You can use a Medicare Supplement plan anywhere that accepts Medicare.
• You have a one-time open enrollment period based around your Part B effective date to apply for a Supplement plan with no health underwriting.

If you have any questions or would like assistance in understanding and comparing the Medicare Supplement plans available in Minnesota, please don't hesitate to contact me at Lakes Health Insurance. I'm here to provide you with FREE, personalized guidance and support throughout the process.

Frequently Asked Questions

When can I get a Medicare Supplement Plan?

Under federal law, you get a 6 month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B, and you are 65 or older. During this time, you: 

• Can enroll in any Medigap policy. 
• Will generally get better prices and more choices among policies.
• You can buy any Medigap policy sold in your state. An insurance company can’t use medical underwriting to decide whether to accept your application - they can’t deny you coverage due to pre-existing health problems.
• Can avoid or shorten waiting periods for a pre-existing condition if you buy a Medigap policy to replace creditable coverage. 

After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment period. It doesn’t repeat every year, like the Medicare Open Enrollment Period.

Generally, your Medigap policy will begin the first of the month after you apply, but you can decide when you want it to start.

IMPORTANT: Annual Election Period (AEP) that occurs each fall is NOT a time when you can get a Medicare supplemental insurance plan with no health questions asked. The AEP has nothing to do with Medigap plans. Instead, it’s a time when you can change your Part D drug plan. 

What is Creditable coverage?

Previous health insurance coverage that can be used to shorten a pre-existing condition waiting period under a Medigap policy. 

How do I know if I have Creditable Coverage?

If you have had at least 6 months of continuous prior creditable coverage, the Medigap 

insurance company can't make you wait before it covers your pre-existing condition. Many types of health care coverage can count as creditable coverage for Medigap policies, but they’ll only count if your break in coverage was no more than 63 days. 

What if I miss my Medigap Open Enrollment Period?

Outside of your Medigap Open Enrollment Period:

• You may have to pay more for a policy.
• Fewer policy options may be available to you.
• The insurance company is allowed to deny you a policy if you don’t meet their medical underwriting requirements.

There are certain situations where you may be able to buy a Medigap policy outside of your Medigap Open Enrollment Period. Situations where an insurance company can’t deny you a Medigap policy are called “guaranteed issue rights” or “Medigap protections.”
 

What are guaranteed issue rights?

In most cases, you have a guaranteed issue right when your other health coverage changes in some way, like if you lose your other coverage. You may also have a "trial right" to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind.

If you have a guaranteed issue right, an insurance company:

• Must sell you a Medigap policy
• Must cover all your pre-existing health conditions
• Can't charge you more for a Medigap policy because of past or present health problems

Learn more about guaranteed issue rights at Medicare.gov.

In certain circumstances, an insurance company must accept you for coverage without asking health questions. For example, if you are on Medicaid and you lose your Medicaid eligibility, you have a short window to apply for Medigap without health questions.

Another example would be for someone coming off employer health coverage that is primary to Medicare. They will have a short window to apply for certain Medigap plans under guaranteed issue rules.

Can I change my Medigap policy?

In most cases, you won’t have a right under federal law to switch Medigap policies, unless:

• You're within your 6-month Medigap open enrollment period, or
• You're eligible under a specific situation or guaranteed issue right (when an insurance      company can’t deny you a Medigap policy). 

Important: If you buy a Medigap policy during your 6-month Medigap Open Enrollment Period and decide you don’t like the policy during this period, you can switch to a different Medigap policy. When you get your new Medigap policy, you have 30 days to decide if you want to keep it (called a 30-day free look period). Don’t cancel your first Medigap policy until you’ve decided to keep your second Medigap policy. You’ll need to pay both premiums for the month that you have both. 

If you’ve had your current Medigap policy for less than 6 months and want to switch to a different Medigap policy, you may have to wait for the new policy to cover your pre-existing conditions. 

When will the new Medigap policy cover my pre-existing condition?

You might have a waiting period for up to 6 months before your new Medigap policy will cover your pre-existing condition (called the pre-existing condition waiting period). 

• Your new Medigap policy must subtract the number of months you’ve had your current Medigap policy or prior creditable coverage (like health insurance you recently had through your employer) from the time you must wait before covering your pre-existing condition. For example, if someone had a pre-existing condition and had coverage (as described above) for 2 months and then gets a new Medigap policy, the policy won’t cover that condition for another 4 months (6-2=4). 
• If your new Medigap policy has a benefit that isn’t in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you’ve had your current Medigap policy. 
• If you’ve had your current Medigap policy longer than 6 months and it has the same benefits as your new policy, the new insurance company can’t exclude your pre-existing condition or make you wait before it covers it.
• If the insurance company agrees to issue the new policy, they can't write pre-existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.

If you have any questions or would like assistance in understanding and comparing the Medicare Supplement plans available in Minnesota, please don't hesitate to contact me at Lakes Health Insurance. I'm here to provide you with FREE, personalized guidance and support throughout the process.