Understanding Your Coverage: Frequently Asked Questions

General Information

What are Medicare Supplement Plans (Medigap)?

Medicare Supplement Plans, also known as Medigap, are insurance policies that help pay for some of the healthcare costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles. Private insurance companies sell Medicare Supplement plans.

What are the eligibility requirements for enrolling in a Medicare Supplement Plan?

Generally, you must be enrolled in Medicare Part A and B to be eligible for a Medicare Supplement Plan. Additionally, the best time to enroll is during your Medigap Open Enrollment Period, which starts the first month you’re 65 and enrolled in Part B.

Coverage Details

What do Medicare Supplement Plans cover?

Medigap policies cover additional costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Some plans also offer coverage for medical care when traveling outside the U.S.

What is not covered by Medicare Supplement Plans?

Medigap plans generally do not cover prescription drugs, long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Do Medicare Supplement plans (Medigap) cover prescription drugs (Part D)?

No, Medicare Supplement plans (Medigap) do not cover prescription drugs (Part D). If you need prescription medication coverage, you must enroll in a stand-alone Medicare Part D prescription drug plan.

How do Medicare Supplement Plans differ from Medicare Advantage Plans?

Medicare Supplement Plans work alongside Original Medicare to fill coverage gaps, while Medicare Advantage Plans are an alternative that provides Medicare benefits through private insurance companies.

Enrollment Process

When can I enroll in a Medicare Supplement plan?

Enrollment periods include the Initial Enrollment Period (IEP) at age 65 or upon enrolling in Medicare Part B, along with Special Enrollment Periods (SEP) for specific circumstances.

How Can I Pay for a Medicare Supplement Plan?

Payment options for Medicare Supplement plans may involve direct drafts from bank accounts, checks, Automatic Clearing House (ACH) transfers, and, occasionally, credit card payments.

Can I switch Medicare Supplement Plans?

Yes, you can switch Medigap policies, but medical underwriting may be required when you make the switch.

Who can help me enroll in a Medicare Supplement Plan?

Please contact an agent* at 913-777-7741 for help reviewing and enrolling in Medicare options.

Costs and Payments

How much do Medicare Supplement Plans cost?

Costs vary by plan, provider, and where you live. It’s important to compare premiums and coverage details before selecting a plan.

Do I need a Medicare Supplement Plan if I have a Medicare Advantage Plan?

No, Medigap policies cannot be used with Medicare Advantage Plans. Medigap is only compatible with Original Medicare.

General Information

What is a Medicare Advantage Plan?

A Medicare Advantage Plan, also known as Medicare Part C, is a type of Medicare health plan offered by private insurance companies that contract with Medicare. It provides all your Part A (hospital insurance) and Part B (medical insurance) coverage, often including extra help benefits like prescription drugs, vision, and dental care.

What are Medicare Advantage Plans (Part C)?

Medicare Advantage Plans, also known as Part C, are all-in-one alternatives to Original Medicare offered by private insurance companies. These plans include Part A, Part B, and usually Part D.

How do I choose a Medicare Advantage Plan?

Compare plans based on costs, coverage, and your specific health needs. Contact an agent* for help comparing plans.

Coverage Details

What do Medicare Advantage Plans cover?

Medicare Advantage Plans cover all the services that Original Medicare covers, often including additional benefits, such as prescription drug coverage, vision, dental, and hearing services.

What are the different types of Medicare Advantage Plans?

There are several types of Medicare Advantage Plans, including Health Maintenance Organization (HMO) Plans, Preferred Provider Organization (PPO) Plans, Private Fee-for-Service (PFFS) Plans, and Special Needs Plans (SNPs).

How is a Medicare Advantage Plan different from Original Medicare?

Medicare Advantage Plans are privately insured alternatives to Original Medicare. They cover the same services as Original Medicare (Part A and Part B) but often include additional benefits, such as prescription drug coverage and dental and vision services.

Enrollment Process

How do I enroll in a Medicare Advantage Plan?

If you qualify, you can enroll in a Medicare Advantage Plan during your Initial Enrollment Period, the Annual Enrollment Period, or a Special Enrollment Period.

The enrollment periods are as follows:

• Initial Enrollment Period (IEP): Begins when you are first eligible for Medicare.
• Annual Enrollment Period (AEP): Runs from October 15 to December 7 each year.
• Open Enrollment Period (OEP): From January 1 to March 31, allowing plan changes or disenrollment.

Can I switch Medicare Advantage plans?

Yes, you can switch plans during the Annual or Special Enrollment Period if you qualify.

Costs and Payments

How much do Medicare Advantage plans cost?

Costs vary by plan and where you live. Some Medicare Advantage Plans have low- cost premiums but may include other out-of-pocket costs such as copayments and coinsurance. You need to review the benefits and out-of-pockets costs to understand how those costs could affect you during a catastrophic health event.

Do I need to pay for Medicare Part B if I have a Medicare Advantage Plan?

Yes, you must continue to pay your Medicare Part B premium for your Medicare Advantage Plan.

General Information

What are Medicare Part D Plans?

Medicare Part D is a prescription drug coverage plan for people with Original Medicare. It helps cover the cost of prescription medications and is offered through private insurance companies approved by Medicare.

Who is eligible for Medicare Part D?

You are eligible for Medicare Part D if you are enrolled in Medicare Part A and/or Part B. You must also live in the service area of the Part D plan you wish to join and be a U.S. citizen or a lawful resident of the U.S.

Coverage Details

What do Medicare Part D Plans cover?

Medicare Part D Plans cover a range of prescription drugs. Each plan has its formulary (list of covered drugs), which must include a range of drugs.

What types of Medicare Part D Plans are available?

There are two types of Medicare Part D plans: stand-alone Prescription Drug Plans (PDPs) that add drug coverage to Original Medicare, and Medicare Advantage Plans (MA-PDs) that include prescription drug coverage and other benefits

How do formularies work?

Formularies are divided into tiers, each with a different cost. Generic drugs are usually on the lowest tier and have the lowest fees, while brand -name and specialty drugs are on higher tiers with higher costs.

Enrollment Process

How do I enroll in a Medicare Part D plan?

You can enroll in a Part D plan during your Initial Enrollment Period, the Annual Enrollment Period, or a Special Enrollment Period if you qualify. Please contact an agent* to review your plans and costs.

Can I switch Medicare Part D plans?

Yes, you can switch plans during the Annual or Special Enrollment Period if you qualify.

Costs and Payments

How much do Medicare Part D plans cost?

Costs vary by plan and location. They typically include a monthly premium, annual deductible, copayments, and coinsurance.

What Is the out-of-pocket maximum for Medicare Part D?

Starting in 2025, the out-of-pocket maximum for Medicare Part D beneficiaries is $2,000. Beginning in 2025, a new Medicare Prescription Payment Plan (MDP) plan will work with your current prescription drug coverage to spread out out-of-pocket costs for the year.

What is the late enrollment penalty for Medicare Part D?

If you don’t enroll in a Medicare Part D Plan when you’re first eligible and don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty for as long as you have Part D coverage.

Health Savings Accounts (HSA) and Medicare

Do I lose my HSA eligibility when I enroll in Medicare?

You aren’t eligible to make Health Savings Account (HSA) contributions after you have enrolled in any part of Medicare.  If you make HSA contributions after your Medicare enrollment date, you could have tax penalties.

How does receiving my Social Security benefit affect Medicare and my HSA contributions?

If you are ages 65 or older and choose to receive your Social Security benefit, you have an extra step.  Receiving your Social Security benefit at age 65 or older will automatically enroll you in Medicare Part A and Part B and you will lose your HSA eligibility. Because Medicare may backdate your Medicare Part A to age 65 or six months prior to your Medicare enrollment, Medicare requires you to stop your HSA contributions six months prior to being enrolled in Medicare.

Which expenses can I reimburse from my HSA once I enroll in Medicare?

Your HSA funds can be used for medical-eligible expenses such as deductibles, copays, prescriptions, and additional items not covered by Medicare. Your HSA funds can also be used to pay for Medicare premiums, but not for MediGap premiums.

Can I pay my family’s medical expenses with my HSA? Can I pay for their Medicare expenses?

You can pay for your own, your spouse’s, and any dependents’ medical costs with your HSA. However, once you’re on Medicare, HSA funds are best used for the things Medicare doesn’t cover.

If my spouse and I are enrolled on my employer’s HSA plan and I enroll in Medicare, can my spouse open an HSA?

Yes. If your spouse is still HSA-eligible (meaning not on Medicare), they can open their own HSA and benefit from the tax advantages provided.

Can I continue contributing to my HSA once I am enrolled in Medicare?

No. Once you enroll in Medicare, you can no longer contribute to your HSA. You can still spend HSA dollars on qualified medical expenses unless you enroll in Medicare options (Part A, B, or C).

Do I face penalties if enrolled in Medicare and contribute to an HSA?

Yes. Once enrolled in Medicare, you must stop all contributions to avoid penalties.

What happens to my HSA if I pass away?

What happens to your HSA when you pass depends on your beneficiary. If your spouse is the sole beneficiary, your HSA will be transferred to your spouse and they will own the account. If your beneficiary is someone other than your spouse, the tax benefits of the HSA does not transfer and the HSA balance will be distributed and taxable.