What Is the Best Medicare Supplement Plan in North Carolina?

Medicare Supplement Plans, also known as Medigap, are private insurance policies that help cover healthcare costs not fully paid by Original Medicare. Original Medicare, which includes Part A for hospital services and Part B for medical services, covers a significant portion of expenses but leaves beneficiaries responsible for deductibles, copayments, and coinsurance. Medigap policies cover these gaps, providing financial predictability. These plans are standardized by the Centers for Medicare & Medicaid Services, meaning each plan type offers the same basic benefits regardless of the insurance company.

Overview of Medicare Supplement Plans

Medicare Supplement plans, or Medigap, act as a secondary payer after Original Medicare (Parts A and B). These plans are sold by private insurance companies and are regulated to ensure standardized benefits. There are ten standardized Medigap plans, identified by letters A through N, each offering a distinct set of benefits. While the coverage for a plan with a specific letter is identical across all insurers, premiums can vary significantly between companies.

Plan A is the most basic Medigap offering, covering Medicare Part A coinsurance and hospital costs for an additional 365 days after Medicare benefits are exhausted. It also covers Part B coinsurance or copayment, the first three pints of blood, and Part A hospice care coinsurance or copayment. Plan B includes all benefits of Plan A, plus coverage for the Medicare Part A deductible.

Medigap Plans C and F offer comprehensive coverage, but are only available to individuals eligible for Medicare before January 1, 2020. Plan F covers the Part A deductible, Part B deductible, Part B coinsurance and copayments, Part B excess charges, skilled nursing facility coinsurance, the first three pints of blood, Part A hospice care, and foreign travel emergency healthcare. Plan G offers nearly identical coverage to Plan F, but it does not cover the Medicare Part B deductible. Plan G is a popular choice for those not eligible for Plan F.

Plan N provides coverage for Part A coinsurance and hospital costs, Part B coinsurance (with some copayments), the first three pints of blood, Part A hospice care, skilled nursing facility coinsurance, the Part A deductible, and foreign travel emergency. However, Plan N does not cover the Medicare Part B deductible or Part B excess charges, and it may require copayments for doctor visits and emergency room services. Plan M covers most of the same benefits as Plan N but pays only 50% of the Medicare Part A deductible. Plans K and L offer different cost-sharing structures, with lower premiums in exchange for higher out-of-pocket limits. These plans pay a percentage of various costs until an annual out-of-pocket maximum is reached.

High-deductible versions of Plans F and G are also available, offering lower monthly premiums in exchange for a higher annual deductible. Beneficiaries must meet this deductible amount for Medicare-approved costs before the plan begins to pay benefits.

Key Factors for Selecting a Plan

Choosing a Medicare Supplement plan involves evaluating personal circumstances and financial considerations. A primary factor is current and anticipated healthcare needs. Individuals who frequently visit doctors or specialists, or those with chronic conditions, may find more comprehensive plans beneficial. Those with minimal healthcare needs might prioritize lower premiums, opting for plans with higher deductibles or copayments.

The balance between monthly premiums and potential out-of-pocket costs is a decision point. Plans with more extensive coverage typically have higher premiums but result in lower out-of-pocket expenses when medical services are utilized.

Coverage for Medicare Part B excess charges is another consideration. These charges can occur when a healthcare provider does not accept Medicare assignment, meaning they can charge up to 15% more than the Medicare-approved amount for a service. Medigap Plans F and G cover these excess charges.

Foreign travel emergency coverage is a feature for those who plan to travel outside the United States. Original Medicare generally does not cover healthcare received abroad, but certain Medigap plans, including C, D, F, G, M, and N, offer this benefit. This coverage typically pays a percentage of medically necessary emergency care costs after a deductible, up to a lifetime limit.

Medicare Supplement plans work with Original Medicare and differ from Medicare Advantage plans. Medicare Advantage plans are an alternative way to receive Medicare benefits through private insurance companies. In contrast, Medigap plans supplement Original Medicare, and beneficiaries cannot have both a Medicare Advantage plan and a Medigap plan simultaneously.

Medicare Supplement Plans in North Carolina

North Carolina residents have access to the full range of standardized Medicare Supplement plans, designated by letters A through N. The benefits provided by a Plan G, for instance, are the same regardless of which private insurance company sells it within the state. However, premiums for the same plan can vary between insurers. Plans C and F are available only to those who became eligible for Medicare before January 1, 2020.

North Carolina has specific state regulations that impact Medigap plan availability, particularly for individuals under 65 who are eligible for Medicare due to disability. North Carolina mandates that individuals under age 65 who qualify for Medicare can purchase Medigap Plan A, and either Plan D or G if those plans are marketed to individuals 65 and older.

Regarding premium pricing structures, Medigap plans in North Carolina may be priced using one of three methods: attained-age, issue-age, or community-rated. Attained-age rated policies base premiums on the policyholder’s current age, meaning premiums typically increase as the individual gets older. Issue-age rated policies set premiums based on the age when the policy is first purchased. Community-rated policies charge everyone the same premium for a specific plan, regardless of age. The “Birthday Rule,” which allows Medigap beneficiaries to switch plans without medical underwriting around their birthday, does not apply in North Carolina.

To find and compare Medigap plans in North Carolina, individuals can utilize resources provided by the state. The North Carolina Department of Insurance (NC DOI) offers an online tool to compare Medicare Supplement premiums. Additionally, the Seniors’ Health Insurance Information Program (SHIIP), a division of the NC DOI, provides free counseling and assistance with Medicare questions, including Medigap plans.

Enrollment and Policy Management

Enrolling in a Medicare Supplement plan involves specific periods and rights. The Medigap Initial Enrollment Period (IEP) is a six-month window that begins on the first day of the month an individual is both 65 or older and enrolled in Medicare Part B. During this period, insurance companies must sell any Medigap policy they offer without medical underwriting. This means coverage cannot be denied or premiums increased based on health conditions.

Outside of the IEP, individuals may still purchase a Medigap policy through guaranteed issue rights. These rights apply in specific situations where insurers must sell a Medigap policy without medical underwriting. Common scenarios include losing employer-sponsored health coverage that supplemented Medicare, when a Medicare Advantage plan leaves the service area, or when returning to Original Medicare after trying a Medicare Advantage plan for the first time. If an individual applies for a Medigap policy outside of their IEP or a guaranteed issue period, insurers may subject the application to medical underwriting, potentially leading to higher premiums or denial of coverage based on health status.

The application process for a Medigap policy generally involves contacting insurance companies or licensed agents. Applicants will need to provide information such as their Medicare claim number and the effective date of their Medicare Part A and Part B coverage. After submitting an application, the insurance company will review it and, if approved, issue the policy. Premiums are paid directly to the insurance company.

Once enrolled, policy management involves understanding the policy documents and paying premiums on time. Premiums can change over time due to factors such as inflation, increasing healthcare costs, and the insurer’s pricing structure.