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Understand What Your Medicare Plan Is And Isn't

Understand what your Medicare Plans are and are not. This will also explain the subtle differences between supplement plans as well as advantage plans

Cover image for the article: Understand What Your Medicare Plan Is And Isn't

​Original Medicare Is

  • Original Medicare is the US health insurance program for people who are 65 or older, certain younger people with disabilities as well as people with End-Stage Renal Disease (ESRD).
  • Original Medicare provides the needed benefits for older Americans including hospital insurance (Part A) and medical insurance (Part B). To receive the covered benefits from Part A or Part B, the hospital, medical provider, procedure or treatment, and/or doctor must accept and be approved by Medicare.

​Original Medicare Isn't

  • Original Medicare does not provide 100% coverage for all your medical and health needs.
  • It does not cover elective procedures, doctors that don’t accept Medicare, or routine dental, vision or hearing services.

​Medicare Supplement Plans (Medigap) Is

  • Medicare Supplement Plans, also known as “Medigap”, covers most of the 20% that Original Medicare does not cover.
  • These plans have monthly premiums that increase annually.
  • Medigap plans F, G and N have different functions based off of the benefit being covered and do have deductible and coinsurance restrictions. 1
  • Guaranteed issued versus underwritten applications. Guaranteed Issue Rights (also called "Medigap Protections") are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can't deny you a Medigap policy, or place conditions on a Medigap policy, like exclusions for pre-existing conditions, and can't charge you more for a Medigap policy because of a past or present health problem. 2

​Medicare Supplement Plans (Medigap) Isn't

  • Medicare Supplement Plans do not cover additional benefits such as dental, vision and hearing. Some plans do cover gyms but are limited.
  • Medigap does not provide Part D prescription drug coverage.
  • Provided as an HMO, PPO or VA Plan. These provider and network options do allow for greater flexibility for your needs.
  • Medicare Advantage Plans have low or even no monthly premiums
  • These plans include Medicare Part D (prescription drug coverage) in most cases.
  • Copays are dependent on the specific type of plan and service.
  • Medicare Advantage Plans do cover additional benefits such as dental, vision and hearing. Additional coverage may also include gym membership and Over-the-Counter (OTC) benefits.
  • Maximum Out-of-Pocket (OOP) limits. Maximum OOP limits provides peace of mind knowing your out-of-pocket costs will not exceed the plan limits.
  • Most Medicare Advantage Plans cover emergency services nationwide.
  • Medicare Advantage is not a Supplemental Plan.
  • It does not cover the entire cost.
  • May not cover certain doctors or facilities. Medicare Advantage Plans provide benefits for services provided by its plan’s in-network doctors or facilities.
  • Some services do require preauthorization.

​Speak with a Qualified and Experienced Medicare Sales Agent

CSG Medicare Pros are licensed, qualified and experienced Medicare agents that can assist you in finding the right plan to fit your needs. Our agents are Licensed Medicare Brokers specializing in Medicare Health Insurance providing Medicare (parts A and B), Medicare Supplemental Insurance, Medicare Advantage (Part C) and Medicare Prescription (Part D) plans. We serve Medicare recipients in every county in Arizona including in the cities of Phoenix, Mesa, Tempe, Chandler, Apache Junction, Gilbert, Tucson, Kingman, Bullhead City, Prescott, Flagstaff, Yuma, Sierra Vista and more. CSG Medicare Insurance Agents are independent, licensed and appointed with multiple insurance carriers to give you a wide variety of choice. For more information, call (480) 635-4050 or (928) 263-8500.

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Written by

CSG Insurance Pros

Licensed Medicare Insurance Experts

CSG Insurance Pros is a family-owned, independent Medicare brokerage in Tempe, Arizona. Our licensed agents compare every Medicare plan available in your ZIP code at no cost to you.

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