Health Exchange Agency – Frequently Asked Questions


Select one of the categories below:

What is Medicare supplement insurance?

Medicare supplement insurance plans, offered by private insurance companies, help pay some of the out-of-pocket costs that Medicare Parts A and B don’t cover. The plans, categorized by letters such as F and N, are standardized, meaning the core benefits are the same from company to company. However plan availability may vary by state and insurer.

Does a Medicare supplement insurance plan replace Medicare Parts A and B?

No. Instead, a Medicare supplement insurance plan works with Medicare Parts A and B to help cover some of the out-of-pocket health care costs. For instance, Medicare Part B generally covers 80 percent of expenses. The rest is up to you. Purchasing a Medicare supplement plan to go with your Medicare Parts A and B coverage may help with medical costs not paid by Medicare alone.

What kind of out-of-pocket costs do Medicare supplement plans cover?

Medicare supplement plans differ from plan to plan, but they all offer the same basic benefits. For example, they provide coinsurance for Medicare Part A hospitalization costs and generally cover 20 percent of Medicare-approved expenses. Basic benefits also pay for the first three pints of blood each year, in addition to providing Part A coinsurance for hospice care.

Are Medicare supplement and Medicare Advantage plans the same thing?

No. Medicare supplement and Medicare Advantage* plans are different from one another. A Medicare supplement plan may be purchased in addition to Medicare Parts A and B coverage, while a Medicare Advantage plan (sometimes called Medicare Part C) provides Medicare-approved standalone coverage that combines hospital costs, doctors’ visits, outpatient care and sometimes prescription drug benefits into one plan.

You cannot have a Medicare Advantage plan and a Medicare supplement plan at the same time. However, both types of coverage are offered through private insurance companies.

*Medicare Advantage is not available in all states/territories.

What is the difference in Medicare supplement plans offered by different insurance companies?

In terms of basic benefits provided under each plan, Medicare supplement insurance plans are the same from insurer to insurer. For example, one company’s Plan F is the same as another company’s Plan F. However, differences may include any added benefits that an insurance company may provide and the level of customer service you’ll receive.

When can I apply for Medicare supplement insurance?

Once you are enrolled in Medicare Parts A and B, you can apply for a Medicare supplement insurance plan at any time.

If you apply for a Medicare supplement plan within six months of your 65th birthday and Medicare Part B enrollment, your acceptance into a Medicare supplement insurance plan will be guaranteed. In some states, your acceptance is guaranteed even if you apply outside of this time period.

Can my plan be cancelled based on new health conditions?

Medicare supplement insurance plans are guaranteed for life, regardless of age or health, as long as your premium payments are up-to-date and you have made no material misrepresentation on your enrollment application.

Do I have to use certain doctors with a Medicare supplement plan?

No. With a Medicare supplement plan, you have the flexibility to choose any doctor, specialist, or hospital that accepts Medicare patients.

Are prescription drugs covered under Medicare supplement plans?

By law, Medicare supplement insurance plans no longer cover prescription drugs. Prescription drug coverage, also known as Medicare Part D, is available separately through private insurance companies approved by Medicare. There is a choice of plans available, and plans vary from insurer to insurer.

How much does Medicare supplement insurance cost?

The monthly premium for your plan will vary and may be based on how much coverage you want and which insurance company you choose.

When you’re looking at Medicare supplement plans, consider how much you’ll pay for services like hospital stays or doctors’ visits, and how much you’re willing to spend on your monthly plan premium and out-of-pocket costs.

Understanding your health care needs and how you will use a Medicare supplement insurance plan will help you choose a plan with the right cost and benefit structure for you.

How much Medicare supplement insurance coverage do I need?

Within the types of Medicare supplement plans offered, you have choices between higher-benefit plans, which typically have a higher cost and lower premium, with fewer benefits.

Higher-benefit plans offer the most supplemental coverage, paying 100% of your out-of-pocket costs for many services.

With lower-benefit plans, you pay a lower premium each month and will pay more out of pocket for covered services.

How can I get help choosing a plan that fits my needs?

While conducting online research is a good start and may provide the information you need, making a decision about Medicare coverage can be complex. Contacting an insurer’s customer service, reaching out to a local insurance agent, or talking with a trusted and knowledgeable friend can make all the difference. Ultimately, the decision is up to you. Think about how much health care insurance coverage you need and how much you would like to pay each month. From there, it may be easier to narrow down which plan is best for you.

Want more information about affordable health insurance?

Your Name (required)

Your Message