Latest / Smart Coverage. Real Advice.: Medicare / Can Medigap Cover My Medicare Advantage Copays in South Carolina? What You Need to Know
Transcript
- Tanya: Will Medigap pay my Medicare Advantage copays in South Carolina? You might be surprised by how these two types of coverage actually work together—or don’t. Tanya: Welcome to Smart Coverage. Real Advice., the insurance podcast from The Jordan Insurance Agency. I'm Tanya, your host, and I'm here with Billy Jordan, a licensed insurance agent and the president of The Jordan Insurance Agency. Billy: Always happy to be here, Tanya. A quick disclaimer: we're not affiliated with or endorsed by Medicare or any government agency, and this is general education, not advice for your situation. Now, let's get into it. Tanya: So, let's start with the big question. If I have a Medicare Advantage plan in South Carolina, can I buy a Medigap policy to cover my copays and other costs? Billy: No, you can't use Medigap to pay your Medicare Advantage copays or other out-of-pocket costs. According to medicare.gov, Medigap policies are only designed to work with Original Medicare—meaning Part A and Part B. If you have a Medicare Advantage plan, which is sometimes called Medicare Part C, you can't use Medigap to fill in the gaps or pay your copays. Tanya: So, if someone tries to buy both at once, what happens? Billy: You actually aren't allowed to have both at the same time. If you currently have a Medicare Advantage plan and you want to switch to Medigap, you have to first go back to Original Medicare. Then, you can apply for a Medigap policy. The two just don't work together, and insurance companies won't sell you a Medigap policy if you’re enrolled in Medicare Advantage. Tanya: Why doesn't Medigap cover Medicare Advantage costs? It seems like it would be helpful. Billy: It would be great if you could stack them, but the two plans are built for different systems. Medigap is meant to pay the gaps in Original Medicare, like deductibles and coinsurance. Medicare Advantage plans have their own structure, with different copays, coinsurance, and out-of-pocket maximums. The government doesn't allow Medigap to pay for anything under Medicare Advantage. Tanya: That could be confusing for people. Can you give an example of how this plays out in real life? Billy: Sure. Let's say someone in South Carolina is on a Medicare Advantage plan, and they’re having to pay a copay every time they visit their specialist. They think, "Hey, I’ll buy a Medigap policy to help with these copays." But when they apply, the insurance company will tell them they’re not eligible for Medigap unless they leave their Medicare Advantage plan and return to Original Medicare. So, they can't use Medigap as a supplement for Medicare Advantage costs. Tanya: What’s a common mistake people make around this? Billy: The big one is assuming that Medigap is just an extra layer of coverage you can add on top of anything. People sometimes buy Medicare Advantage thinking they can add Medigap later, not realizing the two are separate and can't be combined. This can lead to a lot of frustration if they’re counting on extra help with their out-of-pocket expenses. Tanya: So, if someone is thinking about switching from Medicare Advantage back to Original Medicare in South Carolina, how does Medigap fit into that process? Billy: Good question. If you switch from Medicare Advantage back to Original Medicare, you may be able to apply for a Medigap policy. But—and this is important—your ability to buy Medigap might depend on timing. According to medicare.gov, you get a six-month Medigap Open Enrollment Period. That starts when you’re sixty-five or older and first have Part B. During this window, you can buy any Medigap policy offered in South Carolina without worrying about your health history or being denied coverage due to pre-existing conditions. Tanya: What if you miss that six-month window? Billy: If you miss it, you might still be able to buy a Medigap policy, but it could cost more, and the insurance company might use medical underwriting. That means they could deny you coverage depending on your health. There are some exceptions, called “guaranteed issue rights,” but those are specific situations, and medicare.gov says you should check with the South Carolina Department of Insurance for details. Tanya: Are there any special rules in South Carolina for people under sixty-five who have Medicare due to disability or End-Stage Renal Disease? Billy: According to medicare.gov, federal law generally doesn’t require insurance companies to sell Medigap policies to people under sixty-five. In some states, there may be additional rights, but the article doesn’t list the specifics for South Carolina, so it’s something we recommend looking into if you’re in that situation. Tanya: I imagine timing and knowing which plan does what is pretty important. Billy: Absolutely. One example we see is someone turning sixty-five, enrolling in a Medicare Advantage plan because it sounds simple, then realizing later they wanted the flexibility of Original Medicare with Medigap. But if they wait too long, they might not qualify for Medigap without higher costs or being denied. It’s important to understand the rules upfront so you can make the choice that fits your needs. Tanya: For folks listening in South Carolina, what’s one thing you want them to remember about Medigap and Medicare Advantage? Billy: The most important thing is: you have to choose one path or the other. Medigap only works with Original Medicare, and you can’t use it to pay for any costs under Medicare Advantage. Make sure you know your options and the timing, especially around that six-month Medigap Open Enrollment Period. Tanya: Three things to remember. One, Medigap won’t pay Medicare Advantage copays or costs in South Carolina. Two, you can only have Medigap if you’re on Original Medicare, not Medicare Advantage. Three, timing matters—your opportunity to get Medigap is during your six-month Open Enrollment Period. Tanya: For a personalized look at your situation, book a free thirty-minute chat with Billy and his team at thejordaninsuranceagency.com/podcast. Billy: I'm Billy Jordan with The Jordan Insurance Agency. Until next time, take care. Tanya: Thanks for listening to Smart Coverage. Real Advice. from The Jordan Insurance Agency.