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Medicare Supplement plans in Owensboro, compared and explained.
A Medicare Supplement helps pay what Original Medicare does not. The benefits are set by law. The prices are not. I compare the companies I represent so you can see the difference, and I explain the rules that decide when you can switch.
What Original Medicare leaves for you to pay
Original Medicare, meaning Part A for hospital care and Part B for doctors and outpatient care, pays a large share of your costs but not all of them. You still owe deductibles, coinsurance and copayments, and Original Medicare has no yearly cap on what you can spend out of pocket.
A Medicare Supplement, also called Medigap, is private insurance that picks up some or all of those costs. You keep Original Medicare, and your Supplement pays its share after Medicare pays.
- Same letter, same benefits
- Plan G from one company covers the same things as Plan G from any other company.
- Different prices
- Each company sets its own premium and raises it at its own pace over time.
- Your choice of doctors
- Most plans work with any doctor or hospital in the U.S. that accepts Medicare.
- Drugs are separate
- Supplements do not include prescription coverage. That comes from a Part D plan.
Medigap or Medicare Advantage?
These are two different ways to get your Medicare benefits, and neither one is right for everyone. Here is how they compare in general. Specific plans vary, so I walk through the details of the plans available to you before you choose.
| Topic | Original Medicare with a Supplement and Part D | Medicare Advantage |
|---|---|---|
| Doctors and hospitals | Any provider in the U.S. that accepts Medicare | Usually a network, such as an HMO or PPO |
| Monthly premium | A Supplement premium and a Part D premium, plus your Part B premium | Often a low or $0 plan premium, and you still pay your Part B premium |
| When you get care | Low, predictable costs, depending on the plan letter | Copays and coinsurance as you go, up to a yearly out-of-pocket limit |
| Prescriptions | Added with a separate Part D plan | Usually included in the plan |
| Specialists | No referrals required by Medicare | Some plans require a referral first |
| Travel | Coverage goes with you anywhere in the U.S. | Care outside the network is often limited, except emergencies |
| Changing later | Outside protected windows, a company can ask health questions | You can change plans each year during Annual Enrollment |
Thinking about leaving a Medicare Advantage plan for a Supplement? Talk to me before you disenroll. Depending on your situation, the Supplement company may be allowed to ask health questions, and you want an approval in hand first.
Plan G and Plan N, in plain terms
If you turned 65 or got Part A on or after January 1, 2020, you cannot buy Plan C or Plan F, because they cover the Part B deductible. Plans G and N are two of the most common choices for people new to Medicare.
- Plan G
- After you meet the once-a-year Part B deductible, Plan G pays your share of Medicare-approved costs, including Part B excess charges.
- Plan N
- Usually a lower monthly premium. You pay the Part B deductible, a copayment of up to $20 for some office visits, up to $50 for an emergency room visit that does not lead to an inpatient admission, and any Part B excess charges.
Which one fits depends on how often you see a doctor, whether your doctors accept Medicare assignment, and whether you would rather pay more each month or more when you get care.
Kentucky’s birthday rule
Kentucky gives people who already have a Medicare Supplement a yearly chance to change insurance companies without health questions. The window starts on your birthday and ends 60 days later.
- You already have a Medicare Supplement.
- You apply during the 60 days that start on your birthday.
- You keep the same plan, for example Plan G to Plan G.
- You move to a different insurance company.
What the rule does not do. It does not let you change plan letters, and it does not cover someone moving from a Medicare Advantage plan to a Supplement. If you have Plan G, the birthday rule gets you Plan G with another company.
Sources: KRS 304.14-525, 806 KAR 17:570 Section 14, and Kentucky Department of Insurance Advisory Opinion 2023-06.
The enrollment windows that matter
- Around your 65th birthday
Initial Enrollment Period
Seven months: the three months before the month you turn 65, that month, and the three months after. This is when most people sign up for Part A and Part B.
- Starts the month you are 65 and have Part B
Medigap Open Enrollment Period
Six months when a company selling Medicare Supplements cannot turn you down or charge you more because of your health.
- October 15 to December 7, every year
Annual Enrollment Period
You can join, switch or drop a Medicare Advantage plan or a Part D prescription drug plan. Changes start January 1.
- January 1 to March 31
Medicare Advantage Open Enrollment
If you are in a Medicare Advantage plan, you can switch to another Advantage plan or return to Original Medicare, one time.
- Every year, starting on your birthday
Kentucky birthday rule
60 days to move your Supplement to the same plan with a different company, with no health questions.
Still working at 65? If you have group health coverage through your own or your spouse’s current job, you can usually sign up for Part B later without a penalty, while that coverage lasts or within eight months after the job or coverage ends. COBRA does not count as coverage from a current job. The details matter, so ask before you decide.
Prescription drugs and Part D
Medicare Supplements do not cover prescriptions, so most people with a Supplement also carry a Part D drug plan. Each plan has its own list of covered drugs, its own pharmacies and its own costs, and all of that can change every January.
If you go 63 days or more in a row without Part D or other creditable drug coverage after you first become eligible, Medicare adds a late enrollment penalty to your premium, generally for as long as you have Part D. Signing up on time avoids it.
- The name and dose of every prescriptionso each plan can be checked against your actual medications
- Your pharmacybecause prices can differ between pharmacies in the same plan
- Whether you use mail orderwhich can change what you pay
On Medicare before 65?
If you have Medicare before 65 because of a disability or end-stage renal disease, Kentucky law has required every Medicare Supplement plan sold in the state to be available to you since January 1, 2024. You cannot be turned down if you apply before or during the six months that start with your first month of Part B. Your premium cannot be more than a weighted average of the company’s rates for people 65 and older, and there are no waiting periods for pre-existing conditions.
Miss that window and the rules change, so call me before you apply anywhere.
What to have ready for a Medicare review
- Your Medicare card
- Your current Supplement, Advantage or drug plan card, if you have one
- Your prescriptions, with doses
- The names of your doctors and your pharmacy
- Any recent letters from your plan, such as the Annual Notice of Change
Medicare questions
Can a Medicare Supplement company turn me down?
During your Medigap Open Enrollment Period, and during other protected windows such as Kentucky’s birthday rule, a company cannot turn you down or charge you more because of your health. Outside those windows it can usually ask health questions.
Do Medicare Supplement premiums go up?
They can. Companies file rate increases, and some raise premiums faster than others over time. That history is part of what I look at when we compare companies.
Should I choose a Supplement or Medicare Advantage?
It depends on your doctors, your budget, how much you travel and how you feel about networks. Some people are better served by one and some by the other. I lay out both honestly, and you decide.
Does it cost more to buy through an agent?
No. Medicare Supplement premiums are the same whether you apply through an agent or directly with the insurance company.
When can I change my Part D drug plan?
Usually during Annual Enrollment, October 15 to December 7, with the change starting January 1. Some situations, such as moving out of your plan’s service area, open a Special Enrollment Period.
See your options side by side.
Call, or send the form and I will call you back. Your birthday month helps me check your Kentucky birthday window and your enrollment dates.
(270) 302-0524Mike’s direct line