What is Medigap and Do I Need It?

Have you heard of Medigap and wondered how it differs from a Medicare Advantage plan? It can be confusing to navigate the world of Medicare options, but we’re here to break down the key differences to help you make an informed decision.

Medigap vs. Medicare Advantage: Key Differences

• Premium Costs: Medigap typically has higher premiums compared to Medicare Advantage, which often offers lower monthly costs.
  
• Out-of-Pocket Expenses: With Medigap, you’ll generally pay fewer out-of-pocket costs for medical care. On the other hand, Medicare Advantage tends to have higher out-of-pocket expenses.
  
• Where You Can Receive Care: Medigap is accepted nationwide, so you can receive care anywhere in the U.S. Medicare Advantage, however, is typically limited to specific regions and states.
  
• Provider Network: Medigap doesn’t require you to stay within a specific network of providers, while Medicare Advantage plans do, meaning you’ll need to use in-network doctors and hospitals for the best coverage.
  
• Prescription Drug Coverage: Medigap doesn’t include prescription drug coverage (Part D), so you’d need to enroll separately for that. Medicare Advantage, however, usually includes prescription drug coverage as part of the plan.

Navigating Medicare options can be overwhelming, but you don’t have to do it alone. If you have more questions or need guidance, Health Plans of America is here to help. Their team of licensed insurance professionals is ready to provide you with personalized information and resources, making the decision process easier. Connect with a licensed Medicare specialist near you today!

Traveling This Summer? Here’s What You Need to Know About Medicare Coverage

Are you planning to travel within the U.S. this summer? The good news is that most doctors and hospitals accept Original Medicare. If you experience a sudden illness or injury, Medicare Part B typically covers emergency medical care while you’re away.

However, if you’re heading abroad, there are a few important details to consider. Medicare does not cover medical expenses incurred outside the U.S. This includes not reimbursing for prescription medications you purchase while overseas. That said, Medicare may cover certain services abroad, such as inpatient hospital care, ambulance services, or dialysis in foreign hospitals, but coverage is often limited.

For additional protection when traveling internationally, Medigap (Medicare Supplement insurance) can be a lifesaver. Medigap is designed to work alongside Original Medicare, helping to cover costs that Medicare doesn’t pay, such as copayments, coinsurance, and deductibles. Importantly, some Medigap plans offer emergency medical coverage for situations that occur outside of the United States. This is a huge benefit for anyone who plans to travel abroad and wants peace of mind knowing they’re covered if an unexpected health issue arises.

Not all Medigap plans offer this benefit, so it’s essential to choose the right plan based on your travel needs. Medigap Plan C and Plan F, for example, offer foreign travel emergency health coverage, but you’ll need to check with your provider to ensure it’s included in your specific plan.

In addition to offering overseas protection, Medigap helps cover costs not included in Original Medicare, such as:

• Deductibles: Medigap can help you pay for the out-of-pocket costs associated with Medicare Part A and Part B deductibles.
  
• Coinsurance and Copayments: Medigap covers some or all of the coinsurance and copayments that Original Medicare doesn’t cover.
  
• Extended Hospital Stays: If you require additional hospital days beyond what Medicare covers, Medigap can pick up the cost.

If you’re concerned about medical expenses while traveling or want to reduce your out-of-pocket costs at home, Medigap can provide extra peace of mind.

Still unsure which plan is right for you? Reach out to a live insurance expert at Health Plans of America to discuss your options and get the coverage you need today!

Medigap, also known as a Medicare Supplement plan, is offered by private companies to help cover the costs that Original Medicare doesn’t pay for. This includes expenses like copayments, coinsurance, and deductibles, which can add up quickly without additional coverage.

If you’re someone who enjoys traveling internationally, Medigap plans also offer the added benefit of coverage when you’re outside of the United States—something Original Medicare doesn’t provide. To qualify for a Medigap plan, you must already be enrolled in Medicare Parts A and B.

Medigap vs. Medicare Supplement: What’s the Difference?

There’s often confusion about Medigap and Medicare Supplement plans. To clarify, here are some key distinctions:

• Premium Costs: Medigap premiums tend to be higher than those for Original Medicare.
• Out-of-Pocket Costs: Medigap helps minimize your out-of-pocket expenses.
• Where You Can Receive Care: Medigap works in any state, providing flexibility in where you seek care.
• Provider Network: No network restrictions; you can see any doctor who accepts Medicare.
• Prescription Drugs: Medigap plans do not include prescription drug coverage (Medicare Part D is required for that).

Navigating Medicare and its various plans can be overwhelming, but Health Plans of America is here to make the process easier. A team of licensed insurance professionals are ready to assist, offering expert guidance and resources to help you make informed decisions. Reach out today to connect with a Medicare specialist in your area!

If you need help paying for health insurance in 2025, your eligibility will depend on your income and state of residence. Under the Affordable Care Act (ACA), subsidies have helped reduce costs for millions of Americans. However, the enhanced subsidies that were introduced under the American Rescue Plan Act (ARPA) and extended through the Inflation Reduction Act (IRA) are set to expire at the end of 2025. The Trump administration is not expected to renew these enhanced subsidies, which could make coverage more expensive for many Americans purchasing insurance through the ACA marketplace.¹

As of now, you may still qualify for ACA subsidies if your health insurance costs exceed 8.5% of your household income. However, policy changes under the Trump administration could impact subsidy availability, Medicaid expansion, and other aspects of healthcare access.¹ The benchmark plan used to calculate subsidies remains the second-lowest-cost Silver plan available in your state’s marketplace.

If you rely on ACA subsidies to afford coverage, it’s important to stay informed about potential legislative changes and explore alternative options as policies evolve.

Here are updated tips for estimating your expected household income for 2025 before applying for health insurance savings:

1. Estimate Your Expected Household Income for 2025
   • Start with your Adjusted Gross Income (AGI) from your most recent tax return. If you don’t have an AGI, estimate using federal taxable wages and other income sources.
   • Add any non-taxable income that applies, such as tax-exempt Social Security benefits, foreign income, and tax-exempt interest.
   • Adjust your estimate based on expected raises, job changes, or additional income sources during the year.²
     
     
2. Include the Right People in Your Household
   • Count yourself, your spouse, and all dependents you claim on your federal tax return, even if they don’t need coverage.
   • If a dependent earns enough to file a tax return, their income must be included in your estimate.³
     
     
3. Know the 2025 Income Limits for ACA Subsidies
   • Individuals: Income between $15,060 and $60,240 (100%-400% of the Federal Poverty Level) qualifies for subsidies.
   • Families: A household of four earning up to $124,800 may still qualify for financial help.⁴
     
     
4. Report Any Changes During the Year
   • If your income changes after you apply, update your Marketplace application as soon as possible to ensure you receive the correct subsidy.⁵

Wherever you are in your health insurance journey, Health Plans of America is here to help connect you to a licensed insurance agent.

Sources:
¹ https://revelation-partners.com/the-trump-administrations-impact-on-healthcare-a-2025-outlook
² https://www.healthcare.gov/income-and-household-information/how-to-report
³ https://www.healthcare.gov/income-and-household-information/how-to-report
⁴ https://www.aura-insure.com/post/your-no-nonsense-guide-to-aca-income-limits-for-2025
⁵ https://www.healthcare.gov/income-and-household-information/how-to-report

Maximize Your Health Benefits with These Smart Tips

Healthcare costs can add up quickly, and while comprehensive plans often come with a hefty price tag, they might not always cover the things you truly need. At Health Plans America, we’re committed to helping you make the right choices for both your health and your budget. To help you get the most out of your coverage, we’ve put together a few valuable tips to maximize your health benefits:

1. Schedule Non-Emergency Procedures Early
   Plan non-urgent procedures early in the year to help you meet your deductible and maximize your coverage.
   
2. Audit Your Medical Bills for Errors
   Mistakes happen, but they shouldn’t come at your expense. Regularly review your medical bills to ensure there are no errors that could impact your finances.
   
3. Maximize Tax Savings with a Health Savings Account (HSA)
   Consider using an HSA to save on taxes. The money you contribute to an HSA is pre-tax, which can make a significant difference come tax season.
   
4. Shop Around Before Enrolling
   Health insurance laws change regularly. Always shop around to ensure the plan you’re enrolling in provides the coverage you need at the best price.
   
5. Save Money on Prescription Drugs
   Reach out to your insurance provider to understand exactly what prescription drugs are covered. If you’re facing high out-of-pocket costs, consider exploring other options.

Understanding your health insurance options is key to making informed decisions about your coverage. With Health Plans America, finding the right plan for you is simple and hassle-free. Connect with a licensed insurance agent today to discover a healthcare plan that fits your lifestyle and budget.

If you wear prescription glasses and they’re considered “medically necessary,” you may be eligible for coverage through certain insurance plans. For instance, if you require prescription glasses after cataract surgery, this may qualify as medically necessary care. However, it’s important to note that Original Medicare Parts A and B typically don’t cover most prescription glasses, contact lenses, or other eyewear. Understanding the distinction between what’s covered and what’s not is essential to ensuring you get the coverage you need.

If your prescription glasses aren’t considered a medical necessity, Medicare Advantage (Part C) plans may still offer coverage for eyeglasses, contact lenses, and prescription sunglasses. The specific benefits and costs can vary by plan, so it’s important to discuss the details with your provider. Many plans also include coverage for routine eye exams, which could be an added benefit for your eye care needs.