If you, like so many seniors, are looking for a Medigap policy, you have several options at your disposal. You may be researching Medigap policies to fill in the gaps and cover expenses not covered by Original Medicare. If so, you have come to the right place.

Some seniors choose a Medicare Select Plan to pay for their medical expenses. But what exactly is a Medicare Select Plan? According to experts, a Medicare Select Plan is a Medigap policy in which enrollees are only allowed to see certain doctors and attend certain hospital facilities.

Those enrolled in Medicare Select must see certain doctors and attend specific medical facilities if they want to remain in the network and receive all benefits provided by their insurance company. Exceptions can be made in the event of an emergency. Medicare Select policies are required to satisfy all the requirements of a Medigap policy.

Because you are limited to certain practitioners and medical facilities, a Medigap Select Plan can potentially have lower premiums than other Medigap programs. When you visit doctors and medical facilities that Medicare Select pays for, Medicare pays the amount it is required to pay.

The amount Medicare pays is called approved charges. Once Medicare pays its required amount, your remaining balance is paid for by your insurance company. Your supplement insurance policy pays for all benefits in your Medicare Select policy. If you see an out-of-network provider for an emergency, you will be responsible for the entire cost of services.

However, this guideline does not apply to Original Medicare. Medicare still pays for its required amount of medical expenses, regardless of what provider you choose to see. Medicare Select coverage may depend on the area in which you live and the providers that are available. If the area where you need care does not have doctors in a Medicare Select Plan, you may have to choose a doctor that does not participate.

You can only go to hospitals that participate with a Medicare Select policy if you want costs fully covered. If you are in a city without a hospital that participates with Medicare Select, you may need to go to a different hospital that participates with Medicare Select. This may also mean that you have to travel to find a participating hospital. 

The unique thing about a Medicare Select plan is that you are limited to a network of doctors. If you still want to see an out-of-network provider, you will have to pay out-of-pocket for the portion that Medicare does not cover. This is why it helps to plan ahead and put money aside to cover unexpected medical expenses.

Medicare Select is different from other Medigap policies in the sense that it does not pay for all or some of an individual’s medical expenses. Some other Medigap plans pay for some or all of a patient’s outstanding balance. Medicare Select policies are not available everywhere. Some doctors opt out of the Medicare Select policy, and insurance companies can decide if and where they want to support Medicare Select.

Some providers decide to simply remain out-of-network. But what is an out-of-network provider? According to experts, an out-of-network provider is a hospital or physician who decides not to participate in an insurance policy’s network. As a result, those providers do not sign a contract saying they will accept the price of an insurance policy. 

If you are charged by a doctor who is not in your network, your expenses may only be partly covered, and you could potentially have to pay the entire bill out-of-pocket. Plans covering out-of-network care are few and far between. However, companies like these are still available in some areas. 

Deductibles with these plans can be higher than others, and out-of-pocket costs may be higher than other policies. There may also not be a limit on how much you pay out-of-pocket when you see an out-of-network provider.

In-network medical providers, on the other hand, make an agreement with insurance companies stating that they will accept an insurance company’s payment and an individual’s “cost sharing amount” as full payment. 

Medicare Select Plans are an option for many people. However, they are less common than other plans. If you are considering getting a Medicare Select policy, it is important to weigh the benefits of Medicare Select. This will help you determine if it is right for you. Look at the costs you may be expected to pay and if the plan will meet your needs in terms of care.

If you are trying to decide if Medicare Select is right for you, you may want to consider what hospitals and doctors you would like to visit. If you want to see a doctor that is out of your network, you may save a bit on the premium, but chances are you will still pay a lot out of your own pocket.

You should also decide whether you want to see providers who are out of your network. If it is important for you to see specific providers, you may want to explore your options. If you get a severe illness, you may not be able to see the best doctor for your needs. 

So, you must decide which is more important, getting high quality emergency care or paying high out-of-pocket costs. If you find that the Medicare Select Plan is not the best plan for you, you can switch to another policy, but it may require Medical underwriting. If you drop a traditional Medigap plan to enroll in a Medigap Select plan, bear in mind that you have 12 months to change your mind and switch back to your original policy.

You can leave the Medicare Select plan if you leave the area where your insurance company offers coverage. You may also switch policies if your insurance company opts out of the Medicare Select program where you live. Medicare Select is a lot like an HMO Medicare Advantage Plan. Both are available in certain areas and are exclusive to certain doctors and hospitals.

How does Medicare Select compare to a Medicare Advantage Plan? According to experts, Medicare Select is different from Medicare Advantage Plans, because there is no schedule for copayments. Medicare Advantage Plans have a copayment schedule. Select Plans do not cover Medicare Part D, dental coverage, or some benefits offered by other policies.

However, you may have the ability to buy wellness coverage or an Active & Fit benefit. You can visit the Active & Fit website to see if you are eligible for the program. Of course, it also helps to understand the rates associated with Medicare Select programs. The amount you pay per month will ultimately depend on the Medigap program you choose, your location, your plan, and your insurance company.

Premiums can vary greatly, and different companies may charge more for the same coverage offered by other insurance providers. Because of this, it is important for you to look at different plans to decide which one has the best rates for a specific plan. For example, one company may charge more for Medicare Select Plan G than another company. 

Based upon price comparisons, you should be able to pick the best policy for you. There are many benefits to having a Medicare Select Plan, experts say. It is important to understand how Medicare Select Plan G benefits you. Medicare Select is called Select, because it only offers coverage with “select” hospitals and doctors.

Medicare Select Plan G covers all the things that Standard Medigap Plan G covers. The only difference is that Medicare Select restricts the doctors you can see and the hospitals you can visit. 

Plans become more affordable when they are limited to certain doctors and hospitals. Because your choices of doctors and hospitals are limited with Medicare Select, Medicare Select is often a better fit for those with limited funds. Much like other Medigap policies, Medicare Select assists you in paying for costs that Medicare Parts A and B do not pay for.

Medicare Parts A and B do not cover the Medicare Part A deductible for inpatient care. In 2023, the cost of this was $1,600. Medicare Parts A and B also do not cover coinsurance payments. The biggest advantage of Medicare Select is that premiums are typically low. However, if you see a doctor who is out of your network, you will be responsible for paying the 20 percent that Original Medicare does not cover.

If you experience a “cognitive decline” or have a heart attack, you may not get the premium care needed to address your illness or emergency. Instead, you will have to choose a doctor that is in the network. However, the nice thing is that the amount not covered by Original Medicare will be picked up by Medicare Select. Medicare Select pays for most things. However, if you see an out-of-network provider for an emergency, out-of-pocket costs will not be covered.

Of course, Medicare Select makes sense for many people. Because it is relatively low-cost, those with Medicare Select may be able to better afford the necessities they need to live comfortably. 

6 Sources

MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

https://www.dfs.ny.gov/faqs/consumer-health/what-medicare-select.

https://www.anthem.com/medicare/medicare-advantage-plans/mediblue-hmo

https://hwmg.org/wellness/active-and-fit/

https://www.medicare.gov/health-drug-plans/medigap/basics/costs

https://www.medicaresupplement.com/articles/medicare-select-definition-features/

https://www.ehealthinsurance.com/medicare/blog/medicare-tips/what-if-my-medicare-doctor-opts-out/