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.

4 Important Medicare Gaps You Need to Know About

While many people are familiar with the coverage Medicare provides, it’s equally important to understand what it doesn’t cover. Here are four key areas where Medicare falls short:

1. Prescription Drugs: Original Medicare doesn’t include prescription drug coverage. However, you can add this coverage through Medicare Part D or choose a Medicare Advantage plan, which bundles both medical and drug coverage.
2. Long-Term Care: Medicare covers certain nursing services but doesn’t provide for custodial care, such as assistance with daily activities like bathing and dressing. For this type of care, long-term care insurance is your best option.
3. Deductibles and Copays: Even with Medicare Part A and Part B covering some hospital stays and doctor visits, you’ll still be responsible for deductibles and copayments. Medicare Advantage plans, offered by private insurers, can help fill in these gaps.
4. Dental Care: Routine dental services, such as checkups, cleanings, fillings, dentures, and extractions, aren’t covered by Medicare. Some Medicare Advantage plans may offer limited dental coverage, such as basic cleanings and X-rays, but often with coverage caps.

If you’re unsure about your Medicare options or need assistance navigating these gaps, a Health Plans of America insurance professional can guide you through the process and help you find the right coverage. Reach out today!

In today’s world, where technology is everywhere, it can be difficult to tell if you’re falling victim to a scam. When it comes to your health, however, scams and fraud can have a serious impact on your peace of mind and overall well-being.

As we begin the New Year, here are some simple yet effective steps you can take to protect yourself from Medicare scams:

Stay Alert for Suspicious Activity
Be vigilant and trust your instincts. If something feels off, take a moment to assess the situation. Scammers often rely on pressure and urgency, so don’t hesitate to pause and question their motives.

Ask Questions and Seek Trusted Advice
If you’re ever uncertain, ask questions. Whether it’s about a phone call, email, or in-person interaction, probing deeper can help expose scammers. Consult with a trusted friend, family member, or advisor to get a second opinion.

Review Your Statements Regularly
Keep an eye on your Medicare Explanation of Benefits (EOB) and monthly statements. Regularly reviewing these documents ensures you catch any discrepancies or fraudulent activity early on.

Consult Your Doctor, Not Strangers
Scammers may try to convince you that they have your best interests at heart. However, your primary care doctor is the true expert when it comes to your health and care options. Always rely on them for medical advice.

Report Suspicious Activity
If you suspect you’ve encountered a scam, report it. Chances are, you’re not the only one. By reporting the issue, you help protect yourself and others in your community from potential fraud.

With so much information out there, knowing where to start can feel overwhelming. That’s where Health Plans of America can help. They provide the resources and guidance you need to make informed decisions with confidence.