Most people who are under age 65 have a cursory awareness of Medicare. They may believe that Medicare covers everything. It, unfortunately, does not, and would otherwise cost budget-restricted seniors with insurance co-payments and other fees that they may not be able to readily afford.
What Is Medicare Supplemental Insurance?
Medigap is a supplemental insurance policy that covers what conventional Medicare does not cover. In other words, it fills in the gaps for Medicare Plan A and Medicare Plan B participants. That means it could help with co-pays, deductibles, and co-insurance, or even coverage while traveling outside of the United States.
The other major difference from the Medicare policies is that Medigap is sold by private health care insurance companies, not by the U.S. Government, which provides access to conventional Medicare Part A and Part B. For anyone 65 and older who is a participant in Medicare Part B, eligibility for Medigap begins at the time of enrollment. It lasts for six months after the enrollment into the original Medicare plans.
Understanding Medigap Guarantee Issue
For new participants in Medicare, the first six months of open enrollment represent the time when the individual has what is known as guarantee issuance. It means they cannot be denied for suffering from the past or current conditions and are not going to pay higher premiums for having pre-existing conditions either.
There are Plans A through N, most which are guarantee issuance. Though, to purchase Medigap Plan G or Plan N, Medicare participants may go through the underwriting process if they prefer.
Now, several of these plans stopped being offered up such H through J and E. They continue to serve their participants. Because their populations are aging without adding new participants, they are more costly than the new Medigap policies. Both plans M-N supplanted the old plans.
Exceptions To The Rules
Medigap is sold by private insurance companies and for that reason, Medicaid participants under age 65 are not eligible for Medigap, especially not without underwriting. Individual states have their own rules about Medigap, as the plans are sold by private insurers, not the Federal government. Though, most states usually require at least one Medigap policy to participants under age 65. Even some employers will offer Medigap as a benefit.
The Caveat To The Deductible Coverage
Several plans covered Part B deductibles. Those are being phased out by 2020, which include plans C and F. People who can sign up before 2019 ends, will be eligible for deductible payments and Plans C and F.
Users Guide To Medigap
Again, individuals who have Medicare Part A and Part B are eligible for Medigap as long as they are age 65 or older. Those who also have the Medicare Advantage Plans as well, but have to leave their Advantage Plan prior to joining their Medigap policy.
To be clear, having Medicare Supplemental Insurance means having to pay for both the Part B coverage and the Medigap policy. Coverage on the Medigap policies is per person and requires couples to buy separate policies, even if married.
It turns out that the Medicare Supplemental Insurance cannot be canceled regardless of any new health conditions. It can be canceled if you do not pay the premium. In addition, the coverage is offered up by all licensed insurers within the individual’s state.
It is important to know that Medigap has not included prescription plans since 2006. Though Part D is prescription drug coverage. You are ineligible to purchase Medigap if you have a Medicare Medical Savings Account.
Medigap excludes long-term care, dental, vision, and eyeglasses, hearing aids and private-duty nursing usually.
While an individual could be canceled for not paying the premium, it is important to take note of the time if they are going to drop a Medigap policy. Some want to switch to a Medicare Advantage Plan with prescription drug coverage then a late enrollment fee is assessed.
Most People Have Medigap Coverage
The cost of co-pays and the like are high enough to justify paying to purchase the extra Medigap policy or the Medical Savings option with prescription drug coverage.
Older Policies Are The Exception
Medicare Supplemental Insurance that has prescription drug benefits purchased before mid-1992 might pay out more than Medicare Part D plans. It turns out that in Wisconsin, Massachusetts, and Minnesota may pay more than Medicare Part D plans. Qualified Medicare Beneficiaries do not need Medicare Supplement Insurance.
Recall the companies that offer up benefits to retired persons that may include Medigap coverage. It is advisable that the individuals know whether they are better off with their Qualified Medicare Beneficiary coverage. Sometimes group coverage is more favorable than Medigap policies.
Simply comparing the likely usage of the policies given a typical year and typical needs helps immensely with making such a comparison. Look at policy costs and coverage carried among any of the available Medigap policies available to the individual.
Always consider the security and stability of a company that provides coverage to its retirees. Because they could go out of business, be bought out, or plain outright fail which would increase costs while the actual coverage could drop. Consider this when comparing individual Medigap policies against the corporate policies. As with the Medicare Savings Account, if changing plans, the Medigap participant is required to first drop the old policy.
To repeat, the Medigap policies provide many different types of coverage and plug gaps left by Plan A and Plan B. Many people 65 and older like to sign up for a Medigap policy for the purposes of traveling overseas. A Medigap policy provided in addition to Medicare means Medicare covers Medicare-approved health care costs first, followed by the Medigap policy. This is important to keep straight when going to health care providers.
It is important to get clear on the key supplemental coverage Medigap policies offer in comparison to the Medicare Advantage Plan. The latter provides Medicare benefits, while Medigap is supplemental to the Original Medicare plans and their benefits. If questions exist, individuals should contact their local state insurance commissioner.