What is Medigap?
Are you concerned that original Medicare will not cover all of your medical expenses if you need expensive medical treatment to cure a serious or permanent health condition? In most cases, Medicare pays only about 80% of your health care expenses, leaving you a gap. This is where Medigap comes in. As ‘supplemental’ policy to Medicare, Medigap helps you fill in the financial gaps where the basic coverage leaves off.
Did you know that an average knee replacement, hip replacement or heart attack may cost up to $40,000 or more? Which means, in most cases, you will be left with $8,000 or more to pay out of your own pocket. Adding supplemental insurance can lower or even eliminate that risk for you.
Worried by news about high health care, many seniors are looking for the best way to supplement their original Medicare. Supplement plans for Medicare, or ‘Medigap’ were created to help beneficiaries with out of pocket costs such as co-payments, coinsurance and deductibles, plus most plans add benefits which are not covered by your original Medicare Part A or B. By adding a Medigap policy you may stop worrying, as most if not all of your medical costs will be supplemented.
How Can I Add Medigap To My Medicare?
Most persons are first eligible for Medicare when they turn 65 and they may apply for Medicare. This is called “initial enrollment period”. You may add a Medigap insurance plan at the same time your original Medicare Part B is in place. Only at that time (6 months before and after you turn 65) do you have (with specific exceptions) a ‘guaranteed issue right’, and the Medigap insurance company needs to accept you. If you apply at a later time, you may be required to meet the company’s medical underwriting requirements, which means the insurer can deny coverage or charge higher rates, in case of past or current health issues.
What Does Medigap Cover?
The 10 Medigap plans are named Plan A, B, C, F, G, H, K, L, M and N, and all have different benefits. Not every plan may however be available in your state. You can find a chart with Medigap benefits at a glance at here. To find out which one is best for you, you need to compare the benefits and total cost of each plan with your current medical needs.
How Does Medigap Work?
As long as your doctor accepts Medicare, they will usually also accept Medigap, and you can continue to see her. When it’s time to pay your bill, Medicare will first pay its share, then your Medigap plan will, depending on the policy you selected, pick up a part or all of the remaining costs. Among the 10 different plans, there are options that only pay for Medicare approved services and plans that will even pay for costs that are in excess of Medicare approved services. Plan F for example offers the most coverage for services that Medicare doesn’t cover at the hospital and at the doctor, so you won’t have out of pocket costs. Naturally, this all-inclusive plan is more expensive than other choices.
Can I Change/Switch My Medigap Plan If I Don’t Like It?
If you find out after a while that your current policy is not right for you or your health care needs changed, you may want to switch to a different Medigap plan. Please note that in most cases you don’t have a right under federal law to switch plans, however you may try asking your current insurance company if they allow you to switch to a plan that works better for you. Many times they will, but you may have to go through a health screening or have a higher premium for the new plan. Make sure you don’t cancel your current policy until you are enrolled in a new one.
Medigap vs Medicare Advantage
You cannot enroll in Medigap and a Medicare advantage plans at the same time, but must choose one or the other to add coverage to Medicare.
One advantage of Medigap is that, depending on your local area, a large number of health care providers accept it. You are not restricted to a network of service providers as you are in a Medicare Advantage Plan. However, this makes Medigap plans more costly than advantage plans.
Medigap plans are easy to compare. After you have selected the plan option (A, B, C, F, G, H, K, L, M) that best matches your medical and financial needs, you can easily compare the premiums of different companies to find the best rate, as all plans are standardized. Medicare advantage plans will not supplement, but replace your Medicare insurance. These plans must by law provide at least the same benefits as original Medicare, and may add additional benefits, but they are not standardized. Depending on the plan you may or may not have extra benefits such as hearing, vision, basic dental care, wellness/fitness programs, and many times even prescription drug coverage, which is not included in Medigap.
