The Ins and Outs of Medigap Policies
Last week we discussed some basic information about Medicare and the Medicare open enrollment period. In addition to considering the benefits, convenience, and costs of Original Medicare and Medicare Advantage plans when deciding which type of plan is right for you, the option for a supplemental plan should also factor into your decision. These supplemental plans are called Medigap policies, and they are sold by private insurance companies. Medigap policies help cover some of the out-of-pocket expenses that Medicare doesn’t pay for, such as deductibles, copayments, and health care provided outside of the United States. There are some general guidelines to remember when thinking about Medigap policies.
Medigap policies are only available to individuals who are enrolled in Original Medicare. If you have a Medicare Advantage plan, you cannot enroll in a Medigap plan unless you disenroll from the Medicare Advantage plan and return to Original Medicare. In addition, you must have both Part A and Part B coverage to obtain a Medigap plan.
You must pay a monthly premium for a Medigap policy that is separate from your monthly Part B premium for Medicare.
Medigap policies only cover one person. Spouses must each purchase a separate policy if you both desire coverage.
Medigap policies sold after January 1, 2006 are not allowed to include prescription drug coverage. Purchase of a Part D plan is needed to cover your medications.
Multiple companies can sell Medigap policies within any state, but the plans themselves are standardized according to state and federal regulations and are usually identified by letter (for example Plan K will offer the same benefits no matter what company is selling it, but the premiums may vary among companies).
As long as you pay your premium, your insurance company cannot cancel your Medigap policy, even if you develop health problems.
Medigap policies usually do NOT cover expenses such as hearing aids, vision care and glasses, long term care, dental care, or private duty nursing.
Perhaps the most important factor to be aware of when choosing your Medigap policy is the fact that if you enroll in a Medigap plan during the first six months after you are eligible for Medicare, you can purchase ANY POLICY from ANY COMPANY regardless of your health, and pay the SAME COST as a healthy person. After that first six months, insurance companies will use medical underwriting to determine whether or not to accept your application, and how much to charge you for the policy. There are a few special situations which may allow individuals with certain health conditions to change to a different Medigap plan after their initial enrollment period. See www.medicare.gov for details about these situations, plans available in our state, and additional information about Medigap insurance. For most folks seeking a Medigap policy, do your homework and choose wisely the first time to prevent a more complicated and expensive process later on.
Karen Kaslow, RN
Elder Care Coordinator
Keystone Elder Law P.C.