Posts Tagged ‘medigap coverage’

Medicare Supplement Insurance

Friday, February 24th, 2012

Medicare supplement insurance, also known as Medigap insurance, is insurance coverage designed to fill in the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover, like copayments, coinsurance, and deductibles. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Medigap insurance is different from Medicare Advantage because it only supplements the Original Medicare Plan. If you opted for a Medicare Advantage health plan, you cannot also buy a Medigap policy. Although you do have out-of-pocket expenses with Medicare Advantage, they are typically not as great as with Original Medicare.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium.

Insurance companies can only sell you a “standardized” Medigap policy. Eleven standard Medigap policies are available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary. Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Medigap Plan A if they offer any other Medigap policy.

It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost.

You and your spouse must buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

Generally, standard Medigap policies cover some or all of the cost of:

  • Your Part A deductible and coinsurance (i.e. the 20% that Medicare doesn’t cover) for hospital stays
  • Your portion of your doctor’s bills for Part B services
  • The first three pints of blood annually, if needed
  • Hospice care coinsurance

Medigap plans do not cover:

  • Long-term care to help you bathe, dress, eat or use the bathroom
  • Vision care, eyeglasses, hearing aids or dental care
  • Private-duty nursing
  • Prescription drugs, or any out-of-pocket costs for Part D plans

(AARP Medigap: Your Supplemental Insurance)

 

Sources used:

  1. http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/medicare-benefits-overview.aspx
  2. http://www.medicare.org/
  3. http://www.aarp.org/health/medicare-insurance/
  4. http://www.kff.org/medicare/
  5. http://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_medigap.html

Further Understanding Medigap Coverage

Friday, May 14th, 2010

For everyone 65 or older, preferably those who have just turned 65, taking advantage of Medigap coverage is an option one must consider.  This is because Medigap fills in the gaps that your original Medicare Plan does not cover.  It is very easy to get covered by Medigap, as it is readily available through private insurance carriers, and there is no question about the added security and long-term savings Medigap coverage can offer, but there are some things you would need to know before going any further.

Medigap policies currently come in twelve different types of coverage ranging from A to L.  However, changes to the structure of Medigap coverage will eventually bring that number down to ten, as plans E, H, I and J are retired and plans M and N introduced.  Prior to the introduction of plans M and N, plans K and L were introduced in 2005, so who knows?  There just may be some additional plans added in coming years.  Just the same, all this applies for all states except Massachusetts, Minnesota and Wisconsin.  Federal law mandates that each Medigap plan have the exact same features and benefits for every insurance provider, though premiums may vary depending on the provider.  Insurance providers are not required to offer all plans, so if you’re looking for a specific level of Medigap coverage, shopping around for the right provider is essential.

Purchasing a Medigap plan means that your premiums go directly to the insurance provider, while you continue to pay your Medicare Part B premiums.  As long as these premiums are paid, any Medigap policy purchased after 1990 is renewed automatically for added convenience.  For those with Medigap policies purchased before 1990, some states have carriers that refuse to renew Medigap plans and would require you to purchase a new one.  This is a legal practice in those states, and it may be better in the long run to purchase a new policy anyway.

Medigap policies do not work if you are already a member of an existing Medicare Advantage Plan or other Medicare plans – these would be the only instances where we believe it would not be necessary to get a Medigap policy.  There are, in fact, laws that prohibit insurance providers from selling Medigap policies in these circumstances.  It would be illegal for a provider to sell you Medigap coverage if you are a member of a Medicare Advantage Plan not due to expire, if you already own a Medigap policy and are not about to cancel, or are a Medicaid member, unless Medicaid pays for the Medigap premiums or your Part B premium.

Once you already have a Medigap policy, any health service, hospital or doctor that accepts Medicare will be more than willing to accommodate you.  In some cases, though, you may need to visit only specific hospitals or doctors that support your Medigap plan.  This would be, specifically, if you are a member of Medicare SELECT.  Other than that, having Medigap allows for a lot of convenience and flexibility, and at the end of the day, is money well spent.

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