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 Individuals receiving the health care benefits available through Medicare often find themselves seeking additional Medicare Supplemental Insurance, which are also known as Medigap. A Medigap policy is a health insurance policy sold by a private insurance company to help fill the gaps in the Original Medicare Insurance Plan.
Supplemental Insurance and Medigap Policies
There are currently around ten standardized Medicare supplemental insurance plans and these are conveniently referred to as Medigap plans A through J. Each of these insurance policies has a slightly different set of benefits offered to suite the needs of those seeking this kind of insurance policy.
Why Buy Supplemental Medical Insurance?
While some might consider Medicare benefits are very generous there are some pretty significant coverage gaps and the medical cost sharing arrangements can add up. Working in concert with private health care insurance companies the federal and state governments developed a system to help individuals fill in these insurance gaps.
The nice thing about the Medigap system is that just because you're a Medicare recipient no one is obligated to purchase this supplemental insurance. And for those that are interested in providing themselves with additional health care insurance, they can choose from ten different levels of coverage.
Medigap Plan Features
One of important things to know about Medigap plans A through J is that as you move alphabetically from A to J, subsequent plans add to the previous plan's health care coverage. So plan A is considered the core Medigap plan since all the other plans contain at least the benefits of plan A. At the other end of the spectrum, Medigap plan J is the most comprehensive supplemental insurance plan offered.
Another feature of these Medicare supplemental insurance policies is that they are standardized no matter where you live in the United States (Massachusetts, Minnesota and Wisconsin are exceptions). This means that you can make a direct comparison between insurance companies regardless of where you live. In other words, Medigap Plan D is exactly the same, regardless of the insurance company offering the policy. In theory this means that the only difference between companies is the cost of the policy.
Buying Supplemental Insurance
In general, when you purchase a Medigap policy there are at least two components to that policy, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). If you opt to get a Medigap policy, you will need to pay the monthly premium of Medicare Part B directly to Medicare. In addition, you will need to pay an insurance premium to the private insurance company providing the Medicare supplemental insurance.
Just to be clear, a Medigap policy has nothing to do with any coverage you might have from your employer, it is not a Medicare Advantage Plan, it is not Medicare Part B and it is not connected with Medicaid. What it will do is help close the gaps on your Medicare deductibles and some policies will also cover additional benefits that are not covered by Medicare such as routine check ups, at home recovery and other benefits such as prescription drugs.
Additional Benefits of Medigap Plans
As mentioned earlier, as you progress from Medigap Plan A through Plan J you can expect to pay higher premiums for the additional medical benefits covered by each insurance plan. To get a better feel for the types of coverage available as supplemental health care insurance, the following list explains some of the additional benefits offered by these Medigap plans:
- Medicare Part A - Medigap Plans B through J covers the hospital deductible in each benefit period.
- Medicare Part B - Medigap Plans C, F, and J pay the deductible each year for doctor fees and other medical services. Medigap Plans F, I and J pay 100% of the excess charges that occur when a doctor doesn't "accept assignment." Medigap Plan G pays 80% of these excess charges.
- At-Home Care - Medigap Plans D, G, I, and J help cover some payment for services such as bathing and dressing if you're already are receiving skilled home health care that is covered by Medicare.
- Skilled Nursing Home Care - Medicare pays for skilled nursing home costs for the first 20 days of a benefit period. Medigap Plans C through J pays your share of the bill for day 21 through day 100.
- Preventative Care - Medigap Plans E and J offer preventative care benefits such as routine physicals.
- Travel Care - Medicare normally does not cover any health care services you might receive while traveling outside the United States. Medigap Plans C through J will cover some emergency health care costs outside the United States.
Cost of Medicare Supplemental Insurance
The cost of Medicare supplemental insurance policy can vary widely. Although the coverage is standardized, there can be a large difference in the cost that each health care insurance company will charge for the exact same coverage. For example, some companies may base the insurance cost on your age upon enrollment. Other companies may change premiums annually to reflect your current age.
The best time to enroll in a Medigap plan is during your open enrollment period. Open enrollment lasts for six months and starts on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. Once your six-month Medigap open enrollment period starts, it can't be changed.
Finally, the advantages of purchasing Medigap insurance during the open enrollment period include:
- An insurance company cannot deny you insurance coverage.
- The insurance company cannot place conditions on a policy.
- The insurance company cannot charge you more for a policy because of past or present health problems.
About the Author - Medicare Supplemental Insurance
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