What are Medigap Plans?
As the name indicates, Medigap Plans are meant to cover any holes in your original Medicare insurance coverage. Medigap Plans pay towards healthcare costs such as co-pays, deductibles, and medical services that you might require while traveling overseas, among others.
Medigap Plans can be purchased from private health insurance companies. Consumers should read the terms and conditions carefully since these policies usually do not cover long-term care, hearing aids, private nursing, dental or vision services, or hearing aids. Most Medigap Plans are not meant to pay towards prescription drugs.
A Medigap Plan is a supplemental insurance policy, but it is different from Medicare Advantage Plans such as a PPO or HMO, Medicaid, employer or union health plans, Medicare prescription drug plans, long-term care, and veteran’s benefits, among others.
What are the conditions for getting Medigap Plans?
Since Medigap Plans must be purchased in conjunction with an original Medicare policy, there are terms and conditions of which you should be aware. Most importantly, you must have Medicare plans Part A and Part B.
You need to time your application carefully. If you have a Medicare Advantage Plan in place, make sure you can leave this plan before your Medigap Plan begins.
Much like any private insurance plan, your Medigap policy has a monthly premium that you are required to pay to the private insurance company you choose. This is in addition to the monthly Part B premium that has to be given to Medicare.
A Medigap policy is not meant for family coverage. In other words, it’s one policy per person. So if your spouse needs the same coverage as you, you will need to purchase two separate Medigap plans.
In today’s online marketplace for insurance, you will find a lot of private insurance companies selling Medigap Plans. But you must do your research and make sure that the health insurance company that you choose is licensed to sell policies in your state.
One huge advantage of a Medigap Plan is that it is automatically renewable. So irrespective of your health condition, you are guaranteed renewal as long as you pay the stated premium on time. An easy way to assure timeliness is to set up automatic payments with your bank or credit card.
While some select Medigap policies sold before January 1, 2006 covered prescription drugs, that is not the case any more. Under Medicare, those consumers needing prescription drug coverage are required to join a Medicare Prescription Drug Plan (Part D).
Be aware that if you pay towards a Medicare Medical Savings Account (MSA) Plan, you cannot get a Medigap policy. Anyone selling you such a plan is liable for criminal prosecution!
What are some points to remember about Medigap Plans?
Getting medical insurance can be a confusing and frustrating process, so contact your state’s insurance department or access the needed information through the online Medicare Personal Plan Finder.
If you already have a Medicare Advantage Plan, you are not eligible for a Medigap Plan and, all things considered, you do not need such a bridging option.
Every standard Medigap Plan is required to give you a standard table of benefits. However, since the providers are private companies, prices can vary. Premiums vary depending on location, age, and company, so shop around to get the best deal.
The open enrollment period for buying a Medigap Plan, is the first six months of your 65th year, as long as you have Medicare Part B. Alternatively, you are also eligible within the first six months of signing up for your Part B policy. After the first six months, you have no guarantee of coverage and, if covered, you might have to pay a higher premium.
In case of Medigap Plans, you will find that less-expensive plans will have fewer benefits along with higher out-of-pocket costs. Higher premiums will give you access to added benefits such as at-home recovery packages, routine check-ups, and specific Medicare deductibles, among others.
It is very important to remember that a Medigap Plan is not renewable if you drop the policy. Additionally, if you are late in making your premium payments, you might be dropped.
While Medigap Plans no longer cover prescription drugs, if your original plan did so, you are allowed to keep that plan.
What are Medicare Part A and Part B Plans?
Also referred to as the original Medicare, Medicare Part A and Part B fall under the purview of Social Security Administration. Consumers are automatically enrolled in Part A and Part B plans when they turn 65 as long as they get Social Security checks.
Medicare Part A is meant to cover most hospital services that are inpatient. This includes stays in a medical hospital or nursing home, limited home care, and some hospice services. It also pays towards blood transfusions.
Medicare Part B pays for outpatient medical care, which includes doctor’s visits, diagnostic services, home health services, medical equipment, and some medications.