Medigap insurance is designed to provide a wide variety of coverage, and Medigap covers some things Medicare doesn’t.>Many people think that Medicare part A, B, and D are all that is needed to cover everything. But there are some things that are not covered or not covered completely. Medigap fills this gap.
What is a Medigap Plan?
Medigap plans have been around since the 1980’s. The plans were better known as Medicare supplement plans. Their sole purpose was to offer better coverage to those on Medicare insurance. It was designed for things that were not completely covered by the original plan.
Who is Eligible for Medigap Coverage?
When a person reaches the age of 65, they are eligible to enroll in Medicare part A, B and D. Anyone who is currently enrolled in Medicare part B can decide to purchase Medigap coverage. Also, persons who receive SSI disability income, or have end-stage renal disease are eligible for Medicare regardless of age. Medicare part A is for hospital stays only. Part B covers routine medical expenses. For example, X-rays, doctor’s visits and lab work.
Retirement Health Plans and Medigap Coverage
When a person retires, Medicare becomes the primary payer. Any insurance that is through an employer becomes the secondary payer. Some believe that the secondary coverage will cover any additional costs left after Medicare has paid their portion. But depending on the benefit coverage, there may still be costs passed on to the patient.
If there is an injury that requires medical equipment like a pair of crutches, for example, Medicare part B will cover the cost at 80 percent. 20% is passed on to the secondary insurance if the secondary insurance coverage is also 80 percent.
This does not mean 80 percent of the total cost. Medicare already paid the portion that would be covered by the secondary insurance. The 20 percent copay is still passed on to the patient since it is the copay that was in the benefit structure. If the coverage is 90 percent, then only 10 percent will be billed, and so on.
Should I Sign Up For Medigap?
Determining the need for coverage should be based on a person’s health status and planned procedures. There are a few factors to consider. Cost can be a major factor for many people. There are plans that have no additional costs. These basic plans can add benefits to an existing policy by including coverage for what is not covered by Medicare.
When Should You Sign Up For Medigap Coverage
There is an important timeline to consider when signing up for Medigap coverage. When you become eligible for Medicare, there is an initial enrollment period of seven months. During this period, is the time for you to choose a Medigap plan. The reason is simple. During this seven month period, the insurer cannot deny you coverage based on a prior or existing medical condition.
If you decide to purchase a Medigap plan after this seven month period, insurers can opt not to cover you or may choose to give you a higher deductible or premium. Therefore, the best time to buy Medigap coverage is when you enroll in Medicare. This will ensure you have the coverage you need in the future.
Choosing The Best Medigap Plan
We cannot say what the best overall Medigap policy is. You must choose the best policy for you. Factors to consider are your medical needs and cost of the plan. Although Medigap policies are standardized, policies can still differ in additional benefits offered.
Cost Factors and Deductibles
Some plans carry deductibles. Once the deductible is met, then the more expanded coverage begins. Some of the plans may cover all of the out of pocket not covered by Medicare part B.
Physician networks can influence the decision between policies. We are advised not to choose a plan based on a specific doctor. Honestly, many people do just that. It may not be the main factor, but it is a significant one. When a primary care physician or specialist has been established, most people don’t want to look for a new one. Be mindful of the network of physicians when choosing a plan.
Consider Coverage You Will Need
A great way to determine a plan choice is to think about the upcoming year. It is impossible to forecast the unforeseen, but there may be things to consider. Travel plans may mean you will need coverage for out of state emergency care. Upcoming medical procedures may prompt the need for better coverage. For example, specialists, physical therapy, medical equipment, skilled nursing facility, rehab center, or even surgery.
Important Questions to Ask
Begin the search for the right plan by considering the specific needs it will address. Ask yourself the following important questions: Is this plan worth the out of pocket cost? Is a preferred hospital associated with this plan? Is the plan flexible? What will the plan offer if changes need to be made during the year?
Help In Choosing the Best Plan
A trusted insurance agent is a reliable source of the most up to date information on the various plans available. He or she will be able to help you choose the plan that best fits your medical needs and your budget. In addition, calling the number on the enrollment package you receive from Medicare has proved very helpful to many. They are happy to assist you in making the choice that is right for you.
When you sign up for Medigap, remember that Medicare is the primary payer, so it determines where the patient can be seen. Some plans allow additional riders for dental and vision care. No choice is permanent. It can be changed again in 1 year.