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How to Choose a Medicare Supplemental Insurance Plan
Just the essentials...
You can only purchase a Medigap plan if you have Original Medicare Part A and B
Medigap plans are available in every state from most private insurers
There are ten standardized plans with a wide variation of coverage and premiums
Every Medigap provider must offer plans A, C, and F
Shop carefully and make sure you are comparing like plans
There are numerous free resources to help you make a decision
If you have Original Medicare, you may wish to consider the purchase of Medicare Supplemental Insurance plan, more commonly known as “Medigap.” These plans, which are sold in every state by private insurance companies, can help cover some of the health care costs not paid by Medicare.
These commonly include deductibles, coinsurance, and copayments. Some also offer benefits that Medicare does not cover such as medical care outside of the U.S.
The purpose of this article is to give you some basic tools to understand Medigap plans and how to compare them to make the right choice for you.
If you have a Medicare Advantage (Part C) plan, you do not need to go any further. Medigap plans do not work with Medicare Advantage plans. In fact, it is illegal for an insurance company to see you a Medigap plan if you have Part C.
Important Facts to Know about Medigap Plans
There are some things common to all Medigap plans. The most important are these:
You must have Medicare Part A and Part B.
Each Medigap policy has a monthly premium.
A Medigap policy only covers one person. Married couples must buy separate policies.
These policies are guaranteed renewable even if you have health problems.
They do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
How Does a Medigap Plan Work?
In most policies, part of the agreement you will sign allows the Medigap carrier to receive your Medicare claim after the primary carrier processes it. This is sometimes known as “piggyback” coverage.
In this situation, the Medicare carrier pays their portion of the claim, then sends it directly to the Medigap carrier, who also pays the provider. This is most common for Part B claims, but some carriers also offer it for Part A claims as well.
Best Time to Purchase a Policy
When you enroll in Original Medicare Part A and B, you have an automatic six-month open enrollment period. During this window, you may purchase any Medigap policy sold in your state, no matter what your health situation is. These are known as “guaranteed issue rights.”
This is a “no questions asked” grace period to purchase a policy, so it is important to take advantage of it. After this initial open enrollment period, you either may not be able to purchase a Medigap policy or it may cost you more.
Basic Comparison of Plans
There are thousands of Medicare Supplemental Insurance plans available in every state. With this many choices, you might wonder where to start.
An important point to understand is that all Medigap plans are standardized. They must follow both state and federal laws and must be clearly identified as a “Medicare Supplement Insurance.” There are ten plans, designated by the letters A through N.
Not every insurance company offers every plan.
They MUST offer Plan A.
They must also offer Plan C and Plan F.
This link will show you the complete grid of all the plans and what is covered. (You will need to scroll down.) As you can see, there are some things common to almost all plans, while others vary widely in coverage.
There are a few exceptions. If you live in Massachusetts, Minnesota or Wisconsin, be sure to scroll the whole way down the page linked above to see how Medigap plans in your state are organized.
Some states also sell what is known as a “Medicare Select” policy. They are often less expensive, but they may require you to use the hospitals and doctors within that insurance company’s network to be eligible for full benefits.
Start Your Comparison Search
Medicare’s website has a good tool to start your search. Input your zip code and whether you already have a policy and click “continue.” You can also include your health status, but that’s not necessary at this point.
This takes you to a summary page by type of policy (A through N) with a range of premium prices. The “benefits” blocks in the middle give a quick overview of what each policy covers. At the far right, there are two options:
View companies that offer the policy.
View all benefits of each plan.
When you select the first option, you will see a list of all insurance companies in your zip code that offer that particular Medigap product.
Unfortunately, from that point, there is no quick link for a price quote on each one. There is a link to each insurance company’s web page. From there, the method of obtaining their rates varies greatly. Most want specific information to provide a quote.
When comparison shopping, be very careful that you are comparing like plans. (A to A, B to B, etc.)
A Note Regarding Pricing Methods
In the middle of this screen is a column called “Pricing Method.” This is how each insurance company sets its own premiums. This method can greatly influence the pricing of their policies. There are three rating systems:
Community-Rated – The same premium is charged to everyone, regardless of age.
Issue-Age-Rated – The premium is based on your age when you buy the policy.
Attained-Age-Rated – The premium is based on your current age, so it goes up as you get older.
Comparing Insurance Companies
You may already have an insurance company in mind to be your Medigap carrier. You may have had employer group insurance through them prior to retirement and had good experiences.
Perhaps you have word-of-mouth references from friends and family. But what if you are starting literally “from scratch?” There are numerous resources that can help.
Your State Insurance Department – They should have records of complaints against insurance companies. Many also have free guides and comparisons of insurers in your state. There are links to the state insurance departments on Medicare.gov.
SHIP (State Health Assistance Program) – The SHIP for your state should have some type of Medigap comparison shopping guide, which may list rates and ratings. The resources of the SHIPs are always free.
Independent insurance agents
Ratings web sites – JD Power, NCQA, and U.S. News & World Report publish annual reports rating insurance companies. There are many others as well.
Individual insurance companies
Buying Your Policy
Once you have decided upon a plan and an insurer, it’s time to buy your policy. Each policy has an application. Be sure to fill it out completely, including all medical questions. If your insurance agent fills out the application for you, check it carefully.
Most Medigap policies start the first of the month after you apply and pay your first month’s premium. For example, if you apply on May 15, your policy should start June 1.
If 30 days pass and you have not received your policy, call the insurance company directly. If 60 days pass and you have not received it, call your State Insurance Department.