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Understanding Medigap (Medsupp) Coverage

What is Medicare Supplement Coverage?

Medicare Supplement Insurance or Medigap is a specialized form of insurance for Medicare Part A and Part B. Offered by private providers; it was designed to fill gaps left by the original Medicare coverage.

It is not true Medicare insurance because it does not create Medicare benefits. Rather, it is gap coverage designed to cover the areas of costs exposure in Medicare benefits.

Medicare Supplement plans, also known as Medigap, fill in gaps in coverage for the original Medicare. Medigap is valuable coverage because these exposures to deductibles and similar charges re-occur.

The items below are the costs the consumer would have to pay out of pocket:

  • Deductibles
  • Coinsurance
  • Copayments
  • Overseas emergency health coverage

How Does Medicare Supplement Coverage Work?

AdobeStock_61801574-1600x1600Medicare is the primary insurance; the supplemental program pays after Medicare pays. Medicare leaves amounts for the consumer to handle including deductibles, copays, and coinsurance. Some Medicare payments leave a percentage balance unpaid. In some categories, Medicare may not pay anything.

Regarding the mechanics of the Medigap insurance system, the following items are essential:

  • Consumers must have Medicare A and B to get Medigap coverage.
  • Consumers pay the Medigap insurance company a separate monthly premium for the Medigap coverage.
  • This amount is in addition to the monthly Medicare Part B premium paid to Medicare.
  • A Medigap policy only covers one person.
  • If consumer and spouse each want Medigap coverage, they each have to buy policies; the rule is one consumer per policy.

What Do You Need to Do for Enrollment in Medigap Coverage?

Consumers are bound by state laws. They can only buy a Medigap policy from an insurance company that is licensed in the state to sell one. The prerequisite is enrollment in Medicare A and B.

States do not require insurers to offer all of the plans.

However, any insurance company that sells Medicare Supplement policies must offer a precise mix of high deductible policies. States usually require Plan A.

If an insurer decides to offer further Medigap coverage or policies in addition to Plan A, the states often require a coverage balance including Plan C or Plan F.

How much does Medigap Coverage cost?

AdobeStock_62456376-1600x1600The initial cost of Medigap coverage is in insurance premiums paid to the Medigap provider. Prices vary widely and from year to year. They vary by the rating of the plan as to the age and health of the buyer.

The premiums vary by location; location is a driver of costs as some services have much higher costs in particular geographic areas. Premiums rise due to inflation, specific medical costs, and by the age of the holder of the policy.

– Community-rated Medigap Coverage

Community-rated Medigap plans have a flat price and do not depend on the age or health condition of the buyer. Community rating may save money because the premiums do not rise with age or other factors. By giving all applicants the same price or rating, the age or health of the buyer does not raise the premium.

Ten standardized Medigap policies are represented by the letters A through N. Plan F is a high deductible plan. Coverage amounts or percentages and premiums vary from seller to seller, but the letter bands contain similar policies for comparison purposes. A Plan A benefits package in New Jersey is similar to one in Michigan.

– Issues-age-rated Medigap Coverage

The age of the buyer is a permissible basis for pricing a Medigap policy. The same policy will have a different price based on the age of the purchaser at the time the seller issues the policy. The price of the premium will not rise afterward as the policyholder ages.

These issues-age rated policies can be less expensive than those that increase with the age of the holder. The policy price would be lower if you purchased at age 65 and maintained through 70 than for someone who bought it at age 70. Current age pricing is higher for some sellers than attained-age over the course of the policy ownership.

– Attained-age-rated

The age-attained supplemental policy uses the age of the buyer at the time of purchases as a benchmark. The price rises with the buyer’s age, and premiums rise as the buyer gets older, which is the main difference between other ratings and the Attained-age-rated policy.

The best prices go to the youngest buyers; the youngest buyers will experience consistently lower prices than fellow subscribers. Attained-age policies will rise to be the most expensive type of coverage as the age of the holder rises.

When is the best time to buy a Medigap policy?

For the price, terms, and guarantee of success, the best time to buy is in the Initial Medigap Open Enrollment Period. During the initial eligibility period, plan providers and sellers cannot use medical underwriting to vary prices.

They must offer the same policies to all buyers in a state without regard to the buyer’s health conditions.

A one size fits all approach promises the lowest prices for the best coverage for every eligible buyer.

Buying a Medigap policy during Medigap Open Enrollment is subject to medical conditions, exceptions, and delays. States permit plan providers to use medical underwriting when setting premiums and prices.

Sellers may decide not to sell a policy by medical conditions and age. While they cannot use pre-existing conditions to deny coverage to an existing customer with renewal rights, a new customer has no right to a policy.

Are there Restrictions on Medigap Coverage?

hands-walking-stick-elderly-old-person-1600x1600There are a large number of restrictions on Medigap coverage. Each state sets some rules and must authorize the issuance of any given type of policy. To be eligible, consumers must remain insured by Medicare A and B to get or keep Medigap coverage.

The rule is that Medigap policies don’t cover the below-itemized health services and supplies categories.

  • Custodial nursing or long-term care
  • Vision, exams, treatment or services, nor dental care
  • Hearing devices
  • Visual corrective devices such as eyeglasses
  • Personal or private-duty nursing
  • Prescriptions and drugs

Any standardized Medigap policy is guaranteed renewable even if the policyholder has health problems. The insurance company can’t cancel the Medigap policy. As long as the premiums have been paid, the policy will remain in force. There can be restrictions and holds placed on certain kinds of coverage.

A company may insist on a six-month wait for a particular coverage due to a pre-existing condition. The insured can show the condition treated and resolved within the prior six months and receive coverage. These limitations can occur on renewal even when there is a right to renewal.

The buyer’s rights are strong, and the insurer may not legally refuse to sell the insurance.

The problems for consumers are in the holds and delays. While not denying coverage or a Medigap contract, the provider can nonetheless cause a waiting period of up to six months.

How do you compare Medigap policies?

AdobeStock_59598914-1600x1600Medigap policies can be compared several ways to get the information that best reflects a buyer’s situation. Price is a first-level comparison. By any of the methods for rating, the initial price is a good test of value.

The rate of premiums increases is the next level; those based on age might go up faster than others. Costs increases would be a third level not based on age. Research with the issuers can provide useful tips. One can learn about past rate hikes and how quickly they came over time.

– Medigap Benefits

Medigap benefits cover a wide range of situations. They focus on gaps in Medicare A and B coverage. For example, Medicare Supplement plans must provide coverage for the basic benefits listed below. The plan providers can decide to offer total or limited coverage and price premiums accordingly:

  • Medicare Part A co-insurance costs up to an additional calendar year from the end of Original Medicare benefits.
  • Medicare Part A whether by co-insurance or copays, some coverage of hospice services.
  • Medicare Part B co-insurance or co-payment for the doctor and medical services.
  • The plan provides for blood replacement; there are no additional costs for the first three pints of blood each year, per patient.

– Out of Pocket Limits

There are two standard Medigap plans (Plan K and Plan L) to assist with the out-of-pocket limit. Once your health-care costs (including the Medicare Part B deductible) have reached the plan’s limit, the Medigap plan will cover 100% of covered medical expenses for the rest of the year.

The Original Medicare coverage does not limit out-of-pocket expenses. Medicare did not have a cap on the consumer contribution to health care. Persons with long-term or chronic conditions could incur a lot of uncovered expense from frequent medical care and doctor visits.

Health expenses can add up quickly in medical emergencies too. Without a cap on contributions, consumers faced an unlimited annual out- of -pocket amount.

– Plan F Type of Medigap Coverage

Plans that include additional coverage, such as Plan F, may also offer a variation of the below itemized additional benefits.

  • Medicare Part A deductible
  • Medicare Part B deductible
  • Medicare Part B excess charges
  • Skilled nursing facility care coinsurance
  • Foreign travel emergency care (up to plan limits)

Some excess charges and foreign travel emergencies are not limited expenses under the original Medicare. Policyholders face a large potential for out of pocket charges.

– Medigap is Limited Purpose Insurance Coverage

Medigap has a narrow but important function in protecting consumers from large amounts of out-of-pocket costs. To get prescription drug coverage, consumers can buy a stand-alone Medicare Prescription Drug Plan.

Medigap is not the answer for prescription drug coverage since Medigap plans don’t provide coverage for medications. As stated above, consumers should bear in mind that Medigap plans don’t cover benefits like routine vision or dental, hearing, or wellness programs.

References:

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MedicareInsurance.com is privately owned and operated. MedicareInsurance.com is a non-government asset for people on Medicare, providing resources in easy to understand format. The government Medicare site is www.medicare.gov.

This website and its contents are for informational purposes only and should not be a substitute for experienced medical advice. We recommend consulting with your medical provider regarding diagnosis or treatment, including choices about changes to medication, treatments, diets, daily routines, or exercise.

This communication’s purpose is insurance solicitation. A licensed insurance agent/producer or insurance company will contact you. Medicare Supplement insurance plans are not linked with or sanctioned by the U.S. government or the federal Medicare program.

MULTIPLAN_GHHK5LLEN_Accepted Last Updated 3/18/2018