If you are retired or about to retire, it is hard to tell how your health will be in the next few years. To remain safe, many people over 65 years prefer to take a Medicare supplement, also referred to as the Medigap.
However, as a senior, you may be wondering why you need to take the Medigap and whether it is for you. To make the right decision, there are a few things about Medigap that you need to understand.
What Is Medigap?
From the age of 65, you are prone to getting many diseases, which could cost a lot of money for treatment and medication. Medigap plan helps you avoid any unpleasant surprises you may get from your healthcare costs.
Combined with the little fixed income you get at that age, the medical bills could become devastating and impossible for you to handle, which is why you need Medigap.
While you may have the original Medicare coverage, that may not cover everything. Medigap covers what the original insurance does not cover, including deductibles, coinsurance, and copays.
Depending on the plan you choose, your Medigap can take care of 100% of the out-of-pocket costs, and you can also visit any doctor.
To better understand what advantages Medigap offers, you should understand what the original Medicare covers and does not cover. The original insurance has part A and part B, which are hospital insurance and medical insurance.
For part A, you must pay out-of-pocket before you get any benefits for hospitalization. The insurance covers you for the first 60 days in a hospital that accepts the insurance. After that, you have to pay a daily coinsurance amount, depending on how long you stay in the hospital.
Part B insurance has an annual deductible, which, once you reach, covers 80% of eligible testing, medical equipment, and doctor-related expenses. Therefore, with Medigap, you do not have to pay the coinsurance and out-of-pocket deductibles.
How Does Medigap Work?
Medigap policy works in coordination with your original Medicare insurance to reduce your exposure to too many unexpected out-of-pocket medical payments, and it covers you for the rest of your life.
You are the one who decides how much you want the insurance to cover and how much premium you can pay.
Before you qualify to apply for Medigap, you must enroll for the original part A and part B. you should also not have any medical coverage from your employer or a union that pays either part of your medical bills or all the bills.
With Medigap, you never have to worry about filing claims because Medicare coordinated the claims and billing for you between the original insurance and Medigap.
The provider first bills your original Medicare before billing your Medigap insurance. Depending on the type of coverage you have, the provider can bill you for any remaining costs like part B deductibles.
As long as you continue paying the premium, you can renew the Medigap policy. One advantage of the insurance is that the insurer cannot increase your premium payments or cancel your policy based on your health problems.
What Does Medigap Cover And What Does It Not Cover?
The out-of-pocket charges that the Medigap covers are;
• Part A hospital costs and coinsurance costs for an additional 365 days after the original insurance’s benefits are exhausted.
• Hospice care copays and coinsurance for part A
• Part A deductibles.
• Copays and coinsurance for part B
• Part B deductibles.
• Part B excess charged.
• The first three blood pints.
• Above out-of-pocket limits
• Foreign travel emergencies.
Part B excess charges mean charges that doctors add above the amounts approved by Medicare. Some doctors accept the rates set, but others don’t, and they could add up to 15% more.
If you do not have Medigap insurance, you could end up paying for those excess charges or use participating doctors, which is not the best in case of surgeries and emergencies.
With some Medigap insurance policies, you might get coverage outside the United States, which you do not get with the original insurance.
While Medigap helps you with many medical costs, there are some things that it does not cover. Medigap insurance does not extend its coverage beyond what the original insurance covers.
For example, it does not cover vision and dental care, non-skilled home care, and hearing aids. Medigap insurance policies written after 2006 also do not cover prescription drugs. However, if you want to get your prescription drugs covered, you can enroll in an extra plan called part D.
Finally, Medigap does not cover long-term care or private-duty nursing. For these, you have to have a separate long-term care policy.
When You Can Enroll For Medigap
The enrollment period for Medigap covers six months, and it begins the month you turn 65. No insurance company offering Medigap can deny you from that age if you already have your Part B insurance.
If you want to enroll for Medigap at any other time, you must meet the qualifications for a special enrollment period as stated by ClearMatch Medicare.
The insurance company could underwrite you if you apply for the insurance outside the accepted period in some states. That is where the insurer can increase your premiums depending on your health conditions or refuse to give you the insurance.
In other states, this could also happen if you change your Medigap insurance plans.
How Much Is Medigap, And How Can You Pay For It?
With your Medigap policy, you still have to pay premiums, and for some, you also have to pay part B deductibles. Premium is the amount you pay monthly for the insurance, whether you get covered or not.
However, the amount may differ depending on factors like;
• The type of insurance plan you want
• The state or geographical area you are in
• The insurance company you get the insurance from
If you are new to Medicare, plans that cover your part B deductibles may not be available for you. That was passed starting from 1st January 2020.
However, if you already had a plan that covered them, you can continue using it. Also, if you were already eligible for Medigap before then, you can get a plan that covers it.
To pay your premium and deductibles, you send the money directly to the insurance company from which you got the insurance.
What Are The Different Plans You Can Get From Medigap?
There are different plans you can choose from when applying for your Medigap insurance. The federal government has standardized all of them, such that you get the same coverage from the plan you choose, no matter what insurance company you choose.
In total, there are ten plans, A-N, available for you even if you are enrolling for the first time. Plan C and F are, however, no longer available for any newly eligible beneficiaries.
Before deciding what plan you want, you should research all the plans and what they offer and choose the best one depending on the coverage you want. For example, if you want a plan covering most of the costs, you should consider plan C and F.
However, since you can’t get either of the plans if you are a new enrollee, plan G is the next best plan for you. It is similar to plan B, except that it does not cover part B deductibles. One of the disadvantages of that plan is that you have to pay high premiums.
If you take plan A, this plan covers the least expenses, and you have to take other insurance other special insurance policies. However, this plan has the lowest premiums.
If you want a cheap plan with cheap premiums, the best choice for you is plan K. However, you only get 50% coverage for a lot of medical needs.
