7 Questions to Ask About Medigap Insurance
There are a lot of changes that come with getting older, and health insurance is one of them. Once you turn 65, you are eligible for Medicare, but will that be enough?
If you've had any experience with Medicare, you've probably noticed that Parts A and B cover a lot of medical expenses, but some of the cost is your responsibility.
Medicare Supplements, also called Medigap plans, are designed to fill in the "gaps" between what Medicare covers and what you have to pay out-of-pocket.
There are some things to consider when you are looking at Medigap plans, such as:
- What is Medigap?
- Do I Need Medigap?
- What Medigap plans are available?
- What are Medigap household discounts?
- What is the difference between Medigap and Medicare Advantage?
- When can I enroll in Medigap?
- How do I enroll in Medigap?
Understanding all these questions can help you make educated decisions about Medigap based on your needs and current situation.
1. What Is Medigap?
Medigap plans, also called Medicare Supplements, are health insurance policies with standardized benefits designed to work with Original Medicare. Some important things to know about Medigap plans include:
- Private insurance companies sell them – you can choose the carrier you like best
- There are no networks – you can see any doctor that accepts Medicare
- The government standardizes them – the coverage is the same from one company to another
- They are guaranteed renewable – you can't be dropped from your policy as long as you pay your premiums on time
- There are several different plan options – you can choose the plan that best fits your needs
Medicare typically covers 80 percent of medical expenses, leaving you responsible for the remaining 20 percent. The coinsurance can be a large amount, especially if you're facing treatments such as chemotherapy, dialysis, or if you encounter a lengthy hospital stay.
Medigap plans can cover things such as:
- Outstanding deductibles
- Coinsurance
- Copayments
- Emergency care while traveling abroad, which is not covered by Original Medicare at all
Medigap covers many of the costs that Medicare doesn't, and these plans are a great way to help you with out-of-pocket expenses.
2. Do I Need Medigap?
The purpose of Medigap is to cover the expenses that Medicare doesn't. Whether or not you need the extra coverage that a Medigap plan can provide is a personal decision.
Looking at your current health, financial position, and what you expect for your future health can help you decide if you need Medigap, and if so, which plan you should choose.
Medigap can ease the burden for anyone with a significant illness or severe injury. For example, with Original Medicare Part A, you have 100% hospitalization coverage for the first 60 days after meeting your annual deductible ($1,364 in 2019 and $1,408 in 2020). Medigap insurance can help you cover the deductible and the additional 20 percent of other hospital expenses you might incur, such as doctor and anesthesiologist fees.
Aside from major issues, Medigap can also help with routine care by covering copays and deductibles.
If you are financially stable enough to cover significant medical expenses that Medicare doesn't cover and you are incredibly healthy, then a Medigap plan may not be for you.
On the other hand, if you could use help with any extra expenses that might arise from your healthcare needs or you are at risk of developing a serious illness or disease, we highly recommend purchasing a Medigap plan. We recommend nearly all of our clients buy a Medigap plan to offset the financial risks involved with a serious health condition or event.
3. What Medigap Plans Are Available?
There are several Medigap plans available in most states, but there are only three that we recommend because many of them don't offer enough coverage to meet our standards.
The three Medigap plans we recommend are Plans F, G, and N. Of these three plans, Plan F is the most popular and offers the broadest coverage.
Plan F covers:
- Parts A and B deductibles
- Parts A and B coinsurance and copays
- Hospital coinsurance for 365 days (a full year) after Original Medicare Part A benefits
- Hospice care coinsurance
- Skilled nursing care coinsurance
- First 3 pints of blood per year for approved procedures
- Foreign travel emergency care at 80% - up to plan limits
Plan F has the highest premiums of all the Medigap plans because of the broad range of coverage you receive.
One important thing to know is Plan F is being phased out in 2020 for new Medicare members. If you already have Plan F, you can keep it, and if you are a Medicare member before January 2020, it'll still be available.
If you are new to Medicare and were looking forward to purchasing Plan F, the good news is that Plan G is an excellent option because it closely mirrors Plan F.
The only difference between the two plans is that Plan G doesn't cover the Medicare Part B deductible, which will be $198 in 2020.
Plans F and G are the only Medigap plans that offer coverage for excess charges, which are fees that providers out of the Medicare network can charge for services. These very rare fees can be as high as 15% more than Medicare would cost.
Plan N is the third plan that we recommend, and it is also popular with our clients because of the balance it has between out-of-pocket expenses for catastrophic events and its affordable premiums.
Plan N offers the same coverage as Plan F except:
- It doesn't cover the Part B deductible
- It doesn't cover Part B excess charges
- There is up to a $20 copay per doctor visit, and a $50 copay per hospital visit that doesn't result in an overnight stay
Discussing your Medigap plan options with one of our agents will help you make an informed decision as to which plan is right for you.
Read More: The Ultimate Guide for Choosing the Right Medicare Supplement Plan
4. What Are Medigap Household Discounts?
Who doesn't like a discount? Many of the companies that carry Medigap Plans offer a Medigap Household Discount, which is a percentage off your premium. They typically provide this discount to spouses who hold a Medigap Plan with the same company at the same time.
This requirement, however, does vary by carrier and by state. Some companies will offer household discounts if you have another adult living in your home with you, whether they have a policy or not.
The insurance companies are rewarding you for living with someone because usually, those who live with another person make fewer insurance claims than those who live alone, thus saving the insurance carrier money in the long run.
Check with your agent to see what Medigap Household Discounts you are eligible for and if they will make a difference in the plan you choose. You never know - it may be worth choosing one company over another.
Related: Learn the Lingo: What Is A Medigap Household Discount, and How Do I Get It?
5. What Is the Difference Between Medigap and Medicare Advantage Plans?
Medigap Plans and Medicare Advantage Plans are an either/or situation. You can have either a Medigap Plan or a Medicare Advantage Plan – but you can't have both.
Medicare Advantage Plans are similar to employer insurance plans with either an HMO or a PPO. They offer additional coverage that Medicare and Medigap plans don't provide such as:
- Outpatient prescription drugs
- Dental insurance
- Vision insurance
- Hearing tests
With an HMO (Health Maintenance Organization), the premiums are typically lower. Still, the health provider network is more restrictive, and your primary care physician must coordinate all of your medical care.
PPOs (Preferred Provider Organization) have higher premiums, but allow their participants the freedom to see any healthcare provider, even specialists, within their network without a referral.
Medigap Plans work with your Medicare Parts A and B to provide coverage to help cover out-of-pocket expenses you may encounter with your healthcare. When you have a Medigap plan, you don't have any networks, and you can use it in any hospital that accepts Medicare.
Choosing which plan to go with may not be simple, but there are some things you can look at to help you make a decision.
- Consider your current and expected health needs.
- Consider your financial situation – do you need lower monthly premiums or lower deductibles?
- Are there in-network providers or HMO availability in your area?
- Will you need to see specialists for your healthcare needs?
Taking these things into consideration as well as seeking advice from your insurance provider are good ways to help choose which would be the best choice for you.
Medicare Advantage Plan availability is still relatively sparse in the Decatur, IL area, which is why Medigap plans are the more popular choice. However, many clients are starting to gravitate towards the new Medicare MSA plan, which you can read more about here.
6. When Can I Enroll In Medigap?
You have to be enrolled in Medicare before you can purchase a Medigap Plan. When you turn 65, there is a seven-month window within which you can sign up for Medicare. That window includes the three months before you turn 65, the month you turn 65, and three months after the month you turn 65.
After signing up, you'll receive an "effective date" for your Medicare, and then you can apply for Medigap insurance – it's that easy.
If you are still working when you reach 65, and you choose to stay on your employer's group plan, you can sign up for Medicare up to three months before your group coverage ends. Once you sign up for Medicare Part B, you have six months to sign up for Medigap.
Further Reading: When do I need to sign up for Medicare and a Medicare Supplement?
7. How Do I Enroll In Medigap?
Here at Sams/Hockaday, we do all of the research for you. We will get to know you and your situation, and explain each of the Medigap Plans.
We already know which insurance companies sell Medigap policies in Illinois, and we can go over cost comparisons from each of them with you.
Once you decide which is the correct plan, we will help you apply and get you all set up, but we don't stop there.
The best part about us is that we are here for you after the sale. You can contact us at any time with any questions or concerns, and we will help you in any way we can.
Related Article: 6 Reasons You Should Work With A Medicare Supplement Insurance Agent
Is Medigap the Right Choice For You?
Once enrolled in Medicare, you can buy a supplemental plan. Medigap may be what you need to keep your healthcare and your finances in check.
Once you understand what Medigap is and what it has to offer, choosing which plan is right for you should be much more comfortable.
Looking at your current and expected health and financial situation, and discussing any concerns with your insurance provider, is a significant first step. Our agents are ready to help. Contact us today at https://www.samshockaday.com or call us at 800-284-7267.
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