Medigap Insurance: Covering What Medicare Doesn’t

If you’re 65 or older and eligible for Medicare, the federal health insurance program, you have some choices to make, such as: Enroll in Original Medicare, possibly adding Medigap insurance, or choose a Medicare Advantage (MA) plan.

What is Medigap?

Medicare doesn’t pay for every charge or service. You could be responsible for a percentage of your medical bills and out-of-pocket expenses. To help pay those bills, Medicare supplemental insurance, also known as Medigap, is available.

Medigap work with Original Medicare, which has two parts: A and B. Part A pays for inpatient hospital, skilled nursing facility, home health and hospice care. Part B pays for doctors’ visits, outpatient hospital care, durable medical equipment and other medical services.

Private insurance companies sell Medigap policies to cover Medicare coinsurance, co-payments and deductibles that you otherwise would have to pay yourself. Depending on the policy you choose, it could pay for costs that Original Medicare doesn’t cover, such as prescription drugs. You may need to buy a separate policy or Part D drug plan for drug coverage. Note: You are likely to pay a penalty for drug coverage if you add it later, rather than when you first enroll.

What is Medicare Advantage?

Medicare Advantage plans are an alternative to Medicare. These plans are purchased through private insurers and generally consolidate benefits from Medicare parts A and B.

MA is sometimes called Part C and is usually an HMO or PPO, says Patricia Barry, AARP’s “Ms. Medicare” columnist and author of “Medicare for Dummies, 2nd Edition.” With most Medicare Advantage plans, you must use doctors, hospitals and other providers in the plan or you pay more or all of the costs. Most MA plans include prescription drug coverage, but not all, so be sure to check if you want it, Barry says.

Medigap doesn’t have open enrollment period

Is there an annual open enrollment for Medigap plans? I have a Medigap plan and the premiums keep increasing every year. I want to find a similar plan at a lower premium.

Unlike Medicare Part D and Medicare Advantage Plans, there is not an annual open enrollment for Medigap plans. The best time to consider a Medigap plan is when you are new to Medicare Part B.

During the first six months that you have Medicare Part B, you have an initial enrollment period for Medigap plans. Federal rules state that during that first six months that you are both age 65 (or older) and you have Medicare Part B, you may purchase any Medigap plan available in the state in which you live.

Maryland law extends protections to people who are under age 65 and have Medicare due to a disability. Maryland allows the under-65 disabled person the right to some (not all) Medigap plans during the six months a person is new to Medicare Part B.

Outside your initial enrollment period for a Medigap, there are seven other specific times a person over age 65 could be sold a Medigap plan without the plan asking your health history. The booklet, “Choosing a Medigap Plan,” is available by calling 1-800-Medicare or it may be viewed/downloaded by visiting www.medicare.gov. This booklet explains the initial enrollment period and the seven specified “guarantee issue” situations.

Bonus Years: From cotton fields to the top of federal law enforcement

Bonus Years: From cotton fields to the top of federal law enforcement

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My first introduction to classical music was Rossini’s “William Tell Overture.” It wasn’t because Rossini was a favorite on our living room record player or because my parents had tickets to the Lafayette (Indiana) Symphony Orchestra.

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(Phil Burgess)

You state you currently have a Medigap plan. Medigap plans are automatically renewable — meaning a person will automatically maintain enrollment year after year (as long as the person continues to make premium payments). You also mention the premium cost has increased for your Medigap. Over time, Medigap plans increase premium costs.

You want to know if you can switch to a less costly plan. If you do not fall into the initial enrollment period or you do not meet one of the specific “guarantee issue” situations, your enrollment into another Medigap plan is up to the discretion of the new plan.

Savvy Senior: How to choose a good nursing home

Savvy Senior: How to choose a good nursing home

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Bottom line: A new plan can ask your health status and a new plan is not required to sell you a policy. If you find a less costly Medigap plan, do not drop your current coverage until you are certain a new Medigap plan is willing to sell you a policy.

I have heard that if a person has limited income and assets, the state of Maryland could pay the Medicare Part B monthly premium. How do I apply for this program?

People with limited income and assets may apply for the Medicare Savings Program to cover the monthly costs of their Medicare Part B premiums.

Individuals with income below $1,343/month and assets below $8,780 (not counting their home, car, life insurance and personal possessions) may qualify for the program. Married couples may qualify if their combined income is below $1,813/month and their assets are below $13,930.

For more information about this program, contact your local State Health Insurance Assistance Program at 410-222-4257, ext. 3080.

Amy Rubino is director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257, ext. 3080, or ship_program@aacounty.org.

Medigap policies do not cover Medicare Advantage Plan

Posted: Thursday, December 3, 2015 10:15 pm

Medigap policies do not cover Medicare Advantage Plan

By Banker Phares
Contributing Writer

The Daily Sentinel

|
0 comments

This is the first article dealing with Medigap policies. Because of the complexity of the subject, it will be necessary to break the subject into several articles.

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on

Thursday, December 3, 2015 10:15 pm.

Switching your Medigap policy before Dec. 7? Don’t be fooled by the hype

My mailbox is being flooded with ads about switching my Medigap policy to a Medicare Advantage plan, a prescription drug plan – Part D, or a different Medigap company. TV ads also abound.

2016 “Medicare  You” handbook 10050LSome offer plans with premiums “from $0 a month” and use terms such as “urgent” and “don’t delay.”

The deadline for switching to Medicare Advantage or a prescription drug plan – Part D is Dec. 7.

What is Medicare Advantage and what’s all the hype about?

Medicare Advantage a way to combine Original Medicare and supplemental or Medigap policies. The companies receive a federal payment per person per month to manage Medicare benefits for recipients. Instead of receiving statements from Medicare and your Medigap company, you’ll just get one statement.

I’m not a fan of Medicare Advantage plans. Some members of Congress think giving private companies extra money to manage Medicare recipients’ benefits is too expensive. As a result, Medicare Advantage plans could be changed significantly or eliminated.

Other disadvantages:

  • Insurance companies may use high-pressure sales to get seniors to switch to Medicare Advantage plans.
  • Comparing insurance policies is difficult. Unless seniors are careful, they could end up paying more money for fewer services.
  • Seniors may have to change doctors and hospitals.
  • Some Medicare Advantage plans don’t offer prescription drug benefits.
  • Seniors may have to wait for the next enrollment period to transfer out of the plan if they don’t like it.

What the hype is about is trying to get you to switch out of the Medigap policy you have into what the company is offering. They don’t have the best interests of the consumer in mind, just making more money.

And, be wary of getting a policy with a $0 premium. That means you’ll be getting fewer services and paying much higher deductibles. Watch the relationship between premiums and deductibles. The lower the premium, the higher the deductible.

If you have Original Medicare and a Medigap policy, insurance that covers what Medicare doesn’t pay for, you can switch to a different Medigap policy at any time. But, you can’t switch from it to a Medicare Advantage plan or prescription drug plan – Part D. That enrollment period is Oct. 15 to Dec. 7.

The Washington State Insurance Commissioner’s Office suggests before you make your decision, consider the following tips:

  • Plan costs and coverage can change every year, so carefully review all letters and notices from your current plan.
  • Make a list of all current prescription drugs you take, the doses, and how often. Then, use the Medicare Plan Finder at www.medicare.gov to compare Part D plans.
  • Review the 2016 “Medicare You” handbook. Copies are sent to Medicare recipients in mid-October.
  • If you have questions, call SHIBA at 800-562-6900 before you sign up. SHIBA stands for Statewide Health Insurance Benefits Advisors.

To schedule an appointment with a SHIBA volunteer, do one of the following:

  • Call the Insurance Consumer Hotline at 800-562-6900 and ask to speak with a SHIBA volunteer in your local area.

For more information for boomer consumers, see my blog The Survive and Thrive Boomer Guide.

Medigap is ‘grandfathered-in’

Passed by Congress earlier this year, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will prohibit the sale of Medicare supplement plans that cover the Part B deductible, beginning in 2020.

However, the prohibition will apply only to those who become newly-eligible Medicare beneficiaries on or after January 1, 2020.

Current beneficiaries with Medigap plans that cover the Part B deductible will be allowed to retain their coverage.

“We want to make sure Minnesota seniors don’t drop their Medigap coverage because of any misunderstanding,” said Rothman. “Beneficiaries who are already eligible or enrolled in Medicare will be able to continue their Medigap plans even beyond 2020.”

Medicare supplement plans are sold by private insurance companies to cover gaps in Medicare coverage.

They help pay for out-of-pocket costs (coinsurance, copayments and deductibles) related to Medicare-covered services.

For Part B, these include physician, outpatient, preventive and some home health services.

Generally, the best time to purchase a Medicare supplement policy is when you first become eligible for Medicare Part B, because lower rates are available, the application process is simplest and coverage cannot be denied due to pre-existing health conditions.

Medigap ‘help’ from our government

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Editor, Citizen Medicare supplemental insurance, so called Medigap plans have been attacked. Most Medigap plans pay the beneficiaries’ deductibles and co-pays. The reason for purchasing these plans is that they cushion you from the out of pocket impacts of Medicare services which you need when you can least afford them.


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