Business Development Officer, T.D. McNeil Insurance Services, Fresno, California
A “medigap” policy is also known as a Medicare Supplement policy. These policies are issued by a number of insurance companies in response to the out of pocket expenses that are not covered by Medicare, part A and Part B.
A “medigap” policy is almost necessary for all Medicare participants. There can be massive out-of-pocket expenses in Medicare and the money that could be provided by the plan far outweigh the cost of the plan.
These plans were developed by private companies. In response to the wide variety of policies developed the federal government decided to regulate these policies in the 1980s. The desire was to provide uniformity of benefits.
There are ten different “medigap” policies available. They are referenced by letters A, B, C, D, F, G, K, L, M and N. Although these plans can change from time to time they have maintained these designations. Companies are not required to identify their policy by these letters and will often introduce stylized names such as “Senior Select Medigap policy.”
It is most important to understand that all of the plans must contain “core benefits.” As they add additional benefits they must fall into one of the letter categories. This helps to compare plans and to insure that your needs are properly covered.
You can enroll in a “medigap” policy during certain periods. During those periods the policy is guaranteed to be issued without medical underwriting. If the policy is desired after the set period medical underwriting can be required and the premium can be altered. The open enrollment period begins on the first day of the month in which you reach age 65 or older and enroll in Medicare Part B. This enrollment period continues for six months.
People who are disenrolling from Medicare Advantage can receive a guaranteed issued “medigap” policy for 12 months when they enroll in traditional Medicare. There are other circumstances under which a person would be eligible for a “Medigap” policy without providing evidence of insurance.
There are five core benefits contained in every “medigap” plan. The first is that the plan will pay the Medicare Part A copayments for days 61-90. These copayments were $289 per day of hospitalization in 2012.
Another core benefit is Medicare Part A lifetime reserve copayments for days 91-150. These copayments are $578 per day in 2012.
Another core benefit is up to 365 additional days of hospital stay beyond Medicare coverage.
The “medigap” policies also provide cover the Medicare Part B coinsurance. This doesn’t apply to preventive services, and the first three pints of blood if needed.
These core benefits comprise an “A” plan. Subsequent plans offer increased benefits which include skilled nursing facility care copayments for days 21-100. That cost was $144.50 in 2012. The plan can provide for the Medicare Part A hospital deductible. That amount was $1184 in 2013. The plan can provide the annual Medicare Part B deductible which was $147 in 2013. Some plans include coverage for the Medicare Part B excess charges. Several plans include foreign travel emergency coverage.
Every plan is priced by the insurance company. Sometimes the company offers the plan based upon the community. In other cases the pricing is determined by the age at which the plan is initiated. In other cases the plan is based on attained age and can increase as the policyholder ages.
The core benefits can save you a great deal of money. Selecting the additional benefits is probably best done with a counsellor that you trust.
Another name for Medigap policy is Medicare Supplement. Medicare Supplements pay deductibles, co-insurance and co-pays that Medicare does not cover when you go to the doctor or hospital. Most Medicare Supplements pay the Medicare Part A hospital deductible of $1,288 when you are admitted into the hospital and cover the 20% Medicare leaves off for doctor and outpatient visits under Part B of Medicare.
.JPG){kind=avatar}
A “medigap” policy is almost necessary for all Medicare participants. There can be massive out-of-pocket expenses in Medicare and the money that could be provided by the plan far outweigh the cost of the plan.
These plans were developed by private companies. In response to the wide variety of policies developed the federal government decided to regulate these policies in the 1980s. The desire was to provide uniformity of benefits.
There are ten different “medigap” policies available. They are referenced by letters A, B, C, D, F, G, K, L, M and N. Although these plans can change from time to time they have maintained these designations. Companies are not required to identify their policy by these letters and will often introduce stylized names such as “Senior Select Medigap policy.”
It is most important to understand that all of the plans must contain “core benefits.” As they add additional benefits they must fall into one of the letter categories. This helps to compare plans and to insure that your needs are properly covered.
You can enroll in a “medigap” policy during certain periods. During those periods the policy is guaranteed to be issued without medical underwriting. If the policy is desired after the set period medical underwriting can be required and the premium can be altered. The open enrollment period begins on the first day of the month in which you reach age 65 or older and enroll in Medicare Part B. This enrollment period continues for six months.
People who are disenrolling from Medicare Advantage can receive a guaranteed issued “medigap” policy for 12 months when they enroll in traditional Medicare. There are other circumstances under which a person would be eligible for a “Medigap” policy without providing evidence of insurance.
There are five core benefits contained in every “medigap” plan. The first is that the plan will pay the Medicare Part A copayments for days 61-90. These copayments were $289 per day of hospitalization in 2012.
Another core benefit is Medicare Part A lifetime reserve copayments for days 91-150. These copayments are $578 per day in 2012.
Another core benefit is up to 365 additional days of hospital stay beyond Medicare coverage.
The “medigap” policies also provide cover the Medicare Part B coinsurance. This doesn’t apply to preventive services, and the first three pints of blood if needed.
These core benefits comprise an “A” plan. Subsequent plans offer increased benefits which include skilled nursing facility care copayments for days 21-100. That cost was $144.50 in 2012. The plan can provide for the Medicare Part A hospital deductible. That amount was $1184 in 2013. The plan can provide the annual Medicare Part B deductible which was $147 in 2013. Some plans include coverage for the Medicare Part B excess charges. Several plans include foreign travel emergency coverage.
Every plan is priced by the insurance company. Sometimes the company offers the plan based upon the community. In other cases the pricing is determined by the age at which the plan is initiated. In other cases the plan is based on attained age and can increase as the policyholder ages.
The core benefits can save you a great deal of money. Selecting the additional benefits is probably best done with a counsellor that you trust.