Medigap Plans
Medicare Supplement Insurance Plans, also known as “Medigap Insurance”, is a private senior health insurance policy.
It is designed to pay for the 8 gaps in physician and hospital coverage left by Medicare Part A and Medicare Part B.
What is covered by Medicare Supplement Insurance? Medigap Insurance Policies cover medical procedures approved by Medicare at a Medicare Provider. Procedures not approved by Medicare are normally not covered by Medicare Supplement Insurance. Some policies offer limited benefits for expenses not covered by Medicare such as at home recovery.
Who is eligible for Medicare Supplement Insurance? Anyone who is covered under both Medicare Part A and Medicare Part B are eligible for Medigap Coverage. Medigap Insurance Companies reserve the right to set further qualification criteria beyond Medicare Eligibility at their own discretion but can not exclude any person who is in an Medicare Open Enrollment Period or Medicare Guaranteed Issue Period.
What Plans are available: Most states only allow standardized Medicare Supplement Insurance Plans. Any Medigap Insurance company offering supplement insurance coverage is required to offer the Medicare Plan A (base plan) and any other combination of Medigap Supplemental plans B-N at their discretion.
Are there any differences in Medigap plans between companies? The coverage between companies for doctor and hospital visits is exactly the same for the same standardized Medicare Supplement policy. For instance, a Medigap Plan F with one Medigap insurance company will pay exactly the same as a Medigap Plan F with any other Medigap insurance company. Medicare plan Companies may choose which standardized Medicare Supplement Policies they wish to offer but all must at least offer Medigap Plan A.
Can you be excluded for having pre-existing conditions? Medicare Supplement Insurance Companies may put a pre-existing conditions clause that limits their liability on previous medical problems for up to 6 months after the issue date of the policy. Some companies will not exercise this option. All companies must waive this limitation for the time that you were covered under previous creditable coverage such as a private or employer sponsored health plan or another Medigap policy.
How do prices vary? Medicare Supplement Insurance Plans prices vary from Medigap company to Medigap company, from Medigap plan to Medigap plan and from Medicare Supplement area to Medicare Supplement area. There is no Medicare Supplemental Insurance Plan standardization of pricing for Medigap Supplement premiums. Therefore, you could pay substantially more for the exact same Medigap coverage if you do not shop around for the best Medigap rate for your particular situation.
Keeping your same doctors and hospitals? Medicare Supplement Insurance Plans do not limit you on the doctors or hospitals that you may choose. There are no networks. You simply choose any provider that accepts Medicare and your Medicare Supplement plan will pay that provider as stated in your policy.
Filing Claims: Medicare Supplement Insurance Plans have a very easy and mostly automated claims process. For Medicare Part B claims each Medicare Supplement Insurance company is linked directly to Medicare. Medicare will send the insurance company a copy of the claim and how they paid (known as a Medicare Explanation of Benefits or EOB) to your Medicare Supplement provider each time they Medicare pays a claim. This is the claim that the Medicare Supplement insurance companies use to determine how to pay your Medicare claim. Because the claims come directly from Medicare, there is rarely a need for you or your doctor to file a claim for outpatient services.
What is the bottom line? Medicare Supplement Insurance Plans are very important and can provide you the peace of mind of knowing that you will not be burdened by the Medicare gaps left by Medicare Part A and Medicare Part B. However, it is important to compare Medigap plans and Medigap rates to make sure that you find the policy that is best for you. As Medicare Supplement Coverage is standardized in most states and the Medigap coverage is the same from Medigap company to Medigap company, it is very important to shop around to find the best available price.