Medicare was not intended to cover every medical expense – there are still copayment, coinsurance, and deductible payments to be made. Can you afford them yourself, or should you get Medigap Insurance to fill the gaps of Original Medicare?
Medigap insurance is simple: You pay a modest premium each month. In exchange, you take much of the pain out of any possible deductibles or copayments. While Medigap is standardized under federal law, these policies are private health insurance plans that cover expenses you may still have even after Medicare has paid its portion of your medical bills. This may includes copayments, coinsurance, deductibles, physician fees, lab fees, the cost of durable medical equipment, and sometimes more.
There are ten types of Medigap Insurance policies available; all have standardized minimum benefits and use the same letter names (with the exception of Massachusetts, Minnesota, and Wisconsin, which each have their own system). This makes it easier to compare rates offered for the same policy by different companies, and to know what policy to shop for if you move to another state. When considering Medigap insurance plans, your first step is to find out what is available in your state.
The good news is that any standardized Medigap policy is guaranteed renewable, which means that coverage cannot be canceled for any reason other than failure to pay the premium. You cannot be dropped because you are sick.
Am I eligible?
Anyone age 65 or older and enrolled in Medicare Part B can purchase Medigap Insurance. However, you may not need a Medigap Insurance policy if you:
- Are already enrolled in a Medicare Advantage Plan (Part C). In fact, it is illegal for anyone to sell you a Medigap policy if you are already in a Part C Plan, unless your Part C coverage will end before the Medigap insurance begins.
- Are covered by Medicaid. Except for certain circumstances, it is illegal for an insurance company to sell you a Medigap policy if you receive Medicaid.
- Have other health insurance, such as coverage from employer/union group health, TRICARE, or VA benefits.
If you are eligible for and in need of Medigap coverage, it is very important to understand the advantages of the open enrollment period.
What is the open enrollment period? Why is it so important?
The open enrollment period for Medigap insurance is a one-time only six-month period that begins the first day of the month in which you are 65 years of age AND enrolled in Medicare. However, some states like the state of Arizona where I am licensed allow you to purchase a Medicare Supplement policy of your choice if you are age 64 and within 6 months of your 65th birthday. This allows you to have things in place in a timely manner as you prepare to enroll in Medicare.
All the best,
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