Medigap coverage comes from private health insurance companies. Medicare Supplement Plans allow beneficiaries to see any doctor in the United States that accepts Medicare Assignment.
The supplement can’t drop you due to any health issues. Medigap coverage can include the copayments, deductibles, and coinsurances Original Medicare doesn’t cover.
Medigap Coverage Guidelines
It’s important you understand your state’s rules and requirements for Medicare coverage to help you get the best health-care possible. Medigap coverage rules are specific to Medigap plan types, here’s what Medigap beneficiaries need to know.
Having Medigap coverage can protect you from high out of pocket expenses.
Medigap State Rules
State rules can affect Medicare coverage. Moving out of state means you need to re-examine coverage options and rules as soon as possible.
Some states have a year-round Guarantee Issue for Medigap plans, like New York and Connecticut. Beneficiaries living in these states can apply for a supplement at any time without medical underwriting.
California and Oregon have a “birthday rule”. This is a window of 30 days after a Medigap enrollees’ birthday each year. This rule allows enrollees to change plans during this time without underwriting.
Missouri has a period known as the Anniversary Guaranteed Issue Period. Anyone enrolled in a Medigap plan can use this period to change plans, within 60 days of their enrollment anniversary. This is only when you originally enrolled in a Medigap plan.
What Does a Medigap Policy Cover
A Medigap policy will cover medical costs that are not covered by Original Medicare. This includes additional coverage for deductibles, coinsurance, emergency coverage when traveling outside the U.S., etc.
Medigap plans are identified by letters and each plan has a different level of benefits.
Insurance carriers may choose what Medigap plans they will offer. However, every carrier is required to offer at least a basic benefit Plan A.
Premium rates are higher for plans with comprehensive coverage, like Plan G and F. Medigap plan F coverage is the most complete; however, the policy will be retiring in 2020.
When a benefit is covered by Medicare, your Medicare Supplement plan will also provide coverage. Additionally, some supplement plans have out-of-pocket limits that can change from one year to the next; such as Medigap Plan K or Plan L.
Once enrolled in Original Medicare, Medicare Supplement coverage eligibility begins. Enroll during the Medicare Supplement Open Enrollment Period for Guaranteed-Issue rights; then, be eligible for any Medicare Supplement in your area.
The Guaranteed Issue Period means that carriers can’t deny your application due to health-related issues. Medigap coverage eligibility is available in some states before the age of 65. In other states, Supplement plans are only available to beneficiaries 65 and over.
Laws about Medigap eligibility will vary between states.
Paying for Medigap Coverage
The private insurance company will give you a monthly premium, paying for Medigap coverage is your responsibility. If you don’t pay your premium, then you’re going to lose coverage.
Losing coverage from non-payment is considered a voluntary loss of coverage. You won’t qualify for a Special Election Period to enroll in coverage.
This means you’ll go through underwriting to obtain a policy; you could experience coverage denial or coverage at a much higher premium. Paying your premium in a timely fashion is necessary with Medicare Supplement plans; however, the benefits are worth the cost.
Choosing or Changing Medigap
When changing coverage, keep your old plan for 30 days prior to canceling. When filing your application for a new plan, you must promise to cancel your old one after 30 days.
Everyone gets a 30-day free-look period to switch Medigap plans. The free look period will start when your new policy begins. During this period, you’ll be required to pay both premium amounts.
Until you feel secure with your new policy, you should postpone canceling your old one.
Medigap Billing Process
You may be wondering how the coverage billing process works. Well, Medicare makes the first payment, covering allowable costs.
Afterward, coverage kicks in and pays its portion of the costs of health-care services. Of course, if services aren’t covered you must cover the entire cost yourself. So, follow your plan’s rules and guidelines and don’t get stuck with a high bill.
Medigap & Other Insurance
You can’t be enrolled in both Medigap and Medicare Advantage Plans at the same time. A Medicare Supplement offers coverage for some out-of-pocket expenses that Original Medicare doesn’t cover.
Medicare Advantage Plans provide coverage for specific health-care benefits. Some Advantage plans will offer extra benefits that Original Medicare does not.
A Medigap plan might be your best option if you’re pleased with your Original Medicare benefits but need help with the out-of-pocket expenses.
Enrolling in a supplement plan while having Large employer coverage (20+ employees) could be a waste of money. Medicare Supplement plans can’t cover costs of anything until Original Medicare is your primary health insurance.
However, if your group plan costs are astronomical, then switching to Medicare could be in your best interest.
Those with small employer coverage (under 20 employees) will need to enroll in Medicare; otherwise, you could incur the Part B late enrollment penalty.
Benefits of Using an Agent for Medigap Coverage
Medicare insurance brokers are agents working independently who will give you an unbiased opinion for your best Medigap options.
The kicker? You can get FREE advice. Brokers are giving out advice, collecting data for you, and laying out the facts. What are you waiting for? Let us do the hard part!
Give us a call or fill out one of our online forms and get the process going.