Medigap Insurance Policies

Welcome to MedigapInsurancePolicies.com, your one-stop-shop for information on Medicare Supplemental insurance! Our goal is the make this process for you as easy as possible as we know how confusing Medicare can be. Regardless of your current situation we can easily help you find the best Medigap insurance to fit your needs.

By now you have likely received several pamphlets in the mail from many different insurance carriers and Medicare, which leaves most people even more confused on where to start. This website is designed to help walk you through the process from start to finish on the smartest way to choose a Medigap policy.

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Start With the Basics

Let’s start with what it is exactly you are intending to supplement, and why. Original Medicare has what are called “Parts” to them. These are not to be confused with Medigap plans, which we’ll cover in a bit. The parts of Medicare are:

  • Part A (Hospital charges)
  • Part B (Covers Doctor’s Services and charges)
  • Part D (Prescription drug coverage)

There also is something called Part C, which is a Medicare Advantage plan. Parts A, B, and D are often referred to as “Original Medicare”. When you receive your Medicare Card you will have both Part A and Part B listed on it with your effective date of both.

 

Anyone who is turning age 65 in the United States and has paid into the Medicare system through payroll taxes for 10 years (40 quarters) is eligible to receive both Part A, B, and Part D as well as enroll in one of the Medigap Policies offered.

Original Medicare Costs

Although you might have paid into the system all those years to be eligible for Medicare, this does not mean that Medicare is free now. Your payments have granted you eligibility as well as paid for Part A. Therefore there is no monthly premium that you have to pay for Part A coverage. Medicare Part B however, does have a monthly premium and it is based on income.

Medicare Part B Premiums

As you can see the average person who is eligible for Part B will pay a $104.90 per month premium in 2013.

Medicare Part B offers coverage for two types of services you will likely need:

  • Any Medically-necessary services – These are services or supplies that are needed to diagnose or treat a medical condition that fall under normal medical practice accepted standards
  • Preventative services – This is any care you receive to help prevent any illness or conditions, or help detect something early on where treatment can be utilized quickly to be most effective. This might include things like flu shots or blood work

So Why Get Medigap Insurance as Well?

Medicare Part A and B do offer relatively good coverage, however they do not pay for all the expenses you will incur as a patient. Some of the “gaps” or expenses that you are responsible for through Parts A and B are:

  • An annual Part B Deductible – This deductible is $147 in 2013 and fluctuates slightly every year up or down, but is close to $150 on average. Prior to Medicare Part B paying a dime of your medical bills, someone (Either you out-of-pocket, or your Medigap policy) has to pay this deductible.
  • Part A Hospital Deductible – This must be paid each time you are admitted into the hospital  each 60 days, commonly referred to as a benefit period. This means if you do get admitted to the hospital you must pay a $1184 deductible. If you are released and stay out of the hospital for 60 days or more, but then return you must pay this deductible again. Therefore it is not an annual deductible. The most popular Medicare Supplement plans pay this deductible for you along with the 20 percent coinsurance.
  • Part A Hospital Coinsurance – With just Medicare Part A and B you are required to pay hospital coinsurance after a certain amount of days:

Day 61-90 – $296 coinsurance per day of each benefit period

Day 91 and beyond: $592 coinsurance per each “lifetime reserve day” after day 90 of each benefit period

Beyond your life time reserve days you must pay 100 percent of all costs

While that might seem confusing, let’s put it this way: If you have just Original Medicare and end up in the hospital for any great length of time, it gets very expensive!

The gap that would concern more people is that Part B Medicare only pays 80 percent of approved medical bills. This means you are responsible for the remaining 20 percent as well as the other gaps we discussed.

What are Medigap Insurance Policies?

Medigap (Or Medicare Supplements) was designed right along with the Medicare system to allow consumers to purchase supplemental insurance for Medicare from private companies who’s plans were to be regulated through Medicare. These plans are not HMO’s or PPO’s, in fact there is no network as they supplement Medicare which is a federal program.

These plans are designed to pay most or all of the gaps or expenses listed above that are not covered under Part A and B Medicare. For instance a Medicare Supplement Plan F pays 100 percent of the gaps in Medicare.  There is a separate monthly premium you must pay to have a Medicare supplement plan and they offered by several different companies.

 

Who is Eligible?

Anyone who is eligible for Medicare Part A and Part B may obtain Medigap insurance as well. While you may have read about enrollment periods of Medicare, these do not apply to Medicare supplement plans unless you are coming off a Medicare Advantage plan. We’ll cover those scenarios in a bit.

While you may enroll at any time into a Medigap policy, there are certain times where it makes sense to do so, particularly if you have pre-existing health conditions. For most people enrolling in a plan when you first are eligible for Part B Medicare makes the most sense. During this period, called the “Open Enrollment Period” you have 6 months from the effective date of Part B Medicare to enroll in a Medicare supplement policy without having to undergo medical underwriting.

This means you simply fill out an application with any of the Medigap insurance companies and they must accept you regardless of your current health status. And because these plans are guaranteed renewable, the insurance carrier may never cancel your policy based on your own health claims or condition. The only way the policy can ever be canceled is for failure to pay your monthly premiums.

 

What is Your Current Situation? Find Out When To Enroll

Turning Age 65

This is the most common scenario, especially for all the baby boomers coming along.  This is the open enrollment period as discussed above which allows you to obtain Medicare Supplemental insurance regardless of any pre-existing conditions. While this might not matter as much to those who are healthy, it simply makes sense to begin your Medigap coverage the same day as your Part B Medicare so there are no gaps.

Medicare and your supplemental insurance will begin on the first day of the month you turn age 65. If you are born on the first of the month your coverage begins a month before you turn 65. You also have your birth month and up to 3 months after to enroll in a Part D drug plan. Anyone not enrolling during this time will incur a small penalty when they finally do decide to enroll in a Part D plan.

Coming off Group/Employer Health insurance

Many people work beyond the age of 65 as well as hold off on collecting Social security until they can get the full amount. If their employer’s coverage allows many hold off on enrolling in Part B Medicare to take advantage of their group coverage and save on premiums. If this is the case and you are retiring, then the Open Enrollment Period as stated above applies to you. You have 6 months to enroll in a Medigap policy from the effective date of Part B Medicare.

Because Medicare will automatically enroll you in Part B if you are collecting a Social security check, many people are still working and receiving medical benefits from their employer but also have Part B Medicare in effect. In most instances your employer coverage is primary and Medicare is secondary. In this case if you are retiring and your group plan is primary you will likely have 63 days from the termination date of your group coverage to enroll in a Medicare supplement policy with no medical underwriting. This is called “guaranteed issue”. This does not mean you cannot enroll in a supplement plan after this period. If you did wait you would simply have to go through medical underwriting. Therefore if you are in this situation and have health conditions then you will likely want to enroll in a plan during the 63 days.

The time frames listed and your eligibility when coming off group coverage might vary by state and situation. Please contact us and we can easily let you know your eligibility status based on your own current situation.

Shopping for a Better Rate for Your Medigap insurance?

Medicare supplemental insurance offers outstanding coverage for relatively low premiums, however these premiums do go up (typically once per year) as carriers have rate increases which can be based on several factors. As well, the most common question we get asked is “If Medigap insurance companies all have the same coverage, how can they all have different premiums?”

While the plans are standardized, Medigap premiums are not. This is actually a good thing as it’s healthy for the market, but also the premiums are based on the health of the group you are in. If a company has several claims being paid out from a particular group of people, then they must adjust their rates accordingly the following year to be able to maintain business and pay costs.

That being said, this absolutely does not mean you need to stay with any particular company! For this reason we have an annual review process in place where we shop the top carriers every time you get a rate increase to ensure you are always paying the least amount possible for the best coverage that you qualify for.

If you are in fact shopping for a better rate on your Medicare supplement policy, please be aware:

**You May Change Medigap Policies Any Time Throughout The year!**

We cannot tell you how many times people have called us in October to shop their rates because they thought they had to wait until the Annual Enrollment Period to change plans. They were overpaying on their coverage the entire year and could have saved hundreds, sometimes thousands of dollars. This could be partly the fault of their agent who never called them to show them other options. This happens far more than we’d like to see, but this is also why WE shop the rates, so YOU don’t have to each year! We provide Medicare Supplement quotes for free on this website.

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Therefore, if you are looking to change policies you will simply have to answer the medical questions and authorize the new company to check your medical history in order to switch plans. Different carriers have different underwriting guidelines, so please do not feel you would be automatically declined because you have had a medical condition. Let us show you all of your options (and we almost always have an option!) available today, and at the very least we can let you know at what time period you should probably try to make a change. Using our expertise saves you a great deal of time, energy, and money….because our consultations are always FREE!

Just Have Part A and Part B Medicare?

For anyone beyond their initial 6 month open enrollment period (from the day Part B Medicare went into effect) who just has Part A and Part B Medicare, and perhaps Part D, you may still enroll in a Medigap at anytime you wish during the year. You will have to go through medical underwriting on your policy and it is up to the insurance carrier as to if they accept you or not.

If you are in this situation please call us. We almost always have an option for people even if you have pre-existing conditions, or we can at least get you in the right direction if we don’t have the best solution.

Coming off a Medicare Advantage Plan and Returning to Original Medicare

If you have been on a Medicare Advantage plan for more than 12 months and wish to obtain a supplement plan, for instance perhaps a Medigap Plan F, then you must wait until the Annual Enrollment Period (AEP) before you can change. This period runs from October 15th through December 7th and any changes made during this time will take place on January 1st.

There is also a Special enrollment period that you can make this change which takes place from January 1st – February 15th. If you return to original Medicare during this period you must also enroll in a Part D drug plan if returning to Original Medicare.

In either of the situations above if you are leaving an Advantage plan that you have been on for more than 12 months, you will have to go through Medical underwriting and get approved to obtain a Medicare supplement policy.

For people who have been on an Advantage plan for less than 12 months and it was the first Medicare plan they have ever enrolled in, you qualify for a trial-right period if you wish to opt-out of the plan within the first 12 months. As well, if you have been on a Medigap plan since you first were eligible for Part B Medicare, then decide to try a Medicare Advantage plan you are also eligible to return back to the same Medigap plan you had during the first 12 months and not have to go through medical underwriting (Guaranteed issue).

 

Get Expert Help…at No Cost!

As you can see there are several different scenarios that might apply to someone who is eligible to obtain Medicare supplemental Insurance. You might even experience a few of these situations during your time on Medicare. This doesn’t mean you have to go it alone. We’re here to help educate you and take all the guesswork out of the Medicare maze.

Sure you could try to do it alone, but why not take advantage of our FREE, No-Obligation consultations? We’ve helped thousands of people save money on their Medigap insurance policies and we’d love to work with you as well.

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