Medigap Policies

Medigap policies come in eleven different standardized plans. Each is identified by the letter “A” through “N.” Because they are standardized, the benefits provided in any plan with the same letter will be the same, no matter what company sells you the plan. However, the cost for that plan (premium price) will vary between companies.

It is important to compare the different policy types before buying a Medigap plan. Because the plans are standardized, you can easily shop for the company with the best price. The Medigap Rate Guide from the Missouri DIFP can help you find the best prices in Missouri. You may also want to look at that company upon the Complaint Index from Missouri DIFP before purchasing a plan. DIFP has a range of resources on Medigap, including a printable guide.

Companies selling Medigap policies must also meet several requirements. They must guarantee the plan is renewable. Benefits must be clearly disclosed. The insurance company must allow you a 30-day period during which you can cancel the policy with no penalties. They also cannot sell a policy to someone that already has one.

The current benefits for these plans are explained in the following two tables:


Explanation of Medigap Benefits

Basic Benefits(A-N)• Coverage for coinsurance for days 61-90
• Coverage for coinsurance for Lifetime Reserve Days 91-150
• Coverage for an additional 365 days of inpatient hospital care
• Coverage for the first three pints of blood
• Coverage for the 20% coinsurance for Part B services
• Coverage of the hospice 5% coinsurance for Medicare-approved charges for inpatient respite care and 5% coinsurance for prescription pain medications
Part A Deductible(B-G and N)• Coverage for the inpatient hospital deductible for each benefit period
Skilled Nursing Coinsurance(C-N)• Coverage for the skilled nursing coinsurance for days 21-100
Part B Deductible(C, F)• Coverage for the yearly deductible
Part B Excess(F and G)• Coverage for Part B charges over the approved amount
• Plans F, I, and J pay for 100% of the excess charge
• Plan G pays for 80% of the excess charge
Foreign Travel Emergency(C-G, M and N)• Coverage for emergency care for the first 60 days of a trip outside the US
• The beneficiary pays for a $250 deductible and 20% of the cost (up to $50,000)

*High Deductible Option–Plans F and J have a high deductible option. Plans with the high deductible option may have a lower monthly premium. For this type of plan, the beneficiary pays a deductible each year before the supplement pays for any services. This deductible amount is subject to increase each year.


Enrolling

When you first enroll in Medicare Part B, you have six months when you can choose whichever policy you want wants and cannot be turned down. This is known as your open-enrollment period.

If you are eligible for Medicare because of a disability, you will have two six-month open-enrollment periods, one when you first enroll in Part B and the other beginning the month you turn 65.

Once you have a Medigap policy, you may switch companies each year during the 60 days surrounding the anniversary date of your policy. You are only guaranteed to be able to change companies, however, not policies. For example, if you have Policy F, the company does not have to let you switch to Policy J.

Beneficiaries under age 65 have the right to suspend or turn off their Medigap policy if she/he becomes eligible for coverage under an Employer Group Health Plan (EGHP). The beneficiary will not pay the premium and the policy will not pay any benefits. With the loss of the EGHP, the beneficiary may reactivate the policy within 90 days without any pre-existing condition exclusions, waiting periods, or underwriting.

Beneficiaries who become eligible for Medicaid also have this right. Beneficiaries are allowed to suspend a Medigap policy for up to two years. Again, the beneficiary must notify the Medigap company within 90 days of the loss of Medicaid benefits to reactivate the policy without any pre-existing condition exclusions, waiting periods, or underwriting.

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