Medigap policies are the most common form of Medicare Supplements. They cover some needs that Medicare may not. Medigap policies are provided by private insurance companies, not the government.
Medigap policies come in eleven different standardized plans. Each is identified by a 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 that company up on the Complaint Index from Missouri DIFP before purchasing a plan. DIFP has a range of resources on Medigap, including a printable guide.
Companies selling Medigaps 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.
Medigap Plan Options
The current benefits for these plans is explained in the following two tables:
|Basic Benefits||Basic Benefits||Basic Benefits||Basic Benefits||Basic Benefits||Basic Benefits||Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%*||Hospitalization and preventive care paid at 100% ; other basic benefits paid at 75%*||Basic Benefits||Basic Benefits, except up to $20 co-pay for office visit and up to $50 co-pay for ERª|
|Part A Deductible||Part A Deductible||Part A Deductible||Part A Deductible||Part A Deductible||50% of Part A Deductible*||75% of Part A Deductible*||50% of Part A Deductible*||Part A Deductible|
|Skilled Nursing Coinsurance||Skilled Nursing Coinsurance||Skilled Nursing Coinsurance||Skilled Nursing Coinsurance||50% of Skilled Nursing Coinsurance*||75% of Skilled Nursing Coinsurance*||Skilled Nursing Coinsurance||Skilled Nursing Coinsurance|
|Part B Deductible||Part B Deductible|
|Part B Excess (100%)||Part B Excess (100%)|
|Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency|
|Benefits paid at 100% after out of pocket limit is reached||Benefits paid at 100% after out of pocket limit is reached|
|See Money Tip Sheet||See Money Tip Sheet||See Money Tip Sheet|
Explanation of Medigap Benefits
|Part A Deductible(B-G & N)||
|Skilled Nursing Coinsurance(C-N)||
|Part B Deductible(C, F)||
|Part B Excess(F & G)||
|Foreign Travel Emergency(C-G, M & N)||
|*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.
^ Plans issued before Jan. 2010 will pay 80% of the excess charge.
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.
A few things to remember before buying a Medigap Policy:
There are also some things you should avoid: