A Medigap policy (Medicare Supplement Insurance) is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (‘gaps’) that original Medicare doesn’t cover: deductibles, copays, coinsurance. Unlike most Medicare Advantage plans that have a maximum out of pocket cap of $6,700 for in network services, Original Medicare has no maximum out of pocket stop. Consequently, Medigap policies can remove some of the anxiety of potentially high medical and hospital costs associated with Original Medicare.
Medigap plans are not Medicare Advantage plans. Medigaps only work if you have original Medicare. There are a number of Medigap plans, A through N, that are standardized and regulated by Federal and state laws. Even though they are offered by private insurers, the various plans must all contain the same benefits regardless of who is offering the plan. The only difference is if the company offers the plan in your area and the monthly premium. To find out which plans are offered in your area go to Find a Medigap Policy.
When is the best time to buy a Medigap policy?
When you turn 65 you have a ‘guaranteed issue right’ to purchase a Medigap plan with no medical underwriting. They can’t deny enrollment for current health conditions. If you have not creditable health insurance in 63 days prior to enrollment, they can exclude pre-existing conditions for 6 months.
Can they cancel my Medigap plan if I become ill?
No, they are guaranteed renewable.
Can I purchase a Medigap policy later after 65?
You can always purchase a Medigap policy after your initial enrollment period, but you will be subject to medical underwriting, may receive a high premium based on existing health conditions or you could be denied.
How do I know if I need a Medigap plan?
In order to determine if a Medigap plan is right for you it is best to review your past medical history. If you have been generally healthy, rarely see a doctor other than for yearly exams and have a generally good health history, original Medicare or Medicare Advantage plan may work just fine for you.
However, if you have chronic health conditions that need extra attention or are certain you will have medical and hospital expenses in the future, then careful attention to the benefits of a Medigap policy is warranted.
There is a health insurance cost calculator on my home page that has a section for estimating potential costs.
If you would like to spend some time going over the benefits and costs of Medicare Supplement plans either on the the phone or in person, contact Kevin Knauss at 916-521-7216.
More detailed information can be found at www.blueshieldca.com