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Not too many people are familiar with Medigap insurance, although they should be. Medigap is an insurance that covers the gaps left by Medicare. And although Medigap is a private coverage insurance, it is highly regulated by both federal and state government, and for this reason, it is affordable for many seniors.
Since the cost of health care is so high these days, even if you’re only responsible for the deductibles, a major illness could have you facing big bills. And sometimes, when doctors or surgeons charge more than Medicare finds “reasonable,” you will have to pay the difference.
When should you buy Medigap insurance? The best thing is to apply for it within six months of first being covered by Medicare, because at this time insurers are required to sell you the policy you want, even if you are considered high risk, or have a preexisting condition. Medigap plans also must be guaranteed renewable, and cannot be canceled as long as you keep paying the premiums.
There are ten different standardized Medigap plans authorized by the federal government. However, individual states can decide which and how many are offered for sale to its residents. But the basic coverage of Plan A is offered in every state, and every insurance company that sells Medigap must offer it. Basically, Plan A covers payments you would be responsible for if you were hospitalized for over 60 days, and Medicare no longer covered you. Medigap would also pay that part of payment of nonhospital care that Medicare Part B wouldn’t cover. And Plan A would cover the first three pints of blood you would need, in or out of the hospital. So plan A is a basic coverage.
The best plan is Plan J, which includes deductibles for all hospitalization expenses, deductibles for nonhospital care, your coinsurance charges for days 21 through 100 in a nursing home, all doctor’s fees over the approved amounts, at-home recovery care, prescription drugs preventative medical care, and even foreign emergency medical care. Of course, Plan J is the most costly of the various plans.
Choosing among all the policies offered can be confusing, so study the various plans well. The Medigap insurer, however, does have to provide you with a comparison chart that explains clearly what each plan covers or doesn’t cover. You can also call Social Security and ask them to send you their free booklet Guide to Health Insurance for People with Medicare, a very helpful booklet on the various alternatives available. And call your own state’s Department of Aging to find out their individual package plan. The United Seniors Health Cooperative at 1331 H. Street, NW, Suite 500, Washington, DC 20005, offers a free analysis of the various Medigap plans. Getting in touch with them, before making the decision, is a wise move.
When choosing a plan, do as much comparison shopping as possible, before you decide. The American Association of Retired Persons, or AARP, offers a plan, as does Blue Cross/Blue Shield. Generally plans offered by large groups like these, are cheaper.
In the end, study the plans and choose wisely, making sure that your Medicare and Medigap policies together cover as many health crises as possible!
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