What is a Medigap Policy?

A Medigap Policy is another term for Medicare Supplement Insurance. These policies are private health insurance designed to “supplement” or cover the “gaps” that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles.

Medigap Policies sold after January 1, 2006 are not allowed to include prescription drug coverage. If you do not have prescription drug coverage from a previous employer, you can purchase it from a private insurance company approved by Medicare.

To avoid medical underwriting (being asked health questions) purchase your Medicare Supplement within six of enrolling in Part B. If you continue to work after 65 and you work for a company with less than 20 employees you will be required to enroll in Part B. At this point you will have to decide if you would be better off to buy your own policy and go off the small group plan within this 6 month period. If you have pre-existing conditions that could cause you to be declined or “rated up”, you may be better off to purchase your own plan.

The CMS (Centers for Medicare & Medicaid Services) publishes a guide, Choosing a Medicare Supplement policy, that provides a chart detailing the benefits of the 11 different Medigap plans (identified by letters A through N). Since these plans are “standardized”, the benefits are the same no matter which insurance company you choose.

5 Questions you should ask Before Purchasing a Medigap Medicare Supliments consultant Raleigh(Medicare Supplement Insurance) Policy

The first step in purchasing a Medigap Policy is to review a government published guide, such as Choosing a Medigap Policy, and decide which of the 11 standardized plans fits your lifestyle and needs. At no additional cost to you a health insurance broker with a Medicare Supplement license can help you find a plan.

If you want a policy that covers all the “gaps” that Original Medicare does not cover choose Plan F. However, if you are more concerned about a lower monthly premium, then consider a High Deductible Plan F or plans like K or L, which only provide partial payment for your doctor visits.

Since these plans are standardized, it would seem that you should simply choose the insurance company with the lowest premium. However, the company with initially the lowest premium may not be your best deal. Here are the questions you should ask before you buy:

1. How long will my premium be held firm?
Some companies hold your premium firm for a year, but after that you may have increases more than once per year. Others have rate changes once a year at a time that is independent of the policy holder’s start date.

2. Are discounts available to me?
Some insurance companies offer discounts to spouses or other members of your household who buy a Medicare policy from their company.

3. Can I change to a different plan without underwriting (a medical evaluation)?
Some insurance companies will allow you to change from a less expensive policy, such as a High Deductible Plan F, to a very benefit rich policy, like a Plan F without a deductible, after you have been diagnosed with a serious illness.

4. How are the prices set for this policy?
This is important since it affects how much you will pay now and in the future. Medicare Supplement (Medigap policies) are priced these 3 ways:

  • Community rated- Even though your premium may increase due to inflation or other factors, it will not be due to your age. The “community” could be the state of North Carolina and an increase could stem from North Carolina issues affecting medical costs.
  • Issue age (also known as “Entry Age”) – Premiums are lower for those who buy at a younger age and won’t change automatically as you get older. However, they can increase for other reasons such as an increase in claims or higher medical costs.
  • Attained age – Premiums are lower for younger buyers but rise as they get older. Some companies increase the rates automatically once per year or more. Other have no increases or very small ones each year, but increase premiums every 5 years.

5. Do you have a program like Silver Sneakers where I will get a free gym membership?  If you enjoy physical activity this could help you improve or maintain your health without impacting your budget.

Read about Medicare Advantage Plans Here.

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From Our Customers

Dennis Lemley

"Three years ago Wanda saved me a lot of time and aggravation by helping me sort through all my Medicare choices and find a Medicare Supplement plan that fits all my needs."

- Dennis Lemley Wake Forest, NC