What to Know When Considering Medigap and Medicare Advantage Plans
I was wondering if you could help me out. I’m looking for supplemental insurance to go along with my Medicare. The costs are high and the deductible on some is $2,000! I’m 67, retired and on a fixed income. Any suggestions?
– Paul, Chicago
Kathy Lipscomb, health care advocacy consultant at KL Services, LLC, in Skokie, Ill., was one of the experts providing health insurance guidance in the above-mentioned Help Squad column, so it was to her that I turned for advice on Paul’s behalf.
Lipscomb began by explaining that Medicare supplemental insurance, also known as Medigap coverage, is insurance that can be purchased to cover costs that original Medicare _ Part A (hospitalization) and Part B (medical) _ doesn’t cover. These costs can include copayments, coinsurance and deductibles. A Medigap policy will not cover Medicare Advantage Plan (Part C) copayments, deductibles or premiums. Medigap is designed to supplement original Medicare benefits, whereas Part C is a policy purchased from a private insurer to cover Part A, Part B and extra benefits such as vision, hearing, dental and prescriptions. Part C plans are used in place of, not in combination with, Medigap. (Medicare pays a fixed amount each month to the companies providing Medicare Advantage Plans to Medicare policyholders.)
Another important point to note: The timing of Medicare enrollment is different than health insurance marketplace open enrollment. Per the Medicare.gov website: “The best time to buy a Medigap policy is during your six-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B. After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more … If you apply for Medigap coverage after your open enrollment period, there’s no guarantee an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements.”
Lipscomb recommended the following for selecting a Medigap policy: First, go to Medicare.gov, then click “Supplements and Other Insurance” at the top of the page. From the drop-down, select “How to Compare Medigap Policies.” This provides a chart comparing the various plan options and what is covered in each.
Said Lipscomb: “It is important to remember that all policies, by law, offer the same standardized basic benefits. So, Plan G from insurance provider ABC is going to have the same benefits and coverage as from insurance provider XYZ. Only the cost of the policy might be different.” She added that some plans offer coverage when traveling out of the country and some might include your Medicare Part B premium. She emphasized the importance of comparing copays and deductibles before deciding on a plan.
Medicare.gov can assist consumers in finding Medicare supplemental plans in their area if they click on “Find health & drug plans” under the “Sign Up/Change Plans” tab at the top of the home page. Lipscomb additionally recommended checking individual insurance companies’ websites, contacting AARP, and/or speaking with an insurance broker who sells medical insurance.
And for those interested in exploring Medicare Advantage Plans (Part C), Medicare.gov provides assistance via “Your Medicare coverage choices,” which can be found in the drop-down under the “Sign Up/Change Plans” tab.
It is important to evaluate your overall Medicare costs and benefits when deciding whether or not to enroll in an Advantage Plan. As explained on the Medicare website: “Your cost sharing is lower (or included) if you’re in a Medicare Advantage Plan.” However, it is possible that your premium will be higher than it would be if you had original Medicare combined with a Medigap supplement.
Lipscomb advised: “Most major insurance providers have a Part C plan. You can contact insurance providers through their websites. Also, retirees should check with their former employers. If they worked for a large company, they may be able to get Part C coverage through that company.”
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