Medigap Coverage Explained
Randal C. Hill
50plus Magazine
ENROLLING IN MEDICARE AT 65 IS A GOOD START IN protecting yourself as a senior citizen, but this helpful government program does have some gaps in coverage. For example, if you have certain medical needs or conditions, it could cost you — a lot. What to do? Consider Medigap.
What is Medigap? Highly regulated, standardized government insurance that pays fees Medicare doesn’t and helps pay your share of costs for services not covered by Original Medicare Part A and Part B.
What is covered? Medigap policies can add numerous benefits and help defray out-of-pocket expenses associated with Original Medicare — co-payments, co-insurance and deductibles.
What isn’t covered? Most Medigap plans don’t pay for vision or dental, hearing aids, eyeglasses, private duty nursing or long-term care. Also, Medigap plans don’t include prescription coverage; this is available under Plan D Medicare drug plans.
What does Medigap’s cost? It depends on such factors as age, ZIP Code and plan selected. Medigap can be expensive, but compared to what you may have been paying before you turned 65, it may seem like a bargain.
The Pros. Medigap plans defray all or part of Medicare additional fees. You are guaranteed a six-month enrollment period when first eligible. All Medigap plans will approve you, regardless of health, if you apply when you are over 65 and first enrolled in Medicare Part B. Medigap uses the same network as Medicare, so any physician who accepts Medicare accepts Medigap.
The Cons. Switching can be difficult once you’re enrolled. Typically, there is no annual period for changes. If you choose to switch plans, you often must apply and answer health questions for approval. If you missed your initial enrollment and have a pre-existing condition, you may not be eligible for Medigap. Each policy only covers one person, so if you and your spouse both want Medigap coverage, you must each buy your own policy.
When can I sign up? The Medigap Open Enrollment Period is the six-month period starting the first day of the month that you turn 65 and enroll in Medicare Part B. After this, your options to buy a Medigap policy may be limited, and may cost more.
How do I enroll? Find an insurance company in your state that’s licensed to sell Medigap policies and make a list of questions before contacting them. It may be the best call you’ve made in a long time.