So-called “Medigap” coverage is supplemental coverage that’s available for people who opt to be covered under Original Medicare’s Part A and Part B coverage. You buy Medigap insurance from a private insurer. Your primary goal is to determine whether that supplementary coverage actually pays for the things you know you’ll need that Medicare doesn’t cover. You do have to pay a monthly premium for this coverage. And again, if you choose Medicare Advantage (Part C) coverage, you’re not allowed to buy Medigap coverage.
To compare Medicare and Medigap coverage, visit the Medicare Personal Plan Finder on the Medicare.gov website.
There are 12 standardized policies: Plan A to Plan L. Each has a different set of benefits. Medigap policies only work with the Original Medicare plan. You do not need to buy a nor are you even allowed to buy a Medigap policy if you are enrolled in a Medicare + Advantage Plan.
Medigap policies follow certain Federal and state laws designed to protect you. They must be clearly identified as Medigap policies. Medigap policies must provide specific benefits that help fill in the gaps in the original Medicare plan.
Insurance companies must use the same format, language and definitions when describing all of the Medigap policies. They must also use the same uniform chart and outline of coverage to summarize the benefits of each plan. Because of these requirements, it is easier for you to compare the policies of different insurance carriers. Most of the cost difference between providers is due to geographic area of coverage and that particular provider’s claims history.
Standardized Medigap Plans: There are 12 standardized policies. Plan A is the basic benefit package. Each of the other plans includes the basic Plan A, plus different combinations of additional benefits. Plan L will provide the most coverage. Insurance companies cannot change the combinations of benefits or the letter names of them.
Medicare Select: This is a type of standardized Medigap insurance policy. If you choose this policy, you are choosing one of the standardized Medigap plans.
The only difference between Medicare Select and Standardized Medigap insurance is that each insurance company has specific hospitals, and in some cases, specific doctors that you must use. The premiums for this policy are usually lower.
Basic benefits:
• There are basic benefits that every plan (Plans A-L) must include. These are:
• Hospitalization—Pays Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits end.
• Medical expenses—Pays Part B coinsurance (generally 20% of Medicare-approved expenses)
• Blood—Pays for first 3 pints of blood each year
The Medicare coverage selection process involves a lot of choices. Be sure to involve those who might be helping to take care of you in this process. Whether it’s your spouse, your children, or someone else, they will want to help. It may make their job of helping you that much easier.
As always, please visit our website www.weslingfinancial.com or email us at info@weslingfinancial.com for further info and to discuss your personal situation.