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Reasons for Considering Getting Medigap Insurance

supplemental insurance

There are a number of issues to consider before getting private medical insurance such as supplemental insurance/Medigap insurance. Would you benefit from insurance to help pay your Medicare bills (deductibles, copayments, etc.)? Or, are your bills low enough that a Medigap premium would be an unnecessary expense? What about the future? You may be healthy now, but what about 6 months from now?

If you have Medicaid coverage or you are enrolled in a Medicare Advantage Plan, you do not need a Medigap plan. In fact, it is illegal for anyone to sell you a new Medigap plan if you are enrolled in a Medicare Advantage Plan. If you enroll in a Medicare Advantage Plan, you can keep the Medigap plan you already have, but this may not be a wise financial decision. Consider dropping any Medigap coverage when you join such a plan. If, however, you have the financial means to keep such a plan it could still make sense.

Private health insurance providers can advise you with your choices for senior health insurance but it is a good idea to be prepared with questions for them. Ensure that Medigap insurance will benefit you, short-term and long-term.

There are 12 Medigap plans offered labeled A-L. These do not differ from state to state or insurance company to insurance company. Some plans can no longer be sold but you can keep them if you purchased the plans before June, 2010. Two new plans (M, N) are also being added. The fact that these plans do not differ somewhat simplifies your decision. If you live in Massachusetts, Minnesota, or Wisconsin the plans are organized differently. There are actually ten Medigap plans you can currently purchase.

What if I already have original Medicare?

If you have Original Medicare (Part A & B) there may be advantages to getting one of the Medigap plans. You should look into this carefully, study the various plans, and then prepare questions for insurers.

For instance, if you go to doctors or specialists with some frequency it may be sensible to get a Medigap plan. Medigap plans can help with copayments and coinsurance and if your copayments cost more than the premium for a given Medigap plan it would make sense to purchase that plan. Medigap plans can also cover a portion of your Medicare deductible which might make Medigap a reasonable alternative. Not all Medigap plans cover deductibles and all types of copays and coinsurance. Some plans pay for the total copay/coinsurance amount and others a portion. In some cases, some sorts of copays/coinsurance are not covered. The Medicare Part A hospice care is only partially covered by Medigap plans K and L. Compare the plans.

What else does Medigap cover?

Even beyond copayments, coinsurance, and deductibles Medigap plans can make sense. Original Medicare does not cover everything. All Medigap plans cover your Part A hospital coinsurance costs up to an additional 365 days after Medicare benefits are used up. The costs of long term hospital stays after Medicare is used up can be quite high and therefore this aspect of Medigap can come in handy.

Medigap plans also pay for the first three pints of blood at a hospital (Medicare coverage begins after the first three pints). Several sources put the cost of a pint of blood at over $200—sometimes substantially more. Costs for patients are often much higher than the “cost” a hospital pays for the blood.

Skilled nursing facility care coinsurance is covered by some Medigap plans as well. All the Medigap plans, excluding Plan A and B, offer some form of this coverage. Plans K and L offer 50% and 75% coverage respectively. If you are likely to require skilled nursing facility care, a Medigap plan may beneficial.

Plans F and G cover Medicare Part B Excess Charges. These “excess charges” apply when a doctor does not accept Medicare assignment (“assignment” refers to the amount that Medicare assigns to a specific procedure). In this case, the doctor may add 15 percent to the bill and Medicare will lower their contribution my 5 percent. The patient would pay the outstanding amount. How often this will be useful is a matter of debate.

Traveling Abroad

If you travel abroad with any frequency a Medigap policy may also help. Several plans offer coverage for Foreign Travel Emergencies. Plans C, D, F, G as well as the new plans M and N, all offer some level of coverage for Foreign Travel Emergencies. The plans offer different levels of coverage so be sure to find one that suits your needs.

Preventive Coverage

Medicare Part B Preventive coinsurance is also covered by all Medigap Plans. One example of preventative care is a smoking cessation. Medicare will cover up to 8 face to face visits over 12 months. With Original Medicare you will pay 20 percent of the Medicare approved amount for the treatment (after your deductible is reached).

Other cases that are considered preventive include bone mass measurement, cardiovascular screening, cervical and vaginal screening, colorectal cancer screening, diabetes screening, flu shot, Hepatitis B shot, glaucoma test , pneumococcal shot, prostate cancer screening, mammograms, and one-time “Welcome to Medicare” examination.

There are a variety of reasons to look into purchasing a Medigap plan if you have Original Medicare. As important as it is to understand what is covered by these plans it is also important to understand what they do not cover. For some Medicare recipients with Original Medicare, one of these plans will make sense. For others it will not. Individual medical circumstances and finances are the key to determining if a Medigap plan is right for you.

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