Are you 65 or about to turn 65 years of age, but are unsure of which health plan works best for you? If you already have a comprehensive retiree health plan that provides additional and generous benefits, or benefits not covered by Medicare or Medigap policies, you may not need a Medigap plan. However, it is advisable to review your health insurance plan annually and evaluate whether it’s right for you based upon cost, convenience, and coverage. It is time to reconsider your current health plan if you are paying too much for benefits you don’t necessarily need or your health is worsening and you need more benefits.
Depending on the type of health insurance plan you are looking for, your risk factors and how much insurance you want, or what you want to be insured for, a supplemental health insurance plan can be purchased to cover additional expenses that are not covered by the basic health insurance plan such as co-pays, deductibles, and co-insurance.
Eligibility For Medigap
Supplemental health insurance policies such as Medigap supplemental insurance offer disease-specific insurance. While there are possible exceptions, but, if you are on Medicare, Medicare Advantage Part C health plan, have a disability or pre-existing medical condition and are under 65, you aren’t eligible to enroll in a Medigap plan. Available, contingent on the state you reside in, are eleven Medigap policy plans from A through G and K through N that offer different groups of benefits, filling different gaps in Medicare Parts A and B coverage.
It is a general rule that by law, insurers can’t sell you more than one Medigap supplemental health insurance plan. If married, your husband or wife will need to purchase a separate policy if they too need a Medigap coverage, but only if they have Original Medicare Part A and B. Generally, Medigap supplemental insurance plans do not cover any out-of-pocket costs for Part D plans, long-term care, private-duty nursing, dental care, vision care, eyeglasses, or hearing aids.
Standard Medigap policy will cover are some or all the costs of the following:
- About 20% of what Medicare doesn’t cover, such as your Part A hospital deductible and coinsurance
- Part A lifetime reserve coinsurance for 91 to 150 days
- A portion of Part B services such as your doctor’s bills
- Part B deductible
- Part B 20% coinsurance
- Part A and B first three pints of blood annually
- Hospice care and coinsurance
- Foreign travel emergency coverage
- Up to 365 lifetime hospital days beyond Medicare coverage
Rights You Have With Medigap
A few changes have also been made to Medigap rules that require companies to issue a Medigap policy without both a health screening and a new waiting period limitation. For example;
- You now have the right to purchase a Medigap policy without health screenings or a new waiting period if you no longer have insurance that covers all of the cost of Medicare’s 20% co-insurance
- Insurance companies cannot request, require or obtain medical information as part of the application process if you are applying under “open enrollment” rights or if you are entitled to “guaranteed issue” coverage
- “Open enrollment” rights are now extended to include COBRA and CalCOBRA
Regardless of the changes to the law, those who bought their Medigap plans before June 1, 2010, can rest assured that their plan is not only guaranteed renewable every year, but their benefits will remain the same as long as you want to keep it and the premiums are paid.
Bearing in mind that insurance companies are required to offer the same benefits for each lettered plan, but it is your prerogative to shop around and find a Medicare Supplement plan that may fit your medical and financial needs. In essence, insurers have the ability to charge higher premiums for this coverage, they are, after all, trying to make a living too. The following are what they base their costs when they price their plan premiums:
How Premiums Are Priced
Community-rated pricing – also known as No-Age-Rated pricing, the age of the beneficiary does not affect the premium price, but it may still go up due to factors, such as inflation, high deductibles, discounts, and whether you have a guaranteed issue right. Therefore, regardless of your age and overall health condition, the charges are the same premium to all beneficiaries
Attained-age-rated – they are the most common as they represent the largest group of insured policyholders and the monthly premium rate for this policy is based on your current age at policy start. While they increase gradually over time, they are reasonable increments that must first be approved by the Department of Insurance as a way to keep up with inflation.
Issue-Age-Rated – premiums are priced based on the age at which you bought the policy. Depending on your state of origin, these policies will every so often have much higher premiums to start out and are subject to annual rate increments.
It is, therefore, important to do a little research pertaining to how your state rates this policy and also check an insurer’s rate increase propensities over the years before you purchase an issue-age policy or any other policy for that matter.
Medigap plans cover a range of benefits, with some providing more coverage than others. And while Medigap Supplemental insurance plans are standardized in most states, understanding how they are priced will ensure that you are not paying double for the same basic benefits. You may also be subject to medical underwriting that most insurance companies use to collect detailed information about your health and medical history when evaluating your application. It is during this evaluation process that an insurance company will decide whether or not to accept your application for insurance and how much to charge you. They, however, can’t use your health problems to deny you a policy or charge you more for it during your Medicare Supplement Open Enrollment Period. Therefore, be extra vigilant not to miss your Open Enrollment Period to avoid medical underwriting and extra costs.
Learn more about Medigap plans and rates at http://emedigap-plans.com. Medigap Insurance brokers will help you compare Medigap Insurance rates and plans. To talk to an expert in Medigap coverage call toll free 888-452-7949!