Medigap is a supplemental insurance policy that helps cover some of the healthcare costs not covered by Medicare, such as deductibles, copayments, and coinsurance. These policies are sold by private insurance companies and are meant to complement your Medicare Part A (hospital insurance) and Part B (medical insurance). Here’s a detailed breakdown of how Medigap works, its costs, and the rules for buying, switching, or dropping a policy:
How Medigap Works
- Coverage: Medigap policies fill the “gaps” in Original Medicare coverage by covering costs like copayments, coinsurance, and deductibles. Medigap plans do not cover prescription drugs; you would need Part D for that.
- Standardization: In most states, Medigap policies are standardized and labeled with letters (A, B, C, D, F, G, K, L, M, N). Each lettered plan offers the same basic benefits, no matter which insurer sells it. Note that Plans C and F are not available to new Medicare enrollees who became eligible after January 1, 2020. You can choose D and G as an alternative.
- Freedom to choose providers: Medigap allows you to visit any doctor or facility that accepts Medicare.
General Costs
- Premiums: The cost of Medigap policies can vary widely depending on the plan, the insurance company, your location, and your age. Premiums can range from about $50 to several hundred dollars per month.
- Pricing Methods: Insurers use different pricing methods: community-rated (same monthly premium for everyone), issue-age-rated (premiums based on your age when you buy), and attained-age-rated (premiums increase as you get older).
Buying, Switching, or Dropping a Medigap Policy
- Buying: The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which starts the first month you have Medicare Part B and you’re 65 or older. During this period, you have a guaranteed issue right to buy any Medigap policy sold in your state without health screening.
- Switching/Dropping: You can technically switch or drop your Medigap policy at any time, but outside of specific guaranteed issue rights scenarios, you might be subject to medical underwriting or denied coverage based on health conditions.
- Special Circumstances: If you have other insurance (like from an employer) or you want to switch plans, there are specific rules and times when you can do this without losing coverage or being subject to underwriting. For more information , check out this Medigap link or call 1-800-633-4227.
Requirements to Buy a Medigap Policy
- Medicare Part A and Part B: You must be enrolled in Medicare Part A and Part B.
- Not compatible with Medicare Advantage: You cannot have Medigap and Medicare Advantage at the same time.
Medigap policies provide additional coverage to help manage out-of-pocket costs in Original Medicare, but the choice of plan and timing can significantly impact your rights and expenses. When considering a Medigap policy, it’s a good idea to compare all available plans in your area and understand how different policies cover your healthcare needs.
-Nguyễn Bách Khoa-