3 Healthcare Supplements: How to Choose a Medigap Plan
The world of medical insurance is a different thing to navigate in any situation and as such there are a lot of questions you’ll end up asking yourself about insurance: What coverage do I need? How much will it cost? How do I find the best plan? What if my insurance won’t cover everything? Unfortunately, these questions still persist when you become eligible for Medicare, so what do you need to know in order to make this process as painless as possible?
Medicare + Medigap
Perhaps the most important thing to remember is that Medicare isn’t designed to give a person coverage for every medical condition. While Medicare parts A and B cover the most immediately pressing medical conditions—that is to say emergency and inpatient costs—as well as offering mental health coverage, nursing home care, skilled nursing facility care, and several other kinds of coverage, but things such as copays for doctors visits, your deductible costs for your insurance, and your coinsurance costs aren’t covered. That’s where Medigap comes in. Medigap is supplemental insurance for Medicare that is provided by private companies in order to help cover costs that Medicare doesn’t. Medicap covers three basic “gaps” in Medicare insurance: 1) deductibles and copays, 2) excess charges, and 3) expenses that aren’t covered by your Medicare plan. As of 2021 there are 10 different Medigap plans, each one denoted by a letter C through N (although plans C and F can no longer be purchased as of 2021), and are referred to as “Medicare parts”) that insurance companies offer, each of which covers those three gaps to different degrees. For example, Medicare Part L covers the deductibles for Medicare Part A and copays for skilled nursing facilities, but doesn’t cover costs that occur outside of the US, while part D covers all three but not other things. There is also a type of coverage called Medicare SELECT, which is similar to Medigap in most regards and tends to offer insurance for lower premiums than other Medicare Supplement plans. The catch with Medicare SELECT is that your hospital network is restricted, while under a regular Medicare/Medigap plan it is not. In other words, with a Medicare plan you will be able to go to any hospital and see a doctor regardless of whether they are in network for your provider and your visit will still be covered as long as your Medicare plan would otherwise cover that visit; with Medicare SELECT, you pay less per month than for Medicare, but you would only be able to go to hospitals that are in your provider’s network for non-emergency visits.
Things to Remember
There are two very important things to know about from the start when considering medigap options. First, it’s smart to start learning about your different options before you turn 65 and become eligible for medicare and medigap. The reason you should start early is because of the Medigap Open Enrollment period, which is the only period in which you can enroll in any plan without worrying that your insurance provider will deny that plan. The enrollment period lasts for six months after you become eligible for Medigap and during that time insurance providers are not allowed to deny you enrollment for any medigap insurance plan based on your current health condition. So if you need your insurance to cover disability services or other preexisting conditions that insurance providers are generally reluctant to pay for, this is your best opportunity to get that plan approved. This, however, brings us to the second point, and that is that not all Medicare providers offer supplement insurance for disabilities. Make sure your insurance provider offers Medigap plans that cover everything you need, otherwise you might need to switch providers in order to get all of the coverage you need from Medigap. The overall lesson here is to start considering options early; the longer you put it off, the more difficult and more expensive it will be.
For more information on Medicare and Medigap insurance, the government of Iowa has put together a Medicare and Medigap Supplement guide for those considering medicare plans.
