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Eight Things You Need to Know About Medigap Policies

A Medicare supplement plan—also known as Medigap insurance—is sold by a private insurance company, as opposed to being sold by the government as Original Medicare is. Private insurers sell Medigap because Medicare doesn’t cover all of the medical expenses you could possibly need to maintain great health throughout retirement. These policies help pay some of the healthcare costs that Original Medicare doesn’t cover, such as copayments, deductibles, coinsurance and even medical care needed outside of the U.S. However, any expenses or treatments that Medigap supplement insurance covers must be Medicare-approved.

A Medigap supplement plan differs from a Medicare Advantage plan in that it SUPPLEMENTS Original Medicare by providing additional benefits, as opposed to REPLACING Medicare with a private insurance company’s plan. Medicare Advantage plans have stop losses that Medicare does not as well.

With this in mind, here is a list of eight essential things you must know about Medigap insurance before you apply:

Prior Enrollment – In order to purchase a Medigap supplement plan, you must already be enrolled in Medicare Part A and Part B.

You Can’t Have Your Cake and Eat It Too – If you are already enrolled in a Medicare Advantage plan, you can still switch to a Medigap policy, but you must be sure you can leave the Advantage plan before your Medigap policy begins.

No Freebies – In addition to the monthly premium you pay to Medicare for your Part B plan, you must also pay the private insurance company a monthly premium for your Medigap policy.

No 2-for-1 Deals – If you and your spouse both want Medigap coverage, you will each have to buy separate policies, and therefore, pay separate monthly premiums.

In-State – You must buy your Medigap policy from an in-state insurance company that is licensed to sell one (very important).

You’re Never Too Sick for Medigap – Even if you have major health problems, your insurance company cannot cancel your Medigap policy as long as you pay your premiums.

Drug-Free – As of January 1, 2006, Medigap policies are no longer allowed to cover prescription drugs. However, the Medicare Prescription Drug Plan (Part D) can.

Again, You Can’t Have Your Cake and Eat It Too…  – It is illegal for an insurer to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) plan.

Medigap policies are great for those moments when deductibles or copayments are high, or for when you decide to travel outside the country and end up needing medical care while you’re away. They are particularly important for when you have a large medical bill. With Original Medicare alone to work with, you could end up spending tens of thousands of dollars out of pocket if a major medical event were to occur.

These plans still don’t cover everything; some of the treatments Medigap policies don’t cover include long-term care, vision care, dental care, hearing aids, eyeglasses, and private-duty nursing. However, if you want these medical expenses to be covered there are plans available that do so. At MediGap Advisors, we help you find that plan or plans for you, namely the policies that cover all the medical expenses you foresee yourself needing in the future.

We keep you informed with the most up-to-date information about saving money on insurance and prescriptions, and we provide comprehensive reviews of what will work best for you and your loved ones. Best of all, we do it all for free. To see how we can help you find the Medigap coverage you need, check us out at our website.

 

 

 
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  • Gregory Lazarev

    Let me add a couple more of essential Medigap points:

    1) Because Medigap is an extension of Original Medicare, there is no concept of network. ANY doctor accepting Medicare will accept Medicare Supplement. Compare it with network limitations of Medicare Advantage.

    2) Once you have a Medigap policy it cannot be cancel (unless you do not pay premium), but Medigap vendor is NOT required to enroll you in the first place. In general, the medical underwriting is required, and company is entitled to reject your application. There are 2 exceptions: Open Enrollment Period (6 months after you got your Part B) and Guaranteed Issue – in those cases your application cannot be rejected.

    Greg Lazarev

  • Fred Adams

    Gregory,

    Thanks for your feedback. For the most part, you are accurate. Supplemental policies do not require the doctor to participate or contract with the plan. Supplemental policies fill the “gaps” in Original Medicare. This means it helps pay some of the health care costs that Original Medicare does not cover like copayments, coinsurance, and deductibles. Payment of claims can be done by crossover, where the doctor isn’t even involved in the process, or by direct submission of claims to the supplemental policy.

    Crossover is when Medicare sends claims payment information to your supplemental insurance after Medicare has paid its portion of the claim. The insurer decides what types of claims they want to cross over when they set up crossover with Medicare. Only the insurer can change the types of claims that are selected for crossover.

    Crossover should be set up when you receive a new supplemental policy. Just call the company and ask to be set up on automatic crossover so that claims will automatically be sent to your supplemental insurer. Only the insurer can decide or change the types of claims that are selected for crossover. For example, if the insurer chooses not to accept fully denied claims, all other types of claims will be selected, except fully denied claims.

    Not all companies offer this service. Please allow up to 60 business days for electronic set up and 80 business days for manual setup. If it has been more than 60 or 80 business days, please contact your supplemental insurance company.

    If the supplemental insurance company does not offer automatic crossover service with Medicare, the company will tell you how to send the claims to them after Medicare processes the claim. Medicare will send you a Medicare Summary Notice (MSN), and your supplemental insurance company may have you send them a copy of the Medicare Summary Notice.

    Some providers will forward the claim to the supplemental insurance as a courtesy. You may want to ask your provider if he or she performs this service. There is nothing that says the doctor is required to accept your supplemental policy if they are accepting Medicare assignment.

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