Medigap Policies
A Medicare supplement (Medigap) insurance, sold by private insurance companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Below are a few examples of the gaps in Medicare Part A and B:
Part A:
- $1,156 deductible for first 60 days of Hospital stay
- $289/day for days 61-90
Part B:
- $99.90 monthly premium for 2012
- $140 Annual deductible
- 20% coinsurance on doctors visits and services
This is not a complete list of the gaps in Medicare Part A and B, but it does illustrate some of the potential out-of-pocket costs that can occur in Medicare.
A Medigap policy is different from a Medicare Advantage Plan (Part C). Medicare Advantage provides an alternative way to access your Medicare benefits, while a Medigap policies supplement your Original Medicare Part A and Part B benefits.
How Medigap Policies Work
- You must be enrolled in Medicare Part A and Part B.
- You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
- In addition to the monthly Part B premium that you pay to Medicare, you will pay the private insurance company a monthly premium for your Medigap policy.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy. You need to leave the Medicare Advantage Plan before your Medigap policy begins.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs, however Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you will need to purchase Medicare Prescription Drug Plan.
Medigap and Medicare Advantage
If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums. If you want to cancel your Medigap policy, contact your insurance company.
If you leave the Medicare Advantage Plan, you may not be able to get the same Medigap policy back.
If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.
- If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.
- The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Prescription Drug Plan (Part D).
- If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.
Medigap Claim Payments
If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request.
For more information on Medigap policies please visit the NC Senior Health Insurance Information Program (SHIIP) website at www.ncdoi.com/SHIIP or the SC Office of Aging at http://aging.sc.gov/Pages/default.aspx.
To obtain an individual Medigap quote or discuss your Medigap Options, please contact our office.
