Medigap Policies

Medigap policies are the most common form of Medicare Supplements. They cover some needs that Medicare may not. Medigap policies are provided by private insurance companies, not the government.

Medigap policies come in twelve different standardized plans. Each is identified by a letter “A” through “L.” Because they are standardized, the benefits provided in any plan with the same letter will be the same, no matter what company sells you the plan. However, the cost for that plan (premium price) will vary between companies.

It is important to compare the different policy types before buying a Medigap plan. Because the plans are standardized, you can easily shop for the company with the best price using this Medigap Rate Tool from the Missouri DIFP can help you find the best prices in Missouri. You may also want to look that company up on the Complaint Index from Missouri DIFP before purchasing a plan. DIFP has a range of resources on Medigap, including a printable guide.

Companies selling Medigaps must also meet several requirements. They must guarantee the plan is renewable. Benefits must be clearly disclosed. The insurance company must allow you a 30-day period during which you can cancel the policy with no penalties. They also cannot sell a policy to someone that already has one.

Policies

Medigap Plan Options

Effective June 2010, several changes were made to Medigap insurance plans. The current benefits for these plans is explained in the following two tables:

Plans

A	B	C	D	F/F¹	G	K²	L²	M	N	Details
						^*	^*		⁺	Basic Benefits Coverage for coinsurance for day 61-90 of inpatient hospitalization Coverage for coinsurance for Lifetime Reserve Days 91-150 Coverage for an additional year of inpatient hospital care in a lifetime Coverage for the first three pints of blood Coverage for the 20% coinsurance for Part B services New Benefit: Coverage for the hospice 5% coinsurance for Medicare approved charges for inpatient respite care and 5% coinsurance for prescription pain medications * Partial coverage of 20% coinsurance for Part B and first three pints of blood on Plans K & L + N policy has a $20 co-pay for office visits and a $50 co-pay for outpatient ER trip
						^*	^*	^*		Part A Deductible: Coverage for the inpatient hospital deductible for each benefit period * Partial coverage of the inpatient hospital deductible on Plans K, L and M
						^*	^*			Skilled Nursing Coinsurance: Coverage for the skilled nursing coinsurance for days 21-100 for each benefit period. * Partial coverage of skilled nursing coinsurance on Plans K and L
										Part B Deductible: Coverage for the yearly deductible.
										Part B Excess: Coverage for Part B charges over the approved amount at 100%.
										Foreign Travel Emergency: Coverage for emergency care for the first 60 days of a trip outside the U.S.; Beneficiary pays for a $250 deductible and 20% of the cost, up to $50,000.

¹ High Deductible Option: Plan F has a high deductible option Plans with the high deductible option have a lower monthly premium. For this type of plan, the beneficiary pays the Supplement plan’s deductible each year before the plan pays for any services. This deductible amount is subject to increase each year.

² Coverage of 100% of all cost sharing under Part A and B for the balance of the calendar year after out-of-pocket maximum is reached. Out-of-pocket maximums are indexed each year by the appropriate inflation adjustment specified by DHHS.

Explanation of Medigap Benefits

A	B	C	D	F/F¹	G	K	L	M	N
Basic benefits	Basic benefits	Basic benefits	Basic benefits	Basic benefits	Basic benefits	Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%*	Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%*	Basic benefits	Basic benefits, except up to $20 co-pay for office visits and up to $50 co-pay for emergency room visits+
	Part A deductible	Part A deductible	Part A deductible	Part A deductible	Part A deductible	50 % Part A deductible*	75 % Part A deductible*	50 % of Part A deductible*	Part A deductible
		Skilled Nursing Coinsurance	Skilled Nursing Coinsurance	Skilled Nursing Coinsurance	Skilled Nursing Coinsurance	50 % of Skilled Nursing Coinsurance*	75 % of Skilled Nursing Coinsurance*	Skilled Nursing Coinsurance	Skilled Nursing Coinsurance
		Part B deductible		Part B deductible
				Part B Excess (100%)	Part B Excess (100%)
		Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency			Foreign Travel Emergency	Foreign Travel Emergency
						Benefits paid at 100% after out-of-pocket limit is reached	Benefits paid at 100% after out-of-pocket limit is reached

* Partial coverage of 20% coinsurance for Part B and first three pints of blood on Plans K & L
+ N policy has a $20 co-pay for office visits and a $50 co-pay for outpatient ER trip

Enrolling

When you first enroll in Medicare Part B, you have six months when you can choose whichever policy you want wants and cannot be turned down. This is known as your open-enrollment period.

If you are eligible for Medicare because of a disability, you will have two six-month open-enrollment periods, one when you first enroll in Part B and the other beginning the month you turn 65.

Once you have a Medigap policy, you may switch companies each year during the 60 days surrounding the anniversary date of your policy. You are only guaranteed to be able to change companies, however, not policies. For example, if you have Policy F, the company does not have to let you switch to Policy J.

Beneficiaries under age 65 have the right to suspend or turn off their Medigap policy if she/he becomes eligible for coverage under an Employer Group Health Plan (EGHP). The beneficiary will not pay the premium and the policy will not pay any benefits. With the loss of the EGHP, the beneficiary may reactivate the policy within 90 days without any pre-existing condition exclusions, waiting periods, or underwriting.

Beneficiaries who become eligible for Medicaid also have this right. Beneficiaries are allowed to suspend a Medigap policy for up to two years. Again, the beneficiary must notify the Medigap company within 90 days of the loss of Medicaid benefits to reactivate the policy without any pre-existing condition exclusions, waiting periods, or underwriting.

Medigap Tips

A few things to remember before buying a Medigap Policy:

Ask questions of friends and family.
Insist on a simple outline of coverage. Know what you are buying.
Choose the benefits you want and need. Benefits are standardized in Medigap policies. The “C” policy has exactly the same benefits with any company.
Compare benefits for different policies before buying. Consider family and medical history.
Call the Missouri Department of Insurance, Financial Institutions & Professional Registration to ask about the company’s rating.
Read the policy carefully. If you are unsatisfied, you have a 30-day “free look” period.
Keep any proof of prior creditable coverage.
Keep the agent’s name and information for future reference.

There are also some things you should avoid:

Don’t feel pressured to buy right away. You have a six-month open enrollment period.
Don’t drop a current insurance policy until you are sure about your new coverage.
Don’t buy more than one Medigap policy.
Never pay cash. Always use a check made out to the insurance company, NOT the agent.
Don’t buy from agents that claim to be from the government. The government does not sell insurance.
Do not buy a Medigap policy if you are in a Medicare Advantage plan. They will not work together.

Return to Medicare Supplements

Printer-friendly version