Medigap insurance overview:
Medigap insurance is a Medicare supplement insurance provided by a private insurance company. Medigap insurance is separate from the original Medicare insurance plan, as well as being separate from federal programs. It fills in some but not all of the holes in the basic, original Medicare plan. Typically, this Medicare supplement insurance plan pays the cost of premiums, co-payments, deductibles and any physician’s fees that exceed the amount approved and paid by Medicare. It does not cover any charges not covered by Medicare. Also, long-term care is not paid for by Medigap insurance.
Medigap insurance covers people for ongoing medical expenses. It is frequently considered to be a good idea for many people, but is not for everyone. An example may be an individual enrolled in a Medicare advantage plan or other managed-care plans, or group health plan that provides adequate coverage. In many instances, it may even be illegal for a company to sell an individual Medigap insurance coverage when they have these types of plans.
Anyone nearing the level of financial eligibility for Medicaid does not need a Medigap insurance plan. Also, as mentioned above, it is illegal for a company to sell this type of Medicare supplemental insurance plan to someone on Medicaid. However, you should be aware, that Medicaid is run by the individual states that may have their own varying coverage arrangements.
If an individual wants additional coverage, they should consider changing to a Medicare Advantage plan, which may offer some additional benefits (but may also have some limits that you may be uncomfortable with).
If you’re interested in a Medigap insurance plan, you should probably buy it within six months of enrolling in Medicare Part A. During this window of opportunity, your parent or loved one cannot be denied coverage because of existing medical problems.
After this six-month enrollment period is over, insurance companies may be allowed to increase the price of the policy, refuse coverage or even attach an array of conditions to a policy. Your senior may be protected from these increases, denials, and conditions if their current employer, group, or Medicare Advantage health coverage ends for some reason.
Your senior may also switch from one Medigap insurance policy to a different one without penalty for pre-existing illnesses or disability, as long as they have had their current policy for at least six months. The company can however delay coverage beyond what the original policy covered, for six months.
The basic Medigap insurance plan includes the following benefits. All Medigap insurance plans cover certain holes in the original Medicare insurance plan. These include:
Co-insurance for hospitalization.
After Medicare’s hospitalization coverage is used up, 365 additional days (over a lifetime).
Co-payments required by their Part B Medicare insurance (20% Medicare approved fee for doctor services and 50% for mental health services).
The first 3 pints of blood each year (at which time Medicare will then pick up the payments).
Some information from How to Care for Aging Parents by Virginia Morris
Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting