Seniors that are concerned with the rising cost of Medicare can look to Medigap health insurance policies for relief. These policies are also referred to as Medigap Supplemental or Medicare Supplemental insurance plans.
Medigap policies aid seniors by assisting with payments that arise from the gap between what Medicare Parts A and B pay and the cost seniors are responsible for paying out of pocket. Medicare supplement policies can be obtained from private insurance carriers.
Important Facts About Medicare Supplemental Insurance
Policies purchased by seniors must be specifically designated to be Medicare Supplemental Insurance. Medigap plans come with ten options and are labeled A-through N. Plans with unique features are sometimes offered by particular carriers.
Medicare Supplemental Insurance is only available to seniors who are already Medicare users. Supplemental insurance may be used to pay out of pocket expenses for hospital insurance, covered under Medicare A, and medical insurance, covered under Medicare B. Medicare Supplemental Insurance cannot be used to cover expenses associated with Medicare C or D. Nor can it be used for payments under other private insurance policies, Medicaid, VA Benefits, or Tricare.
Federal and state statutes are used to regulate Medigap policies which results in the basic benefit options being constant despite the carrier used. The main difference seniors will find from one insurer to another will be in price and which of the ten benefit options are offered.
The main considerations for seniors looking for Medicare Supplemental Insurance are to carefully choose a trustworthy health insurance provider that offers the best plan for the senior’s specific situation at the most affordable price.
The states of Texas, Wisconsin, Massachusetts, and Minnesota have an additional option known as the Medicare Select policy. The use of this Medicare Supplement Insurance requires that seniors use a specific network of health care providers.
When Can Seniors Enroll In Medicare Supplemental Insurance Plans
Open enrollment for Medigap plans begins on the first day of the month in which a senior turns 65 years of age if covered by Medicare Part B. The senior will have six months from this day to enroll. If under 65 years of age, seniors must check with the Social Security Administration in their respective states to determine if additional enrollment periods exist.
It is important to note that when a senior enrolls during the six-month period that starts at the beginning of the month of their 65th birthday, insurers do not have the option to refuse to sell them a Medigap policy. The senior is also protected from higher premiums due to preexisting illnesses, and waiting periods to begin benefits if applying for Medigap plans during the six-month period.
Medicare Supplement Insurance plans enrolled in outside of the six month period are subject to underwriting by the insurer. This means a physical examination may be required and the insurer has the right to refuse to sell a plan or adjust the premium according to a senior’s specific healthcare situation.
Seniors enrolled in a Medicare Advantage Plan are ineligible for Medicare Supplemental Insurance plans. However, seniors that return to Medicare parts A and B within one year of joining the Medicare Advantage Plan may become eligible for Medigap plans.
How Insurers Set Premiums
Three methods are used by insurers to determine the cost of Medigap premiums:
Community-related: Premiums are standard for all citizens
Issue age-related: The cost of premiums is determined by age policy is purchased. The younger a senior is when enrolling, the cheaper the premium will cost them.
Attained age related: The cost of Medigap premiums correlates with the age of the policyholder. As the policyholder ages, the premiums become more expensive.
Additional factors that can affect the premium rates for Medicare Supplemental Insurance plans are geographical location of the senior, economic inflation, and the underwriting policies of the insurer. It is important to examine the policies of each insurer before making a choice.
A final consideration for seniors looking to purchase a Medigap plan is the issue of preexisting conditions. A preexisting condition is any health-related condition the senior has before the purchase of a policy. In some instance, preexisting conditions can greatly affect the nature of policies offered to seniors, and in some situations may disqualify the senior from being eligible for policies with certain insurers.
Seniors with preexisting conditions should carefully read all documents explaining an insurer’s plan options to understand the impact of preexisting conditions on the insurance coverage that will be granted.
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