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Which Medigap Plan is Best for Me

Written by Brian Gruss

Before picking the Medigap plan that you need for yourself, let us comprehend what you need to know about this plan, its coverages, and connection to Medicare.  Choosing which Medigap plan is best is not easy, but we are here to help you with that choice.

A Medigap plan is private health insurance that helps supplement Original Medicare. It helps pay a portion of the health care costs that Original Medicare doesn’t cover like copayments, coinsurance, and deductibles. These are spaces in Medicare coverage.

While Medicare is a government health care program that covers the vast majority of people over the age of 65. Some younger individuals who are handicapped or who have permanent kidney failure are allowed to get Medicare coverage early and are called beneficiaries.

Medicare pays for much of their health protection, unfortunately not all are covered. Medicare covers most intense therapeutic conditions from which a patient response to treatment. It doesn’t include most Care given at home, helped living offices or nursing homes, for people with severe disabilities and diseases. There are considerable gaps in Medicare’s prescription drug plans for many people.

Both Original Medicare and a Medigap policy will pay its shares for Medicare-approved amounts for covered health care value. Medicare Advantage Plan like HMO or PPO are ways to get Medicare benefits, Medigap doesn’t work that way. It is an add-on to the costs of your Original Medicare.

Here are some tips that might help in choosing a Medigap Plan

1.    Always review your options.

Letters from A to N identifies Medigap Policy; each standardized Medigap Policy has the same benefits regardless which insurance company offers for sale, different companies have a different cost for the policy with the same letter. All Medigap policies are controlled by the Federal and State Law to protect its citizen. The plans must distinctly recognize as Medicare Supplement Insurance; private companies only sell a standardized Medigap policy except for the states Massachusetts, Minnesota, and Wisconsin have their standard policies.

2.    Check the rates and coverages. Below are the coverages from Plan A-N

  • There is 100% coverage for Medicare Part A coinsurance and hospital costs up to an additional one year after Medicare benefits are exhausted.
  • 100% coverage for Medicare Part B coinsurance or copayment except for Plan K which covers only 50% and Plan L which includes 75%.
  • 100%  coverage for Blood (first 3 pints) except for Plan K which covers 50% and Plan L which covers 75%
  • 100% coverage for Part A hospice care coinsurance or copayment except for Plan K which covers 50% and Plan L which includes75%
  • 100% coverage for Skilled nursing facility care coinsurance except for Plan K which covers 50%, Plan L  covers 75%, Plan A and B with no coverage.
  • 100% coverage for Part A deductible except for Plan K which covers 50%, Plan L which covers 75%, Plan M covers 50% and Plan A with no coverage.
  • 100% coverage for Part B deductible is only applicable for Plan C and F.
  • Plan F and G only has 100% coverage for Part B excess charges.
  • 80% coverage for Foreign travel emergency and no coverage for Plan A, B, K, and L.

Medigap Policies don’t cover :

  • Nursing care
  • Vision or dental care
  • Hearing aids
  • Eyeglasses
  • Private nurse

Coverages that are NOT Medigap policies

  • Medicare Advantage Plans (Part C), like an HMO, PPO, or Private Fee for Service Plan
  • Medicare Prescription Drug Plans (Part D)
  • Employer or union plans, including the Federal Employees Health 
  • Benefits Program (FEHBP)
  • TRICARE 
  • Medicaid
  • Veterans’ benefits 
  • Long-term care insurance policies 
  • Indian Health Service, Tribal, and Urban Indian Health plans
  • Health Plans from Health Insurance Marketplace

Premium Pricing Method

  • Policies are priced based on the age of the holder at the time of purchase and may increase as the holder gets aged or because of the inflation or other considerations. Be aware of how your policy is calculated. Premium prices are set into three different ways and two options for some other states.
  • Community-rated or No age rated. 
  • The least expensive plan and sometimes not necessary on your first purchase. It has the same premium charge regardless of age.
  • Issue-age-rated
  • The premium is on based on your age the moment you buy the policy; It might go up due to inflation and not because of your age.
  • Attained-age rated. 
  • It is the most expensive rate, the premium starts low and goes up as you get older.

What we need to know before buying a Medigap policy

  • Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) is a must have to buy a Medigap policy.
  • If you are planning to take back you Original Medicare and already have Medicare Advantage Plan you may apply for Medigap before the end of your coverage. Your Medigap broker can sell it as long as you are ending the plan, for you to have continuous coverage, let him know that the new Medigap policy will start when your Advantage Plan enrollment ends. 
  • Aside from the monthly premium that you have for Medicare Part B, an additional premium is charged by the Private Insurance for your Medigap policy.
  • A Medigap policy is for one person only.
  • When its time for Medigap Open Enrollment Period you can purchase a Medigap plan from any authorized insurance agency in your state.
  • Cancellation of Medigap policy is through a written letter requesting for the policy to be canceled, typically your agent can’t cancel it for you.
  • Medigap policy is renewable. As long as you are enrolled and paying the premium, the Insurance company can’t cancel your plan even if you have health issues.
  • Compare the same policy from one company to another. Insurance companies may charge different premiums for the same plan.
  • Some states may have laws that may give you additional protection.

3.    Know the Best time to Buy

The open enrollment period is the best time to purchase a Medigap Policy; it is during the six months after you turn 65 and first enrollment to Medicare Part B.  In this period the insurer will consider your current health or medical history when arranging the plan’s premium.  However, you may have to wait for six months before the coverage if you have a pre-existing condition when you buy the policy.

4.    Check the Insurance Company stability

Sign up only to a company with a good reputation and licensed by the state, for promptly and efficiently paying claims and providing great client benefits and treating customers well.

The decision of getting Medigap requires self-assessment, the best for others may not be best for you due to differences in age and health condition. You may familiarize yourself with common medical insurance terms and ask your broker to assist you all the way in purchasing a plan.

Consequently you can now see that it isn’t which Medigap plan is best, but which Medigap plan is best for me.

About Just Medigap
About Just Medigap

We work with individuals across the nation to secure the best Medigap rates.  Please don’t hesitate to call us at 352-508-4221 or fill in your information in the form to the left.

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