Medigap is a supplemental insurance plan that fills in the gaps left in Original Medicare, a fee-for-service plan managed by the federal government. Medigap policies are private insurance policies that cover Medicare coinsurance, co-payments and deductibles that you'd otherwise have to pay yourself. While Medigap does not pay prescription costs for individuals enrolled after 2006, it does cover a wide range of treatments and medical services. When shopping for a Medigap policy, you should review the most current insurance information available. As with any type of insurance coverage, limitations, exclusions and approved services are subject to change.
Confirm eligibility. You must have Medicare Part A and Part B to buy a Medigap policy. There are 10 standardized Medigap policies. Medigap insurance is differentiated by letters A through N.
Consult a Medigap benefits chart (see Resources). Medigap policies can change annually, so review an updated schedule of each Medigap policy to find the one that’s right for your situation. According to Insure.com, as of November 2010, “Plan A offers a very basic supplement to Medicare coverage. Plan F offers much more coverage but is also more expensive. Plans K and L offer payment of 50 or 75 percent on certain co-payments, coinsurance and deductibles.”
Purchase a Medigap policy through an insurance company. Private insurance companies set their own monthly premiums, so shop around for the best rate. According to Medicare’s website, “A company can choose to set a uniform price for all premiums, set prices according to a buyer’s age group or based on pricing a buyer’s yearly age, meaning prices automatically go up in price as you age.”
Choose a Medicare SELECT policy if you wish to reduce premium costs. A potential drawback to the Medicare SELECT policy is that you must visit hospitals and, in some cases, doctors within a specific network. Check the company's network beforehand for a list of approved hospitals and doctors. Also, inquire about “high-deductible options,” which may be available in your state and will hold down premium costs. Inquire about discounts for nonsmokers and for married couples purchasing two policies.
Decide which benefits you want to buy to cover your current and future health care needs. (Changes to your policy may not be allowed.) Select a Medigap policy that pays most or all of your Medicare coinsurance fees and deductibles. Not all Medigap policies pay for emergency medical care in a foreign country, so check eligibility if you require this type of coverage.
Enroll in a Medigap policy during your Medigap open-enrollment period, which lasts for six months and begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. Contact Medicare to determine if your state has additional open-enrollment periods for people under 65. Complete an application for your Medigap policy.
Pay your private insurance carrier a monthly premium for your Medigap policy. This payment does not include the monthly Part B premium that you pay to Medicare. Only you are eligible to receive coverage under your Medigap policy. Your spouse must purchase his own policy.
Contact your State Health Insurance Assistance Program for a Medigap rate comparison shopping guide. Request a written summary of your Medigap policy. Medicare SELECT is not available in all states.
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