Original Medicare (Parts A&B) only pays for 80% of your Medicare related bills, leaving you responsible to pay the remaining 20%. These costs include copayments, coinsurance, deductibles, etc. that you are responsible for paying.
This 20% is known as the Coverage Gap. It’s difficult to predict how much out-of-pocket costs will be, so many retirees supplement their Medicare coverage with a Medicare Supplement plan, also known as a Medigap plan. Medicare Supplement Insurance enhances Original Medicare by paying for medical expenses in that 20% gap.
“Medigap plans are standard across the U.S. Every Medigap policy must follow federal and state laws designed to protect you. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs.“
Due to the skyrocketing costs of healthcare the majority of seniors in the U.S. currently choose Medigap coverage.
For example, suppose that you require surgery at the local hospital and the cost for Medicare approved doctors, nurses, facility usage, preparation, doctor follow up visits, and other expenses total $100,000. Original Medicare (A&B) will pay $80,000 of the bill. Without a Medigap policy in effect, you are responsible for the balance of $20,000.
But if you purchased a Medigap policy it would pay the remaining $20,000. Enrolling in a Medigap plan ensures your Medicare related costs are 100% covered, therefore keeping your financial retirement secure.
With a Medigap plan there is normally an inexpensive monthly premium. Your monthly premium is determined by a number of factors, such as the zip code of your primary residence and whether or not you use tobacco products.
Part D Enrollment
Most people enrolling in a Medigap plan for the first time will also choose to enroll in Part D prescription drug plan to avoid penalties. Not enrolling in a Part D plan when eligible may result in penalties.
Note that Medicare prescription drug coverage is voluntary and you will need to sign up through private insurance companies. (Private insurance companies are not allowed to call and ask you to enroll in Medicare Part D prescription drug plans.)
Part D plans can be added on to your Original Medicare coverage, certain Medicare Cost Plans, Medicare Medical Savings Account (MSA) plans, and Medicare Private Fee-for-Service (PFFS) plans.
You cannot be enrolled in both a Medicare Supplement insurance plane and in a Medicare Advantage plan. If you are currently in a Medicare Advantage plan that includes drug coverage and you join a separate, stand-alone Medicare Prescription Drug Plan, you will be automatically disenrolled from Medicare Advantage and reverted back to Original Medicare.
Medicare Part D Eligibility
To be eligible for Medicare Part D enrollment, you must have Medicare Part A or Part B, and live in the service area of a plan that provides prescription drug coverage (Part D). You can enroll through a licensed Insurance Agent/Producer such as Medicareinc.com, by clicking here. You may also call the Medicareinc.com licensed experts at (866) 395-4789, Monday through Friday, 8am-9pm, or Sunday, 8am-9pm MST.
Be prepared to provide your Medicare number and the date your Medicare Part A or Medicare Part B coverage started, which is all on your Medicare card.
Guaranteed Issue Rights
During your Medigap Enrollment Period, by law, insurance companies cannot refuse to sell you or offer you a Medigap policy even if you have pre-existing conditions.
Guaranteed issue rights (or “Medigap protections”) are your rights in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company must sell you a Medigap policy, must cover all your pre-existing health conditions, and cannot charge you more for a Medigap policy because of past or present health problems.
You can buy Medigap Plan A, B, C, F, G, K, or L that is sold in your state by any insurance company if:
- You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.
- Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
- You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area. You can keep your Medigap policy, or you may want to switch to another Medigap policy.
- You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.
- You are in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area. You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.
Trial Right Period
In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “Trial Right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind. The Trial Right period lasts for one year and only occurs the first year you enroll in a Medicare Advantage (Part C) plan.
If you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare, you can buy any Medigap policy that is sold in your state by any insurance company.
If you dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time and you have been in the plan less than a year, and you want to switch back, you can buy the Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy a Medigap Plan (A, B, C, F, G, K or L) that’s sold in your state by any insurance company.
The Best Time to Enroll in Medigap
The best time to buy a Medigap policy is up to 6 months before your Medigap open enrollment period begins. Let’s take a quick look at what this means.
There are two different open enrollment time periods, or windows of opportunity: the first window is your Part B enrollment and the second window is your Medigap enrollment.
Medicare Part B enrollment window
You have a seven-month window to enroll for the first time in Medicare Part B beginning three months before the month you turn 65 until three months after your birth month; a total of seven months. If you miss this window you may end up paying Part B late enrollment penalties.
Because Medicare Part B has a monthly premium, some people choose to delay enrollment if they are already covered under a different plan, such as an employer group health plan (either your own or your spouse’s).
If you delay Medicare Part B enrollment because of coverage under a current employer, you can qualify for a Special Enrollment Period when this group coverage ends and will not be subject to Part B late enrollment penalties.
Many people choose to cancel their employer health plan and enroll in a Medigap plan because Medigap plans are more cost effective and generally have no co-pays, co-insurance, or deductibles.
Medigap enrollment window
Once you are enrolled in Part B, you have a six-month window to enroll in a Medgiap plan. During this period, you have a guaranteed right to buy any Medigap policy sold in your state regardless of your health condition.
This six-month enrollment window begins on the first day of the month that your Part B becomes effective. However, Medigap insurance companies allow you to enroll in a Medigap plan up to six months before your official enrollment period begins.
This means you can compare different plans and even purchase a Medigap policy up to six months (180 days) before your 65th birth month. Your selected plan will go into effect the month you turn 65 and are enrolled in Part B.
If you wait until after turning 65 or after your part B is effective to shop around for a Medigap plan and you end up going to the hospital or doctor, you may end up paying out of pocket medical bills that would have otherwise been covered by having a Medigap plan in place on the first month of eligibility.
When will my Medigap coverage start?
After purchasing a Medigap policy your coverage will begin on the first day of the month you turn 65 and are enrolled in Part B.
Remember not to wait for something to happen before exploring your Medigap options. Shop for your best options in advance of your eligibility and decide what you will want to have in place before you need it. Start shopping early and enroll as soon as you are eligible (6 months prior to your 65th birth month.) Have your coverage working for you the very first day of your birth month or the month your Part B is in effect.
Don’t get left behind
It is very important to enroll during this open enrollment period!
Remember that Medicare generally will only pay 80% of your Medicare-related costs. A Medicare Supplement insurance policy will cover the remaining 20%.
The Guaranteed Issue Right that occurs within the Open Enrollment Period is only offered to you one time. You cannot be denied Medigap coverage, no matter what your health status is during this enrollment period. If you do not enroll in a Medigap plan during this enrollment period, there is no guarantee a plan will accept you and offer you a supplemental plan.
With a Medigap plan you are 100% covered for the following medical services not covered by Part A or Part B:
- Most doctor services
- Outpatient care
- Medical supplies
- Preventive services
Enroll in a Medigap plan before your official open enrollment period
Although Medicare gives you a one-time six-month enrollment window to purchase a Medgiap plan, strategically, the best time to purchase Medigap insurance is six months before your official enrollment period begins.
In other words, the best time to purchase a Medigap plan is six months before the month you turn 65. Enrolling during this time frame is crucial because Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy, so you will need to have already determined what Medigap plan you will have working for you in advance of the effective date.
During this period you can buy any Medigap policy, even if your health is less than perfect, for the same price as people with excellent health. This is commonly known as “Guaranteed Issue”. Remember, Medigap Guaranteed Issue is only offered to you one time when turning 65 or if it’s your first time enrolling in part B. Once this open enrollment window closes you may be subject to underwriting guidelines resulting in higher premiums or denial of coverage.