Information on Medigap Insurance
A Medigap insurance policy is a type of health insurance sold by private insurance companies to bridge gaps in traditional Medicare. These policies can assist you in paying your share of Medicare service costs, such as co-payments, co-insurance, & deductibles. Medigap plans do not cover Medicare Prescription Drug Plans (also known as Part D), Dental, or Vision Insurance. Some are used to this being covered if you are coming off of Group or Individual insurance. Even though its not covered by a Medigap ins carrier there are reasonably priced stand alone plans that we can offer you.
A Medigap insurance policy is also known as Medicare Supplemental Insurance. It was created to supplement traditional Medicare. In other words, it covers gaps in coverage. For example, if you have traditional Medicare and Medigap insurance, Medicare pays it share for the type of health care costs it approves. These policies differ from HMOs or PPOs because these plans supply Medicare benefits, but Medigap Ins just supplements traditional Medicare benefits. Medicare does not involve itself with paying any costs associated with obtaining a Medigap policy.
Medigap State Laws and Regulations
All policies are required to follow Federal and state laws for protecting you and are also required to clearly identify the plan as “Medicare Supplement Insurance.” Insurance companies selling the plans are only allowed to sell you plans designated as plans A through N. These policies are standardized and only offer the same set of benefits, regardless of which company is selling it. When offering plans of the same letter, the only real difference between different company plans is usually cost.
Companies selling these policies are not required to offer all lettered plans, but they are required to offer Plan A when offering any Medigap policy. When offering any plan other than Plan A, they are also obligated to offer Plans C or F. Although each individual insurance company can decide which policies they will offer, state laws can impact which ones are offered. In some situations, insurance companies are required to sell you a policy, even though you have health problems currently. If you are in the open enrollment period or have a guaranteed right of issue, you are entitled to purchase a policy. There are other situations where you can buy a policy but can be denied because of your health by the insurance company.
Medigap Insurance Open Enrollment & Exclusions
The most favorable time to purchase a Medigap policy is when you have your open enrollment period. This time frame is 6 months in duration, beginning after age 65 for those who are enrolled in Part B Medicare. There are also other open enrollment periods offered by different states for those under age 65. An insurance company is not allowed to employ medical underwriting during this time frame. Therefore, they cannot perform these actions due to any of your health problems: 1) Not sell you any Medigap plan they offer. 2) Charge more for such a policy than they do for those without health problems. 3) Force you to wait for coverage to begin (with some exceptions).
Although an insurance company cannot force you to wait for the beginning of coverage, it is permitted to have you wait for pre-existing condition coverage. This condition is one you have prior to the beginning of a new policy. Sometimes, the insurance company is allowed to deny coverage for out-of-pocket expenses for such health problems for a duration of 6 months. Following the 6 month waiting period, the policy then covers that pre-existing condition. For those services covered by Medicare, traditional Medicare still provides coverage, with the exception of copayment or coinsurance.