The Secrets of Medigap

Medigap, also known as Medicare Supplement Insurance, is designed to fill the "gaps" in Original Medicare (Part A and Part B). These gaps include costs like deductibles, copayments, and coinsurance that you would otherwise have to pay out of pocket.

Here are some key points that can feel like "secrets" to navigating Medigap more effectively:

1. Enrollment Timing is Crucial: The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and starts on the first day of the month in which you're both 65 or older and enrolled in Medicare Part B. During this time, you have a guaranteed issue right to buy any Medigap policy sold in your state, meaning companies can't deny you coverage or charge you more due to pre-existing conditions.

2. Standardized Plans: Medigap policies are standardized differently in most states. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. The only difference is the cost of the policy. This standardization makes it easier to compare plans.

3. Not Part of Medicare: Medigap policies are sold by private insurance companies, not by Medicare. While these policies are designed to supplement Original Medicare, they are distinct from Medicare Advantage Plans and work differently.

4. Doesn't Cover Everything: Medigap plans generally do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Understanding what isn't covered is as important as knowing what is.

5. No Drug Coverage: Medigap plans sold after January 1, 2006, are not allowed to include prescription drug coverage. If you want drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

6. Plan Differences Across States: While Medigap policies are standardized in most states, Massachusetts, Minnesota, and Wisconsin standardize their Medigap policies differently. It's important to understand the specific options available in your state.

7. One Policy Per Person: A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

8. Can't Have Medigap and Medicare Advantage: If you have a Medicare Advantage Plan, you can't use a Medigap policy to cover costs in that plan. You must switch back to Original Medicare if you decide to purchase a Medigap policy.

9. Premiums Vary: The cost of Medigap policies can vary widely. Even though the benefits of a specific plan (like Plan G) are the same no matter which company sells it, the premiums can differ significantly. It's worth shopping around.

10. Guaranteed Renewable: As long as you pay your premiums, your Medigap policy is guaranteed renewable. This means the insurance company can't cancel your Medigap policy as long as you're paying the premium, even if you have health problems.

Understanding these aspects of Medigap can help you make informed decisions about your healthcare coverage in retirement. It's always a good idea to consult with a knowledgeable Medicare insurance agent to help navigate your options based on your specific needs and circumstances.