Did you know that all Medicare recipients may enroll in a Medigap policy with no health questions asked if they do so within their open enrollment window? Hi there. If we have not met yet, I’m Justin Eggenberger from the Apex Planning Group. I will explain what Medigap policies are, how they work, what they cover, and why it’s so important not to miss your one-time Medigap open enrollment window.
When you turn 65 and start using your original Medicare benefits, you will discover that your medical services are not totally free. You will have deductibles to pay along with co-pays for things such as visits to medical professionals. Another overlooked expense is coinsurance. Medicare Part B only pays for eighty percent of your expenditures. This leaves you paying the other twenty percent for items such as laboratory work, diagnostic imaging, medical materials, and even big-ticket items like outpatient surgical treatment or chemotherapy.
What is really concerning is there is no cap on that twenty percent. You will pay it forever with no stopping point. This naturally is a huge concern for many individuals who may be retired and are living on fixed incomes. Paying twenty percent of the cost of surgery or dialysis could be fiscally ravaging. Luckily, there is a method for you to safeguard yourself against those future expenditures. Enrolling in a Medigap policy during your open enrollment window will offset some of those expenses.
What is the Medigap policy? A Medigap policy is often called a Medicare supplement. It is a supplemental medical insurance policy that fills in the gaps in Medicare’s protection. Here’s how it works. A medical service provider bills Medicare for healthcare services that a client received. Medicare then processes the claim and pays its share minus any deductibles and coinsurance that a client would typically be held accountable for. Medicare then sends the rest of that bill to the Medigap policy which begins to assist in paying for a few of those deductibles, co-pays, and coinsurance which would typically be the client’s obligation.
There are presently ten standardized Medigap plans readily available in all states except for Minnesota, Massachusetts, and Wisconsin, where strategies vary slightly. You can find out more about rules in those states on the Medicare website. https://www.medicare.gov/ Most clients will have these ten standardized strategies to select from and each strategy covers a different set of benefits. The most detailed strategies, like F and G, will leave clients with little-to-nothing to pay out-of-pocket. There are also less detailed Medigap plans, like Strategy N, with lower premiums that pay some gaps and leave others for clients to pay.
Medigap plans give clients the option to choose a policy with personalized costs and advantages. Due to the fact that the federal government standardizes Medigap plans in most states, clients may chart strategies in their locations based upon price. For example, the benefits for a Medicare supplement G policy are the same no matter which insurer you choose. Here at Apex Planning, we supply quotes for our clients, quote all insurance companies’ existing rates in a particular postal code, and in addition, examine their rate boost history. This helps us identify the insurance provider that is the perfect option for a particular client.
As mentioned above, there is an open enrollment window to enroll in any Medigap policy. This window opens three months before your Part B effective date, and it is a “use it or lose it” window. This can be crucial if a client has any severe health conditions. There is one opportunity to purchase a Medigap plan with no underwriting and with no health questions asked. We often hear from clients who were pretty healthy when they turned 65 and chose not to exercise that one-time opportunity to get a Medigap policy. These clients thought they would simply wait until they got sick and then purchase the Medigap policy.
Regrettably, this is simply not the way it works in most states. If a client misses his/her open enrollment window he/she may still complete an application for a Medigap policy later, but insurance companies do not have to accept it. They can refuse acceptance for an array of reasons. This leaves clients paying twenty percent out of pocket on their own. For something like cancer, paying twenty percent of the expense of chemotherapy or radiation could be financially debilitating. If you want Medigap protection, be sure not to miss your open enrollment window for Medigap or any other creditable coverage.
Additionally, Medicare supplements do not include most prescription drug coverage. Prescription drug plans are often call Part D coverage. Most clients couple a supplement with a prescription drug plan for medication coverage. If you are interested in learning more about prescription drug plans, please click here.
I hope this information helps you better understand what Medigap plans are and what they cover. Further, I hope you understand why it is essential to not miss out on the Medigap open enrollment window. (It only happens around your 65th birthday.) If you wish to have someone in your corner with Medicare, please reach out to us for help choosing your coverage.
Finally, if you have been pondering whether to enroll in a Medigap strategy or a Medicare Advantage plan, please give us a call or fill out our contact form.