We always enjoy when people ask why they should use us for their Medigap needs because it lets us explain how we’re different.
We entered the Medigap business by request rather than design. For years, our core business was centered strictly on personal and commercial insurance. But customers began to ask us to provide Medigap products because they were looking for the same kind of service and trust we provided to them in other insurance lines. We always listen to our customers – so we started our Medigap line.
We focus is solely on Medigap products rather than all Medicare products such as Parts C and D. We did this because we prefer being Medigap specialists to being Medicare generalists. We’re often struck by the conflicting information and advice on websites and from ‘experts.’ By concentrating on Medigap alone, it gives us a laser-like focus and deeper and more extensive expertise.
Education & Information
Understanding Medigap rules, regulations and options can be a real challenge. We invest significant time in sharing our knowledge with people to educate and inform them about Medigap and all its options. Researching online and getting quotes online may be fine for those with the expertise and time to do so. But it can lead to uninformed decisions. Our goal is to work personally with customers to help them learn the ins-and-outs of Medigap for better decisions.
The Six Cs
We employ the same high standards to our Medigap products as we do with our other lines. We call this our
Six Cs: Cost … Choice … Convenience … Coverage … Customer Service …Claims.
This means being easy to do business with … offering quality choices … providing the best coverages for your budget … and doing so with superior service and a hassle-free efficient claims process.
What is it?
Medicare Supplement Insurance policies (Medigap) help pay some of the health care costs that Original Medicare Parts A and B don’t cover, such as:
Although there are different types of Medigap plans (each designated by a single letter), every Medigap policy and plan must follow federal and state laws designed to protect you. Each specific Medigap Plan is standardized by law; however, some plans provide better coverage so you can choose the one that best meets your needs.
Medigap insurance policies are sold via private insurance companies, Each insurance company can decide which Medigap policies to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:
- Don’t have to offer every Medigap plan
- Must offer Medigap Plan A if they offer any Medigap policy
- Must currently also offer Plan C or Plan F if they offer any plan
- Must comply with standardized coverage for each plan, as defined and regulated by the Center for Medicare and Medicaid Services (CMS), a federal agency. For example, the benefits for a Medigap Plan F must be the same for every insurer.
What Medigap Does Not Cover:
Medigap policies generally do not cover:
- Long-term care
- Dental care
- Hearing aids
- Private-duty nursing.
Medigap Plans We Offer:
We offer five (5) Medigap policies: Plans A, C, F, G and N.
There are other Medigap plans, but we sell these plans because they are the ones most requested by our customers. For example, Plan F is currently the most popular plan nationally and Plan G is the second most popular – both because of their outstanding coverage.
We also believe the plans we offer also represent the best overall value for cost vs. coverage. We’re always pleased to take the time to explain why. We would rather lose a sale than sell a plan that was not right for our clients.
Although the coverage for each plan is identical by law, we only partner with Medigap insurers with a sterling reputation, an excellent A.M. Best rating, a superior service record and a willingness to conform to our Six C standards.
|Medicare Part A co-insurance and hospital costs (up to an additional 365 days after Medicare benefits are used)||100%||100%||100%||100%||100%|
|Medicare Part B co-insurance or co-payment||100%||100%||100%||100%||100%|
|First three (3) pints of blood||100%||100%||100%||100%||100%|
|Part A hospice co-insurance or co-payment||100%||100%||100%||100%||100%|
|Skilled Nursing Facility co-insurance||No||100%||100%||100%||100%|
|Medicare Part A Deductible||No||100%||100%||100%||100%|
|Medicare Part B Deductible||No||100%||100%||No||No|
|Medicare Part B Excess Charges||No||No||100%||100%||No|
|Foreign Travel Emergency (Up to Plan Limits)||No||80%||80%||80%||80%|
* Please note that due to recent regulatory changes, Medigap Plans F and C will be phased out in 2020, with the following conditions:
- If you already have Medicare Supplement Plan F (or Plan C, which also covers the Part B deductible), you can generally keep it.
- If you were eligible for Medicare before January 1, 2020, you may be able to buy Medicare Supplement Plan F or Plan C.
- If you qualify for Medicare on January 1, 2020 or later, you may not be able to buy Medicare Supplement Plan F or Plan C.
Medigap Facts & FAQs
Learning the language
Medigap can sometimes seem as though it has its own language. There many technical and arcane terms – too much to share here. But there are three basic terms to keep in mind: Parts, Plans and Policies.
Some websites, and even some experts, use these terms interchangeably – and, at times, a little too loosely. Being precise can help avoid confusion.
PARTS: These refer to the four (4) fundamental types of Medicare coverage:
- Medicare Part A – (Hospital Insurance)
- Medicare Part B – (Medical Insurance; e.g., outpatient care; doctor visits)
- Medicare Part C – (Medicare Advantage, like HMOs or PPOs. Combines A, B and usually D)
- Medicare Part D – (Prescription Coverage)
Medicare Supplement (Medigap) only applies to Parts A or B (Original Medicare).
PLANS: Refers to the ten specific options for Medigap coverage (depending on the state). These plans are: Plans A, B,C, D,F,G, K,L,M and N.
POLICY: Medigap policy refers to the actual contract with a specific insurer. For example, ‘I have a Plan F policy with ABC Insurance Co.”
10 things to know about Medigap (source: medicare.gov)
- You must have Medicare Part A and Part B to obtain a Medigap policy.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium paid to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurer cannot cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It is illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you are switching back to Original Medicare.
- Once you have a Medicare Supplement policy, it is illegal for an insurance company to sell you a second policy unless you inform them in writing that plan to cancel the first policy.
- Your Medicare supplement insurance policy allows you to see ant doctor or hospital that accepts Medicare patients. No networks or referrals are needed.
When can you apply for a Medigap Policy?
You can apply for a Medicare supplement insurance policy just about any time, once you are eligible for Medicare and enrolled in Medicare part B, including:
- Your Open Enrollment Period (see below)
- If you are past your open enrollment period but do not have other coverage
- If you leave a Medicare Advantage plan
- Your employer discontinues its group retiree health coverage
The best time to enroll and buy a Medigap policy is during your Open Enrollment Period. The Open Enrollment Period is a one-time window that lasts for six months, starting on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B (some states may have additional open enrollment rights under state law).
During your relevant Open Enrollment Period: 1) you can buy any Medigap policy; 2) an insurance company cannot use medical underwriting; and 3) you cannot be rejected due to health reasons.
What happens after my Open Enrollment Period?
According to the medicare.gov website, if you apply for a Medigap policy after your Open Enrollment Period, your application will be subject to medical underwriting. There is no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you meet certain special criteria. After the Open Enrollment Period, the insurance company can:
- Refuse to sell you any Medicare supplement insurance policy it sells
- Make you wait for coverage to start due to pre-existing conditions (except in limited circumstances)
- Charge you more for a Medicare supplement insurance policy because of any past or
present health conditions
When can I change a plan?
Unlike Medicare Part C (Medicare Advantage) or Medicare Part D (Prescriptions), you can change your Medigap policy at any time during the year. For example, if you want to change the type of coverage (plan) that you are currently enrolled in, you can do so at any time. Please note that except for a few states, this change could result in underwriting considerations.
What if am 65 or over but still have a group health plan?
If you are 65 but defer enrolling in Medicare Part B due to having group health insurance through an employer or union, your Medigap open enrollment period will start once you sign up for Part B.
If Medigap plan coverages are standardized,
why does the cost vary?
The coverage for each type of Medigap plan is uniform regardless of the insurer, as required by the Center for Medicare and Medicaid Services (CMS), a federal agency.
This means that the coverage benefits for a Medigap Plan G policy from Insurer 1 will be identical to those for Plan G for Insurer 2. In other words, in terms of coverage, a Plan G is a Plan G.
This begs the question: if Medigap coverages are standardized, why do Medigap rates vary so much?
Medicare coverage is a true apples-to-apples comparison because it is standardized. However, this is not true for Medigap pricing.
The basic answer is although the CMS sets Medigap plan coverage requirements, insurance companies set the Medigap rates. The individual insurer is free to set its prices, resulting in them varying by carrier.
At a more detailed level, prices for the same Medigap Plan policy vary based on three (3) primary factors:
Where you live has a major impact on the rates for the policy you choose.
Although Medigap plan coverages are federally regulated, each state is allowed to create legislation that can affect premiums. This causes Medigap rates to vary between states. This results in a current price differential of over $600 between the least expensive and most expensive state.
For example, a monthly premium for a Medigap Plan in Massachusetts, Louisiana or Nevada is more costly than the same Plan in Hawaii, Oregon or Wisconsin. In fact, rates can even vary considerably by zip code within the same state.
Some states (e.g., California, Oregon, Maine, Missouri) make it easier for people to switch Medigap policies, especially for people with health issues. But if a significant pool of unhealthy people switch to a plan, the costs can increase and affect the rates.
Age also affects Medigap rates. Medigap insurers use three (3) pricing models:
Your age does not affect your premiums.
Premium is based on your current age and continues to increase as you get older.
Your premium is locked in when you purchase your plan. For example, if you purchase a plan at age 70, you get the 70-year-old rate for life. Location and Age factors can work hand-in-hand to affect Medigap pricing. For example, states do not allow attained-age pricing.
Each insurance company determines how to price its Medigap plans. Therefore, the pricing can vary based on how each carrier uniquely assesses its market and operates its business. Cost is obviously a major factor in choosing a Medigap provider. However, there are other factors besides costs to consider:
- Underwriting: When medical underwriting considerations come into play, each company has their own set of health questions. Those companies choose who they want to accept based on the answers to these questions. The companies that have harder health questions will offer a cheaper price, while the opposite occurs for the easier companies.
- Inflation can affect pricing.
- Rating & Reputation: It is still wise to choose a Medigap insurer with an excellent reputation and A.M. Best rating. Choosing a company with a great rating and reputation doesn’t mean having to pay a higher price. But a company with a low customer industry rating or poor customer service might try to offset that negative with lower premiums – but it could end up costing you more in the long run if that company fails to meet your needs.
- Service: Some companies invest more in customer service than others. Companies that provide superior customer care, efficient claims handling and helpful representatives may charge a few dollars more in monthly premiums for that value. But in the long run that difference can be a better alternative to those companies that cut corners in service in order to cut premiums.
- Claims experience If a company has to pay out a lot of claims over a given period, this can increase rates. This will vary from carrier to carrier, and depends on whom they accept or decline.
Paying the different prices for the same Plan does seem strange. We hope that the information we have provided here will help more sense of why that is.
For More Information:
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