Medigap Policy

2014 Medicare and Medigap Updates

Medigap Policy

With the on-going issues concerning Universal Health Care for the older population, you and your spouse need the utmost in health care insurance. Until the government manages to come up with a health care policy that everyone can agree on, your best bet at keeping your family covered is to rely on the Original Medicare Coverage coupled with a supplemental Medigap Policy.

A Medigap policy exists because the Original Medicare package does not pay for all types of health-related and medical services. A Medigap plan is your stop-gap solution to illnesses and services that Original Medicare does not cover, so that regardless of the condition you or your spouse find yourselves in, you are assured of health insurance. Just a few of these potential “gaps” addressed by a Medigap policy are co-payments, coinsurance, and deductibles that can add up to a lot of dollars in the event you are hospitalized for a long period and need urgent medical care.

The way a Medigap policy works is it fills in the areas that Original Medicare doesn’t take care of. If your Medicare policy only shoulders 80% of an out-patient charge, your Medigap policy will come in to take care of the remaining 20%. As an example, if you have an illness that requires you to regularly visit the doctor, your Medicare will shoulder 80% of approved office visit fees and Medigap shoulders the rest. If for that illness, Medicare authorizes $100 in office visit payments, Medicare will pay for $80 and your Medigap policy will shoulder the remaining $20. It is important to note that if for a visit you paid $130 and Medicare only authorizes a ceiling payment of up to $100 for that type of visit, you will have to shoulder the remaining $30 to cover the payments. It’s not a zero-payment system but the 20% coverage over time can amount to a significant figure that will not be charged to your bank account – that can account for a lot!

To get a Medigap policy, you will have to purchase it from a private insurance company that offers Medigap as a service. The Federal government has a complete list of approved and accredited companies that can offer Medigap services so it is important to check with those before you decide which company you will be availing the services from.

Also, Medigap policy offerings are classified from letters A to L. These refer to standard packages as defined by federal and state laws. You should carefully choose a package that suits your needs. The wrong package can cause you to overpay for your coverage, or you can underpay for it but you won’t be sufficiently covered which renders your Medigap policy futile if not useless. Also take note that the same packages contain the same benefits regardless of the offering company so if you have decided to get, say a Plan D Medigap Policy, you should set out to compare premium prices before you pick a company.

As a general rule, Plan A policies offer the fewest benefits, the least coverage, and therefore the cheapest premium. It also follows that higher plans like Plan J or Plan L offer more benefits, bigger coverage, and higher premiums. If you think you do not need an overly aggressive Medigap policy, consider Plans C or F which offers coverage for major benefits without being too expensive.

While plans significantly vary from one to the other, there are benefits that you can expect to get from almost every plan. This includes hospital annual deductibles (applicable to all plans except for A), skilled nursing facility co-insurance (plans C to L), Par B annual deductibles, emergency care during foreign travel (plans C to J), in-house recovery care, prevented care, and Medicare Part B excess doctor charges. Plan your selection carefully along these benefits so you can get the best one for you and your family.

You have to remember that a Medigap policy will not cover for everything that Original Medicare, Part A and B, will not cover. But it will provide you more than adequate assurance that when Medicare reneges on a payment, you still have a second option that you can turn to.

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