Medicare Your Coverage Options

Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan

Written by Diane Archer
While people with Medicare have the choice of the government administered traditional Medicare or a commercial Medicare Advantage plan that provides Medicare benefits, most people opt for traditional Medicare because it gives them easy access to the doctors and hospitals they know and trust anywhere in the U.S. Moreover, with traditional Medicare, you can fill gaps in coverage and protect yourself against high costs in one of three ways:  a “Medigap” or Medicare supplemental insurance that you buy in the individual market, Medicaid (including Medicare Savings Programs administered through Medicaid) or retiree coverage, if it’s available to you from a former employer. With a Medicare Advantage plan, you can have very high out-of-pocket costs, including deductibles and copays, for which you cannot budget.
Here are four things to think about when choosing a Medigap plan:
  1. Enrollment: To avoid what could be high out-of-pocket costs if you need care, you should sign up for a Medigap plan through a private insurer at the same time you enroll in traditional Medicare. You will then be fully covered for medical and hospital care.  (Your local area agency on aging, www.eldercare.gov, can provide you with a list of Medigap insurers in your state.) If you wait to buy Medigap insurance, you might not be eligible to get it right away and, in many states, your premium will be based on your health status. (N.B. You cannot buy a Medigap plan to fill gaps in coverage in a Medicare Advantage plan,)
  2. Choice: You have a choice of many different Medigap plans lettered A through N. Every plan covers basic gaps in traditional Medicare coverage, including gaps in medical and hospital coverage and 365 days of additional hospital coverage. Plan A is the most stripped down of the plans but does cover the basics, including the 20 percent coinsurance for doctors’ services. Other plans fill additional coverage gaps. Most people do well buying Plan C, which covers all your basic needs. Plan F is also popular and covers a little more.
  3. Standardization: With Medigap coverage, the gaps filled by plans A, B, C, D, F, G, K, L, M, N, will be the same no matter which insurer you buy the coverage from.  (Keep in mind that these lettered plans are different from Medicare Parts A, B, C and D.)  These plans can be compared on price alone.
  4. Premiums: Premiums can be based on the age at which you buy the policy (issue-age rated), your current age (attained age-rated) or the cost of providing the coverage to everyone in your area (community-rated).  Community-rated premiums will be the same for everyone in your area no matter what age you buy the policy.  Please note that the lowest priced policy today might not be the lowest priced policy over time.

You can call the Medicare Rights Center hotline for free help choosing a plan at 1-800-333-4114 or your local State Health Insurance Assistance Program (SHIP).

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