Medigap Plans:

 

Choosing a Medigap Policy

Choosing a Medigap policy is one of the most important decisions you will make when you go on Medicare or turn age 65. While there are, obviously, many choices to choose from, some of those choices are much more advantageous than others. Because of that, it is important to be informed, make a thorough comparison and pick the plan that is right for your health and financial situation.

There are three factors that you should consider about yourself before choosing a Medigap plan:

  • Your health history. Are you someone who has always been healthy, on no medications, no major health problems? Or, are you someone who is currently being treated for a health condition or has some ongoing maintenance-type medications. This factor will, and should, weigh in to your decision of which plan to choose. If you are especially healthy, maybe you want to elect a lower-tier plan, like N or D. This will save you some money each month and may be sufficient coverage for you.
  • Your financial means. Do you anticipate being able to pay premiums in the future for the plan you select? This is important to know upfront. The last thing you want to do is be “over-insured” but in good health from age 65-70, then decide to save money on a lower level plan later and incur health problems. It is always important to think long-term and think about the big picture.
  • Your personal preference. Do you mind having some small co-pays at the doctor and/or hospital? If you prefer to not have to write a check for a co-pay or deductible for each visit, then maybe Plan F is the way you should go. But if you are accustomed to having co-pays and don’t mind continuing to pay a small co-pay, maybe a plan like Plan N would be a good fit for you.

The Two Most Important Things to Know

When selecting a Medigap plan, you should find out two things about the plans you are considering. These two things, when looked at as a whole, should give you a good idea of what plan would be most advantageous for you. You should be able to get the following information for any company from any agent, broker or from the insurance companies themselves:

  • Premium – What is the monthly premium for your age and zip code? Since coverage is standardized, this is far and away the most important thing about choosing a Medigap policy.
  • Company Rating/Reputation – To a lesser extent this is also important. Obviously, rates being equal, it is better to be with a more highly rated company. That said, I would not ever base a decision solely on this. You must put the premium at the forefront of the decision-making process.

What Do Medigap Policies Not Cover

Medigap policies typically “follow” Medicare. By this, I mean that they cover things that Medicare covers. But for things that Medicare does not cover, the Medigap plan typically will not cover it either. This includes things such as long-term care (care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing service.

Types of Plans That Are Not Medigap Plans

There are several types of plans that are NOT Medigap plans. Many people mistakenly refer to them as Medicare Supplements, when in reality, they are not. Medicare Supplements are ONLY the standardized plans that you see on the standardized plans chart. These are NOT Medigap (Medicare Supplement) plans:

  • Medicare Advantage plans
  • Medicare Part D prescription drug plans
  • Medicaid
  • Employer or union plans
  • TRICARE
  • Veterans’ Benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans

Where Can I Get More Information about Choosing a Medigap Policy

You can visit our Medicare Resources page to get more information.
Also, you can download a copy of the book Medicare publishes each year called “Choosing a Medigap Policy”: http://www.medicare.gov/publications/pubs/pdf/02110.pdf. This book has more information about how to choose a Medigap policy and contains coverage information, as well as information about when you can sign up for a plan and under what circumstances.