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What is Medigap?

Medigap insurance was designed by private insurance companies to cover the “gaps” found within the government provided medicare program.  These gaps exist between what medicare reimburses (or covers) and what is left over for the consumer to pay.  Medigap insurance has risen in popularity over the past years and continues to gain more traction due to the significant increases in seniors turning age 65, otherwise known as baby boomers.   It is estimated that over 10,000 per day for the next 20 years will be turning 65 …which opens up a very large demand for medigap insurance.  It appeals to many because for a relatively low monthly premium,  it can cover a substantial amount of potential financial risk.

Although it is possible to have Medicare prior to age 65, you are only eligible to enroll for a medigap policy when are 65 or older.  In addition, to qualify you must be signed up with medicare part A and medicare part B.  Medicare Part A is the hospitalization portion, while part B is the outpatient and doctors office portion.  Medicare Part A is automatic and has no cost, but Part B is $104.90 this year…and for most people comes directly out of their social security.

You may purchase a medigap policy during specified open enrollment periods.  When enrolling during this period, your acceptance into the plan you choose is guaranteed, meaning you cannot be declined due to medical conditions in your past or present.  Open Enrollment occurs for everyone 6 months prior to their 65th birthday.  There is also an Annual Enrollment Period…which occurs at the end of every year. This year is between October 15th and December 7th.  During this period, ALL people with medicare can change their health program as well as their Part D Prescription Drug plan.  If you are you happy with your current set up, it’s simple….you don’t need to do anything at all.

Medigap has a variety of benefits.  To start,  there are no network restrictions.  This gives people the satisfaction of being in greater control of the hospitals, clinics, doctors and procedures that choose.  Becuase Medigap insurance is controlled my private companies and not the government, they are not set up as “annual contracts”  which means you never run the risk of your plan choosing to not renew for the year, forcing you to change carriers..which can be a big hassle.

Medigap also has a 100% coverage option. This is the only plan of its kind to be offered in all of medicare.  It is called a Plan F.  It covers every single out-of-pocket expense, or gap which Medicare does not cover.  There is a great peace of mind the lies within knowing there will never be a penny paid out of pocket…regardless of the severity of the medical condition.  Many people like this option because it is hassle free.  In addition to Plan F, is Plan G.  Plan G offers all of the same characteristics of Plan F, but does not cover one thing- the Part B annual deductible.  This year, the Part B annual deductible is $147.   Many people consider Plan G because it’s monthly price tag is generally quite a bit less than Plan F.   They may feel confident that they will not use all of the $147 deductible…and should that be the case, they save hundreds of dollars annually on the reduced premiums.   (to see all plan options available…click here)

All Medigap plans have been standardized by CMS. This means that insurance companies, or any agent/broker representing them, cannot offer a different variation of the same plan.  They must all be the exact same letter plan.  The only thing a consumer needs to look at is which plan is right (we suggest either Medicare Plan F or Plan G) and then find the company that offers the most competitive price, while also maintaining a good reputation.

It is important to use a knowledgable, licensed agent to assist you when seeking a private medigap plan.  The right agent will will steer you into the most competitively priced and reputable insurance company for the letter plan you wish to purchase.  At MedigapGroup.com, we have a team of dedicated enrollment specialist ready to assist you with every question or concern you may have.

PlansPlan APlan BPlan CPlan DPlan F*Plan GPlan
Plan MPlan N
Medicare Part A Coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up
Medicare Part B Coinsurance or Copayment
Blood (First 3 Pints)
Part A Hospice Care Coinsurance or Copayment
Skilled Nursing Facility Care Coinsurance
Medicare Part A Deductible
Medicare Part B Deductible
Medicare Part B Excess Charges
Foreign Travel Emergency (Up to Plan Limits)
Out-of-Pocket Limit 2016**

*Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,180 in 2016 before your Medigap plan pays anything.

**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medigap plan pays 100% of covered services for the rest of the calendar year.

***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.

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