What is a Medigap Plan and why is it called a Medicare Supplement?
A Medigap Plan, often referred to as a Medicare Supplement, is a way for a Medicare beneficiary to purchase an insurance plan to work alongside their Original Medicare plan. Medigap plans are purchased from a private insurance carrier and will coordinate with Medicare to pick up some or all the costs that Original Medicare does not cover completely. Some type of supplemental coverage is needed to go along with your Medicare because there is no out of pocket stop loss on Original Medicare (which are Parts A and B of Medicare). That means the uncovered deductibles for Parts A and B and the 20% co-insurance that Medicare does not cover, could add up to seriously large amounts of money if you do not have some type of supplemental coverage. That is because these leftover cost from Medicare are the responsibility of the Medicare beneficiary (you) to pay.
What do Medigap plans NOT cover?
Medigap plans do not cover many additional benefits above and beyond the services that Medicare approves, except for some emergency coverage outside of the USA available on some plans. All Medicare plans with the same letter name, like a Plan G or N, cover the same benefits from carrier to carrier. However, some insurance carriers do include a health club membership, like Silver Sneakers, when you purchase your Medigap plan through them. Please be aware that no Medigap plans include your Part D outpatient prescription drug coverage. You much purchase a stand along Part D drug plan.
Choosing the Right Medigap Insurance Company is Important!!
Just make sure you are purchasing your plan from a trusted carrier with a good track record and a good history of low renewals. This is important because you will not be able to change your Medigap Plan/Carrier after your initial enrollment, without going through underwriting. You see, when you first enroll in Medicare Part A and B (or join Part B if you are leaving a company group health plan after age 65, or leaving a group health plan even if you have already been on Part B of Medicare) you have the right to join a Medicare Medigap plan without being asked any medical questions, as long as you follow the time table allowed by Medicare. In other words, you can join a Medigap plan with no underwriting. That means if you have any health conditions, the insurance carriers cannot decline to offer you coverage or increase the premium they offer you. But if you try to change your plan later, when you no longer have any kind of guaranteed issue option, they will require you to answer health related questions and can decline to offer you coverage or offer you an increased premium.
Medigap Insurance Cost in Georgia
The cost of a Medigap Plan G in Georgia averages around $125 for a 65-year-old depending on the insurance carrier you choose to purchase your plan through. Most people will also need to purchase a stand-alone Prescription drug plan called a Part D plan, to cover their outpatient drugs. These plans range in price from $15-$70 in Georgia. However, it has been my experience that most people are well served by plans costing between $17-$30 a month. The determining factor in the plan you should choose is based on the prescription medications that you take.
Advantages of Medigap Plans
For people that like to keep their monthly expenses steady, a Medigap plan G is a nice way to control your out of pocket costs for your medical services. It allows you to know what your medical cost will be for the month. You pay your Medigap premium up front every month. You are then responsible for the Medicare Part B deductible, which is $185 in 2019, for the calendar year. Then the Plan G picks up most or all the costs left over from Original Medicare for Medicare covered medical services, for the rest of the calendar year. But keep in mind that your prescription drug cost will very as they are not covered under your Medigap plan, unless they are Part B covered drugs. Those Part B drugs are typically drugs administered in a medical facility, usually by infusion like Chemo therapy. Your outpatient, self-administered drugs will be covered under your Part D drug plan that you will purchase separately.
With a Medigap plan you can see any doctor that accepts Medicare. That means the doctor or facility must be in network with Medicare, meaning they have agreed to accept the Medicare reimbursement rate for services rendered. Many beneficiaries like that about a Medigap plan because it gives them the largest possible network of providers and facilities available to Medicare members.