People With Medicare
Choosing a Policy - 5 Simple Steps
You will need to decide if Medigap is right for you. If it is, you will need to know when to buy a policy and which type you need. We can help you decide. Just follow these 5 simple steps.
Step 1: Check to see if Medigap is right for you.
When you turn 65 and enroll in Medicare Part B, you will need to decide if you want a Medigap policy. You may not need a Medigap policy if you already have other health insurance, such as:
- An employment-related health plan, with comprehensive medical coverage
- A retiree plan, with comprehensive medical or a Medicare supplement
- Medicaid, with medical assistance benefits
- Medicare Savings Program
- Tribal or Indian health benefits
- Military benefits, such as TRICARE for Life
- Veterans' benefits
- A Medicare Advantage plan, sometimes called a Medicare health plan
Note: If you have Medicaid or if you are enrolled in a Medicare Advantage plan, you should not be sold Medigap. It is against the law.
You should carefully review the benefits of your current coverage. Then decide if having a Medigap policy will help lower your health care costs. If you do not have other insurance, you may want to consider buying a Medigap.
Still not sure if you need a Medigap? Get personal help.
Step 2: Decide if you can enroll, and when.
There are certain times when you can buy a Medigap policy. They include:
- When you reach at least age 65 and enroll in Medicare Part B
- In certain states, people under 65 who get Medicare because a disability can buy a Medigap when they enroll in Part B
- When you lose your employer health coverage or use up your COBRA coverage
Step 3: Decide which type of Medigap plan meets your needs.
There are 11 different standard Medigap plans that can be sold, except in Massachusetts, Minnesota, and Wisconsin. For help with plans in Massachusetts, Minnesota, or Wisconsin, you can use Medicare's online tool, Find and Compare Medigap Policies, or get personal help.
The 11 standard plans are labeled A-D, F, high-deductible F, G, and K-N. Each of these plans covers different services. Insurance companies are not required to sell all these plans. But, they must offer Plan A and either Plan C or Plan F if they want to sell any other plans.
You will need to decide how much coverage you need and which plan best meets this need.
See Medicare's chart (page 11) for what each plan covers.
Note: If you also want prescription drug coverage, you also need to enroll in a Medicare prescription drug plan.
If you want help reviewing the different Medigap plans, get personal help.
Step 4: Pick a plan and a Medigap insurance company. Then sign up.
Your state insurance department has a list of the companies and plans you can buy. Many different companies sell Medigap plans. But each company must sell the exact same benefits, or standard benefits, of each plan. This means that Medigap Plan C sold by Company X must have the same benefits as Plan C sold by Company Y.
Where you may see a difference between companies is in the cost, or premium, that the company charges you for the plan. Be sure to shop around. Decide if it makes sense to pay more for exactly the same coverage.
Why are the costs so different if the benefits are the same?
There are many reasons why the cost varies between companies. It may be based on how old you were when you bought the plan, your current age, and whether you smoke. The number of people in the plan can change it, too. Also, there are rules for setting policy rates. And they are different depending on the state where you live.
Here are some questions you can ask an insurance company. These can help you sort out some of the differences between companies:
- Has the premium for your plan changed in the last 3 years? If so, by how much? How often does it change, or go up?
- Will the premium change as I get older? Or is it the same for everyone, no matter what age?
- How long is your wait for pre-existing conditions?
What if I am not sure about the plan I am buying?
By law, when you buy a Medigap you have a 30-day "free look" or "trial" period. If you change your mind, you can cancel it and get a refund. You must do this within 30 days of the day your policy started.
Note: When you switch from one plan to another plan, be careful. Do not cancel your first policy until after your free look period is over. You may have to pay two premiums for one month. But at least you will have the chance to change back if you need to.
Where can I get help with comparing Medigap plan options?
You can compare the average costs for all the Medigap plans in your state by visiting Medicare's Find and Compare Medigap Policies online tool. This tool can show you the differences in premiums, deductibles, and any other costs you will pay for a Medigap policy.
If you want, you can get personal help.
Step 5: Use Your Coverage
Who Pays First?
Make sure you understand how and when to use your coverage. In most cases, your Medigap will pay your doctor directly after Medicare pays. Make sure your doctor has copies of both your Medicare and Medigap insurance cards. This way, your care will get billed properly.
If you have any questions or problems with your coverage, contact your insurance. Your plan's booklet of benefits will have their number and Website.
You can also get personal help.