3 Things You Need To Know About Medigap

Health & Medical Blog

If you are a senior over the age of 65, or you have either a disability or kidney failure requiring dialysis treatment, then you'll want to take advantage of Medicare coverage to help pay large medical bills. Sometimes, however, you may still face an intimidating payment above and beyond what standard Medicare can cover -- and that's when you need a Medicare supplement plan commonly known as Medigap. Here are three important things you need to understand if you're considering this supplemental coverage.

1. How to Get It

Like any form of health insurance coverage, a Medicare supplement plan comes with its own set of requirements and qualifications. If you intend to apply for Medigap, keep in mind that:

• You must first be participating in Medicare Parts A and B. Participation in both of these parts is not necessarily automatic -- if you live in Puerto Rico, for instance, you're automatically enrolled in Part A but you have to sign up for Part B on your own initiative.
• Medigap requires an additional premium payment on top of the regular premiums you're already paying to Medicare.
• Medigap does not cover more than one person at a time. Spouses and other family members must sign up for their own Medigap coverage separately.

2. When and Where to Get It

Any Medigap provider in your state can sell you a Medicare supplement plan, but the timing of your application could prove critical. Six months of the year you'll have access to any kind of Medigap policy you want without underwriting, thanks to open enrollment. This is the best time to schedule your application. If you miss the open enrollment window, you can still get Medigap coverage, but you may be forced to undergo an underwriting process that results in higher premiums based on pre-existing conditions or other factors.

3. What It Covers (and Doesn't Cover)

Medigap is designed to provide additional or "gap" coverage to help you pay substantial medical fees not covered by Medicare or private health insurance. (Either your private plan or your Medicare plan will pay up to its coverage limit before the other kicks in, depending on which one is designated as the primary payer.) If you're looking at major co-insurance, co-payments or deductibles, Medigap could prove invaluable for reducing that financial burden. Be aware, however, that Medigap does not apply to every kind of medical circumstance. Exceptions include:

• Dental procedures
• Vision care
• Vision or hearing devices
• Long-term care (nursing homes, assisted living)
• Home health care/private nursing care
• Prescription drugs (as of changes made in 2006)

Once you have a basic grasp of how Medigap works, you can use it to your best advantage. Contact your insurance agent or a Medicare specialist today to see whether Medigap could help stabilize both your health and your bank balance! You can visit a website like http://scis.us to learn more about Medicare supplement plans.

21 January 2015