Medigap Coverage to Change

By Ellyn S. Kravitz and Lauren I. Mechaly

Medigap is Medicare Supplement Insurance sold by private insurance companies that helps pay for certain health care costs not covered by Medicare, such as co-payments, co-insurance, and deductibles.  Medigap effectively “fills the gap” in the Original Medicare Plan. 

There are 12 different Medigap Plans (Plan A through Plan L).  Because each plan provides different benefits, it is important to consider your health needs, identify the benefits you would like, and pick the plan which best suits those individual needs.  Although private insurance companies are permitted to charge varying premiums, the benefits offered under each plan cannot change.  This means that Plan A, for example, will always offer the same benefits, regardless of insurance carrier, but will not always cost you the same amount.  Note that insurance companies are not required to sell every plan.

In order to purchase a Medigap policy, you must have Medicare Part A or Part B.  You and your spouse must buy separate Medigap policies.  Medigap policies do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private nursing. 

The best time to purchase a Medigap Plan is during the six-month open enrollment period which begins on the first day of the month in which you are 65 years or older and enrolled in Medicare Part B.  In New York, insurance carriers writing Medigap insurance must accept a Medicare enrollee’s application at any time throughout the year.  Health status, claims experience, medical condition, or whether the applicant is receiving health care services may not be considered at the time of application.  Further, New York allows insurance carriers to sell Medigap policies to applicants under 65 if the applicant has a disability or ESRD (end-stage renal disease).

Effective June 1, 2010, there will be important changes to Medigap insurance policies.  As of that time, Medigap Plans E,H, I, and J will not be available to new applicants.  The Medigap preventative care and the at-home-recovery benefits will no longer be available, although co-insurance coverage of hospice care will be added to all Medigap programs.

Medigap Plans M and N will be introduced on June 1, 2010.  These plans will offer lower monthly premiums but will add, respectively, deductibles and co-payments.  Both plans will have similar benefits to Medigap Plan F. 

Medicare Supplement Plan M will charge slightly lower monthly premiums but will split the Medicare Part A deductible with their insurance company.  Plan M will not cover the Part B deductible.  Plan M is expected to cost approximately 85% of current Plan F premiums. 

Medicare Supplement Plan N will also charge slightly lower monthly premiums but slightly higher deductibles ($20 for a doctor visit and $50 for a trip to the emergency room).  Plan N is expected to cost approximately 70% of current Plan F premiums.

For more information on Medicare Supplement Insurance Plans and premiums, contact your insurance provider.

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