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As we age there are certain things that start to weigh heavy on our minds, who will take care of me? Where will I go? What medical expenses will Medicare cover? What is Medigap insurance?
Medicare is a complicated issue and should not be taken lightly, in that vein, many people are confused about Medigap plans and therefore are not able to get the benefits that they need and deserve to live out their retirement. It is important that if you are using Medicare that you also understand Medicare supplemental insurance and what it can do for you.
What is Medigap Insurance?
Medigap insurance, or Medicare Supplemental Insurance, is quite simply, insurance that is sold by third party independent insurance companies to cover the gaps or bills that are not paid by Medicare. This helps to keep your out-of-pocket expenses low and affordable. Many of these policies, however, only pay for procedures and bills that are deemed medically necessary by Medicare.
For instance, if you go in for surgery that costs $5,000 and Medicare pays for $4,200, this means that you have a remaining balance of $800. While Medicare has done their part and paid the majority of the bill, there is still a large outstanding balance that you may not be able to afford. If you have a supplemental plan this is where it will come in, the supplement will then pick up some of the remaining balance to help reduce out-of-pocket costs.
While a supplement may not pay all of the remaining balance, they will pay a large chunk making your payments more manageable. These plans are labeled A-N and all have different benefits like emergency care out of the country and more.
Your Rights As a Medigap Consumer
As a Medicare Supplemental consumer you have several rights when it comes to your coverage. The first is that companies cannot discriminate on age or prior illness, if you are enrolled in Medicare Part B and are over 65 or have been enrolled due to disability they have to sell you a policy. Second, if you are disabled you have the same rights to open enrollment as seniors.
Also, you may be able to enroll in a new plan if you lose your old coverage even if the open enrollment period is over. Another right you have is the guaranteed renewability of policies and the ability to try out a plan for 30 days prior to signing on. This means that you can always renew your plan no matter what and that you can try out coverage prior to becoming a member. Lastly, your doctor has to submit claims to Medicare for you from which the supplemental insurance company will be billed for a portion of the remainder.
Does Everyone Need a Medigap Insurance Policy?
No. Quite simply, everyone does not need a supplemental plan. Supplemental plans are put into effect to help cover charges that may not be readily payable for some users. Those that have health insurance coverage through retirement plans or other means may not need a supplement plan.
Those who have Medicaid or are part of the Qualified Medicare Beneficiary will likely need a supplement to help cover charges. If you are unsure about your rights, what coverage you need, or what coverage you already have, you can contact Medicare directly or talk to an insurance representative.