ABOUT MEDIGAP PLANS
Medigap refers to various private supplemental medical insurance plans sold to Medicare recipients in the USA that provide coverage for medical expenses not or only partially covered by Medicare.
Medigap's name is derived from the notion that it exist to cover the difference or "gap" between the expenses reimbursed by Medicare and the total amount charged. As of 2006, 18% of Medicare beneficiaries were covered by a Medigap policy
Eligibility:
A person must be enrolled in part A and B of Medicare before they can enroll in a Medicare supplement plan. During the open enrollment period which begins within 6 months of turning 65 or enrolling in Medicare Part B at 65 or older, a person may obtain a Medigap plan on a guaranteed issue basis (i.e. no medical screening required). Outside of open enrollment, the issuing insurance company may require medical screening and may obtain an attending physician's statement if necessary. Medicare insurance is not compatible with other forms of private Medicare coverage, such as a Medicare Advantage plan.
Products available:
Medigap offerings have been standardized by the Centers for Medicare and Medicaid Services (C.M.S.) into twelve different plans, labeled A through L, sold and administered by private companies. Each Medicare supplement plan offers a different combination of benefits. The coverage provided is roughly proportional to the premium paid. However, many older Medicare supplement plans offering minimal benefits will cost more than current plans offering full benefits. The reason behind this is that older plans have an older average age per person enrolled in the plan, causing more claims within the group and raising the premium for all members within the group. Since Medicare supplement is private insurance and not government sponsored, the rules governing the sale and offerings of a Medicare supplement insurance policy can vary from state to state. Some states such as Massachusetts, Minnesota, and Wisconsin require Medigap insurance to provide additional coverage than what is defined in the standardized Medicare supplement plans. Some employers may provide Medigap coverage as a benefit to their retirees.
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