Medicare Supplements (Medigap Plans)

With all the bickering, backbiting, and general uproar in Congress over proposed changes in Medicare, seniors are understandably confused about the future of their health coverage. Even without any change in Medicare, however, many are confused about the purchase of private supplemental (Medigap) insurance for what is not covered by Medicare - the annual deductible, co-payment of 20 percent of doctors' bills, outpatient prescription drugs, certain preventive screening tests, a portion of long-term hospital stays, and coinsurance for home nursing care.

Medicare supplements are commercial insurance plans often called a Medigap Plan. People who have a Medigap Plan are enrolled in Original Medicare, sometimes referred to as Fee-for-Service Medicare.

Medicare beneficiaries, under age 65 in California can choose from a limited number of Medigap Plans, during the first six months after accepting or signing up for Medicare Part B. Individuals with ESRD, however, are ineligible for Medigap policies.

Medigap policies can cover Medicare co-payments and deductibles, and a few may also provide limited prescription drug coverage. Plans are standardized by Medicare and offered in a system that uses ten letter names called Plan A through Plan J. Benefits are identical from one carrier to the next for each specific lettered plan, although prices vary between companies. Not all Medigap Plans are offered by all insurers, nor are they available in all counties. An individual can go to the Medicare website and use the Medicare Personal Plan Finder to find the plans available in his or her zip code, as well as to compare premiums and cost of coverage. Premiums for Medigap policies can be expensive, with some costing several hundred dollars per month. Individuals with disabilities often pay a higher premium than most retired persons.

Medigap policies only work with Original Medicare and will not pay benefits if an individual joins a Medicare Advantage plan.

Medigap insurance companies can impose a waiting period of up to six months before covering a pre-existing condition. The pre-existing condition waiting period can be shortened, waived, or eliminated if the individual has had at least six months of prior, continuous health coverage before applying for a Medigap policy during initial enrollment.