Medigap

Frequently Asked Questions

Medigap FAQs

How do I know if my Doctors will take my plan?

As long as your doctor accepts Medicare, the Doctor has to take your Medicare Supplement – regardless of the company. However, when someone is enrolled in a Medicare Advantage plan, you must check to see if your Doctors are in-network or out-of-network with your plan.

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CAN I CONVERT/CHANGE MY MEDIGAP ANYTIME DURING THE YEAR?

Yes! A Medigap policy can be converted/changes to a new Medigap policy any time during the year. Conversely, a Medicare Advantage plan can only be converted during the Annual Enrollment Period (AEP) which is October 15th through December 7th.

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WHEN CAN I BUY A MEDIGAP POLICY?
Buy a Medigap policy when your are first eligible.

The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance), and it can’t be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more due to past or present health problems.

During open enrollment.

Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

Outside open enrollment.

If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements. 

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WILL MEDICARE COVER ME OUTSIDE OF THE COUNTRY?

No! Medicare is a federal program and does NOT cover you outside of the country. However, if you have a Medicare Supplement policy, eight of the plans have coverage for “foreign Travel.” The care must be a Medically-necessary emergency beginning during the first 60 days of your trip. That coverage has a $250 deductible and a $50,000 maximum. If the Medicare Supplement policy you choose has foreign travel benefits, you pay the $250 deductible, 20% of the remaining charges and all amounts over the $50,000 lifetime maximum. If traveling for an extended period of time it is recommended to also get additional travel insurance.

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WHY ARE PREMIUMS DIFFERENT FROM CARRIER TO CARRIER FOR THE SAME STANDARDIZED PLANS?

Several factors are calculated in the premium including claims history, age, zip code, sex and health. Companies that have higher than 65% claims loss ratio (Medicare suggestion) may charge a higher premium and have larger yearly increases in order to pay claims and stay solvent. Conversely, a carrier that has a 65% or lower claims loss ratio will be more competitive and keep increases lower over the years. When deciding on a company, look at the percentage amount of increases over the years. The carrier with the lowest percentage will most likely be the most competitive over the long run.

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

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IF I MOVE TO A DIFFERENT STATE, WILL I NEED A NEW MEDIGAP POLICY?

Keep in mind that Medicare is a Federal program. One of the most attractive features of a Medicare Supplement is the ability to receive services from providers and hospitals nationwide. As long as the provider accepts Medicare, you can use any carriers Medicare Supplement for secondary coverage. Other than changing your address with the carrier, there is no need to convert/change to a new Medicare Supplement plan. All standardized Medicare Supplement plans are portable.

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