Thursday, July 3, 2014

Should You Get Medigap Supplemental Insurance with Your Medicare?

As I mentioned in a recent post, within three months before or after your 65th birthday, it is important that you contact the Social Security Administration to sign up for Medicare.  This is true even if you already have insurance through an employer or the military.

Once you have completed the paperwork for Medicare, the next thing you will need to decide is if you want to get a Medigap policy (Medicare Supplement Insurance) or a Medicare Advantage Plan.  In this post I will go over the Medigap Supplemental Insurance plans, like the one that my husband has selected.  You may also want to read "Should You Get a Medicare Advantage Plan with Your Medicare?" and "How to Sign Up for Medicare." These articles will help you consider all the options available to you.

Medigap Supplemental Insurance  

The reason why someone would want to have a Medigap policy is because Medicare doesn't pay for everything.  While regular Medicare will cover most of your medical expenses when you are over age 65, there are large deductibles and expenses that are not covered.  Medigap policies are designed to "fill the gap" by covering some of those expenses like copayments, coinsurance and deductibles, so that patients do not end up with a lot of large medical bills.   Some of the Medigap policies also cover things that Medicare does not include at all, such as emergencies during foreign travel, although each plan is different so you need to shop around to make sure you are getting the coverage that meets your needs the best.

You will have to pay a premium with a Medigap policy, in addition to the premiums you pay for Medicare.  You cannot have both a Medigap policy and a Medicare Advantage policy.  You have to choose one or the other.

One of the reasons that people sometimes choose a Medigap policy rather than a Medicare Advantage Plan is because they want to stay with their current doctors rather than be limited only to the doctors that are part of a Medicare Advantage HMO or PPO list of approved providers.   

For example, my husband has CKD (chronic kidney disease) and he was very happy with the doctors who were treating him prior to his 65th birthday.   He contacted all the physicians that he sees and discovered that all of them accepted both Medicare and Blue Shield.  As a result, he chose to buy a Blue Shield Medigap policy so he could stay with his favorite doctors. Conversely, I was not that attached to my physician so I chose a Kaiser Permanente Medicare Advantage plan.  My plan is substantially less expensive, but his plan allowed him to stay with his current physicians, which was important to him.

My husband also chose a Plan "F" Medigap insurance policy.  This is the most expensive Medigap plan.  He pays about $275 a month in addition to the $104 that Medicare takes out of his Social Security.  However, when he had a heart attack, we paid no deductible or co-pay.  On the other hand, I only pay $104 a month to Medicare to cover the cost of my Kaiser Medicare Advantage plan.  However, spending the same amount of time in the hospital and having heart surgery would have cost me at least $1000 in deductibles and co-pays.  In other words, my husband pays an extra premium, but no co-pays and deductibles.  I do not pay an extra premium, but I do have co-pays and deductibles ... although they are quite reasonable.  

Whatever policy you choose, if you are unhappy with it, you should know that once a year in the fall  open enrollment period (between October 15 and December 7) you can select a different plan to use the following year.  However, if you have end stage renal failure (which means you are on dialysis), there are severe restrictions on switching plans.  This is one reason my husband wanted to keep his current doctors.  He did not want to change doctors, end up unhappy, and then be stuck with new doctors he did not like.

You can find a lot more information on the Medicare website.  In addition, as you approach age 65, you will be contacted by a number of Medigap and Medicare Advantage companies in your state.  You may want to attend their seminars and learn about the differences between what the various companies offer before you make a final decision.

Contact Information for Medicare:

http://medicare.gov/

1-800-MEDICARE  (1-800-633-4227)
TTY 1-877-486-2048

Questions about Eligibility for Medicare:

Social Security Administration:  1-800-772-1213

To Get Personalized Insurance Counseling:

Call the State Health Insurance Assistance Program which is also called SHIP.  The number is different for each state. The one for California is listed below:

California SHIP:  1-800-434-0222

Related Articles You May Want to Read:

Should You Get a Medicare Advantage Plan with Your Medicare? 
How to Sign Up for Medicare

Regardless of your circumstances, nearly everyone should contact Social Security within three months before or after their 65th birthday and decide what they need to do.  This is the first step you should take in the process.

If you are interested in learning more about preparing for retirement, you may want to check out the tabs at the top of this page.  They contain links to hundreds of articles on family relationships after retirement, where to retire in the United States or overseas, financial planning and medical issues.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit: www.wikipedia.org/commons

1 comment:

  1. This issue can be complicated and confusing but you did a great job of presenting it in a clear way. Thanks!

    ReplyDelete

Thank you for leaving a comment. Your thoughts are always appreciated.