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How To Choose The Right Medigap Plan For You


Choosing the right Medigap policy is important if you have a serious medical condition because the guaranteed right to Medigap ends once the open enrollment ends. Choosing the wrong plan initially can lock you into a plan that is either not broad enough or too expensive.

Any attempt to change to another Medigap plan after the open enrollment period closes may require evidence of good health. (At least once a year, you can change to a Medicare Advantage Plan but then you may lose the freedom you have under Original Medicare.)

Choosing the right Medigap plan is a matter of matching your needs with the benefits based on their value to you personally and the amount of premiums. Look at the benefits you need and match them to the plans that offer them. Compare the total costs to see which plan with the benefits you need offer the best price for the benefit provided.

A good source of help for choosing a Medigap Policy is on the medicare site at offsite link.  In the search box, type: "Choosing a Medigap Policy".

Keep in mind that whie each medigap plan with the same letter must provide the same coverage, the price can vary greatly between different insurers. You can compare prices by using the Medigap Search tool at offsite linkor at most state insurnce department sites which you can access through offsite link

NOTE: For a fee ($99 in 2015), you can get a personalized report to help you choose from Weiss Medigap ( offsite link)

Additional thoughts:

The first step to determining which Medigap plan is best for you is similar to that in Health -- Evaluating Health Insurance Policies.

  • What are your needs: what types of medical charges can you expect to incur with your condition? Statistically, how much can you estimate each charge will cost you per year?
  • What is the balance between your needs and how much you can afford to spend each month in Medigap premiums?

Let's take a look at the benefits offered under the federal Medigap plans from the point of view of whether or not you would benefit from them:

Basic Benefits: Basic Benefits are included in all ten plans so when deciding which Medigap policy to choose, the choice generally relates mainly to how much you need the other coverages.

In-Patient Hospital Deductible: The Medicare Part A Hospital Deductible in 2015 is $1,260 per benefit period. If this is a concern, you can add it to the Basic Benefits and purchase Plan B, which is usually only slightly more expensive than Plan A.

Skilled Nursing Benefits: This coverage picks up the co-payments in a Skilled Nursing Facility if you remain confined for more than 20 days in a benefit period after satisfying the requirements described in Medicare -- Schedule of Benefits. For instance, this benefit only covers care in a Skilled Nursing Facility after a hospitalization. It does not cover custodial care. (If the odds are high that you will need custodial care in a Skilled Nursing Facility, consider whether you can qualify for Medicaid. See Medicaid.)

Foreign Travel: This benefit covers one of the areas that Medicare does not cover at all, care for an unexpected but non-life-threatening medical condition while traveling outside the United States. If you do not plan to travel outside the country much and do not need other benefits, then you might only need Plan B rather than more expensive Plan C which also which includes Skilled Nursing Benefits and Foreign Travel. Plan B generally costs less than Plan C. (You can also insure against this risk with a Travel Insurance policy when needed. See Travel Insurance Post Diagnosis.)

NOTE: As you can see from the chart in Medicare: Medigap Benefits, the above four benefits are each added to all plans from D to J.

Part B: Medical Deductible: While this could be a frequently used benefit, keep in mind the Part B deductible is $147 in 2015. Unless the cost to add this coverage is extremely low, the benefit may not be worth the premium. In the typical case with a serious health condition the benefit is close to the cost so it is not worth buying a Medigap plan just for this coverage. If you are only going to trade dollars with an insurance carrier, you may as well keep them in your pocket. If you don't have the need, you'll keep the money.

At-Home Recovery Care: This is another benefit for which it is worthwhile to compare cost to benefit since this is a limited benefit. In addition, the most expensive portions of home care (skilled nursing and an aide), are covered under Medicare itself. Also consider how frequently you would need this benefit.

Part B: Excess Charges. This is an important benefit if your primary caregivers do not accept Medicare assignment. See Medicare -- Claims -- Maximizing Your Benefits for a discussion of Medicare Assignment. If you want this coverage, it is advisable to compare the premium difference to the benefit when considering whether to choose 80% or 100% coverage.

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