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10 Things You Should
Know About Buying A Medigap Policy
1.
Know Why You Might Need a Medigap Policy
A Medigap policy is health insurance sold by
private insurance companies to fill the “gaps”
in Original Medicare Plan coverage. Medigap
policies help pay some of the health care costs
that the Original Medicare Plan does not cover.
If you are in the Original Medicare Plan and
have a Medigap policy, then Medicare and your
Medigap policy will each pay their share of
covered health care costs.
2. Some Examples of
“Gaps” in Medicare
You may want to buy a Medigap
policy because Medicare does not pay for all of
your health care. There are “gaps” or
“out-of-pocket” costs that you must pay in the
Original Medicare Plan. Some examples of costs
not covered are hospital stays, skilled nursing
facility stays, blood, Medicare Part B yearly
deductible and Medicare Part B covered services.
3. Some Examples of Care
Not Covered by Medigap
Long-term care, Vision or
dental care, hearing aids and private-duty
nursing are things that a Medigap policy will
not cover.
4. Eligibility Requirements
To buy a Medigap policy, you generally must have
Medicare Part A and Part B. You are guaranteed
the right to buy a Medigap policy if you are in
your Medigap open enrollment period or covered
under a Medigap protection. You might not
be able to buy a Medigap policy if you are in a
Medicare Advantage Plan, have Medicaid, already
have a Medigap policy or are under the age of 65
and you are disabled or have End-Stage Renal
Disease.
5.
Pre-Existing
Conditions
A pre-existing condition is a health problem you
had before the date a new insurance policy
starts. In some cases, if you have a health
problem before your Medigap policy started, a
Medigap insurance company can refuse to cover
that health problem for up to six months. This
is called a “pre-existing condition waiting
period.” The insurance company can only use this
kind of waiting period if your health problem
was diagnosed or treated during the six months
before a Medigap policy started.
6.
In Most Cases, You
Cannot Be Dropped From Medigap
If you bought your policy after 1990, the policy
is guaranteed renewable. This means your
insurance company can drop you only if you stop
paying your premium, you are not truthful about
something under the policy or the insurance
company goes bankrupt. Insurance companies in
some states may be able to drop you if you
bought your policy before 1990. If this happens,
you have the right to buy another Medigap
policy.
7.
Shop Around for the Best Medigap Policy
Look for a Medigap policy that you can afford
and that gives you the coverage you need most.
As you shop for a Medigap policy, keep in mind
different insurance companies may charge
different amounts for exactly the same Medigap
policy, and not all insurance companies offer
all of the Medigap policies.
8. Make Sure the
Insurance Company is Reliable
To help you find out if an insurance company is
reliable, you can take the following actions:
Stop before you sign anything, call your state
insurance department and confirm that the
insurance company is licensed to do business in
your state. You can also call the State Health
Insurance Assistance Program in your state.
These programs can give you free help with
choosing a Medigap policy.
9. Watch Out for
Illegal Insurance Practices
You should know it is illegal for anyone to
pressure you into buying a Medigap policy, lie
or mislead you to switch to another company or
sell you a second Medigap policy when they know
that you already have one. It is also illegal to
sell you a policy that cannot be sold in your
state.
10. Understand Your
Medigap Rights and Protections
You need to know that under Federal law, you
have rights and protections regarding your
Medigap coverage. These include your right to
buy Medigap coverage, protections if you lose or
drop your health care and your protections for
people with Medicare under the age of 65. Call
your State Health Insurance Assistance Program
to better understand these rights and
protections.
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