Council on Aging Answers 2016 - 90

What Is Medicare
Supplemental Insurance?
COUNCIL ON AGING - ORANGE COUNTY

Commonly Known as a Medi-Gap Plan

During any of these times, the purchaser is entitled to
"Guaranteed Issue." Guaranteed issue means there is no
Medicare supplemental insurance is health insurance medical underwriting and you cannot be denied coverage.
sold by private insurance companies to fill the "gaps" in
Medi-Gap plans can be purchased at other times but
Original Medicare plan coverage. Medicare supplements may require the purchaser to go through underwriting
are frequently known as Medi-Gap policies. Original
and you may be denied coverage or charged a very high
Medicare provides 80% of health insurance with
premium.
the beneficiary responsible for 20%, plus associated
Every Medicare supplemental insurance policy has to
deductibles. Medi-Gap policies cover the co-pays and
follow federal and state laws designed to make the buying
deductibles of Original Medicare. They do not pay for
process easier for the consumer. Medigap insurance
costs not covered by Medicare.
companies can only sell a "standardized" Medigap
A major benefit of Original Medicare and a Medipolicy identified by letters A, B, C, D, F, High-Deductible
Gap policy is the portability of the insurance. Both plans F, G, K, L, M and N. Each Medigap policy must offer the
allow a beneficiary to travel anywhere within the US and same basic benefits, regardless of the insurance company
have healthcare insurance. For example, if you would
that sells it. Cost is usually the only difference between
like to see a specialist at Sloan-Kettering in New York or
Medigap policies.
the Mayo Clinic in Minnesota you can do so. There is no
There are three methods that insurance companies
need to get approval of a primary care provider to see a
use to establish their premiums: issue age, attained age,
specialist as is the case with Medicare Advantage plans.
and community aging. Plan premiums may increase
Some Medigap plans may include benefits for services
over time. Ask your insurance agent about the variables.
that Medicare doesn't pay for such as emergency medical A Medigap policy is guaranteed to be renewable as long
costs incurred while traveling outside of the U.S.
as the premium is paid. It cannot be cancelled because of
To purchase a Medigap policy, you must be
a person's health condition or for any reason other than
enrolled in Original Medicare parts A & B. Medi-Gap
non-payment of the premium.
policies do not work with any other type of health
insurance, including Medicare Advantage insurance
How Much Do Medi-gap Plans Cost?
plans, employer/union group coverage, Veterans
At initial enrollment, pricing for Medi-Gap Plan F
Administration (VA) benefits, or TRICARE.
(the most comprehensive plan available,) ranges from
$170 to $190/month in premiums. Other plans may be
When Should I Purchase a Medigap Plan?
much lower.
The best time to purchase a Medi-Gap plan:
n At age 65 when initially enrolling in Medicare
If I have additional questions, who can help me
parts A&B
understand Medicare Supplemental Insurance?
n When retiring and losing employment insurance
For information contact the Council on Aging's
n If during the first twelve months of being enrolled
Health Insurance Counseling & Advocacy Program
in a Medicare Advantage plan you plan to return to
(HICAP) at 1-800-434-0222. You can also visit the
Original Medicare, or when you move out of your
California Department of Insurance website to compare
Medicare Advantage plan service area
company plans and premiums at www.insurance.ca.gov.

INSURANCE

n Linda Walton-HICAP Program Manager-RN, MS

90

Answers Guide 2016	

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http://www.insurance.ca.gov

Table of Contents for the Digital Edition of Council on Aging Answers 2016

Contents
Council on Aging Answers 2016 - Intro
Council on Aging Answers 2016 - Cover1
Council on Aging Answers 2016 - Cover2
Council on Aging Answers 2016 - 1
Council on Aging Answers 2016 - Contents
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