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5 Key Things to Know About Medigap

By Kirtland Financial Services

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If you qualify for Medicare, you have likely already heard of Medigap. Medigap insurance is a supplemental policy that private insurance companies sell in conjunction with Medicare Parts A and B to fill in the gaps where Medicare coverage may be lacking. This supplemental insurance will help you to pay out-of-pocket costs, such as copays and deductibles.

Want to learn more about Medigap? Below are a few things to consider when looking into a Medigap policy.1

1. You Must Enroll in Medicare Parts A and B

Before purchasing Medigap coverage, you must sign up for Medicare Parts A and Part B. These sections cover hospitalization and doctor visits. The Medigap coverage purchased with these two parts will provide you with coverage for the deductible, coinsurance, and copay portions of these policies that would normally be out-of-pocket.1

2. Medigap Policies Are Standardized

Different Medigap policies are assigned a letter, such as G, N, etc. Each of these policies is standardized in most of the states they are offered. This means you can count on the policies being the same, even if you move during your retirement. It is important to note that even though the structure of these plans is standardized across state lines, not all states carry all types of policies.2

3. Medigap Signups are Guided by Specific Rules

As with Medicare policies, there are rules and deadlines that come with signing up for a Medigap policy. After enrolling in your Medicare Part B plan, you will have six months to decide whether you want to purchase a Medigap policy. If you wait longer, the insurance company will be allowed to perform a health history check and decide whether or not they want to insure you. Having to undergo medical underwriting may mean your insurance is denied, or you will pay higher premiums.2

4. Premium Costs for Medigap Varies Wildly

Even though the policy benefits and coverage are pretty fairly standardized, premiums vary widely from state to state. States with lower living costs will typically see the lower end of policy premiums, whereas states with a higher cost of living, such as New York, may see premium rates almost four times higher. The factors that primarily influence the premium difference are state healthcare costs and the loss ratio experienced by the insurance companies in the area.2

5. Ratings on Medigap Plans Matter

How a particular Medigap plan is rated will also affect the policy premium difference. “Community-rated” plans will have the same rate for everyone regardless of age or health. If the policy is based on the “attained age,” the rate when you purchase the policy will be based on your age, and the premium will increase as you age. Finally, there are “issue age” policies that will stay the same premium you purchase but will be determined by your age when you buy it.2

1 What is Medigap, National Council on Aging, https://ncoa.org/article/what-is-medigap

2 Here are key things you need to know if you’re eyeing a Medigap policy alongside basic Medicare, CNBC, https://www.cnbc.com/2023/01/06/key-things-to-know-if-youre-eyeing-medigap-policy-with-basic-medicare.html

Content in this material is for educational and general information only and not intended to provide specific advice or recommendations for any individual.

All information is believed to be from reliable sources; however, LPL Financial makes no representation as to its completeness or accuracy.

This article was prepared by WriterAccess.

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