Page 18 - Cover letter & Medicare evaluation for Mr. Carl Zambon
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Medigap policies -- an overview
Frequently asked questions about Medigap policies
What is a Medigap policy? What are the most popular plans?
It's a standardized supplemental insurance Plan F accounts for 40% of Medigap policies
policy that fills some of the gaps in Medicare sold, followed by Plan C at 13%. Of the four
coverage. There are 10 plans (see pp. 6-7). comprehensive plans that have higher cost
Medigap policies don't have network sharing, Plan N is the most widely sold.
restrictions, so policyholders can see any
doctor who accepts Medicare. Also, Are premiums based on my health?
Medicare makes the coverage decisions, not When you buy a policy during your initial six-
the insurance company. month open enrollment period, you cannot be
denied coverage or charged more because of
Which plans have the best coverage? pre-existing conditions.
Plans C, D, F and G all have solid What are the open enrollment rules?
comprehensive coverage. Because of a Even though you will not be asked health
recent change in the law, Plans C and F questions during your initial open enrollment
cannot be sold to people who turn 65 in period, insurance companies may adjust
2020 or later. For these individuals, Plan G is premiums based on your age, gender, and
the most comprehensive plan available, smoking status. After the initial six-month open
covering all Medicare's gaps except for the enrollment period is past, in most states you
Part B deductible. Those who turned 65 will have to answer health questions before you
before 2020 can still get Plan C or Plan F. can get a premium quote.
People in good health might also consider Can I switch insurers and plans later?
one of the Medigap plans with higher cost- Yes, in some cases. A handful of states have
sharing -- Plans K, L, M, and N. Medicare laws that allow you to switch your Medigap
covers 100% of the cost of preventive policy to another insurance company without
services, which reduces your risk with these disclosing pre-existing conditions. But in most
plans. In particular, Plan N is likely to save states, you will have to answer questions about
money for those in good health. your health before you receive a quote. And if
Which plans have the most risk? you have health problems, you could be denied
Plans A and B both have coverage gaps of coverage and would have to remain with your
almost $13,000 for skilled nursing facility current insurer. In a limited number of
care. For that reason, they are riskier than situations, you have a guaranteed right to get a
other Medigap plans. Plan K also has fairly policy without answering health questions. As
sizable risk, but unlike Plans A and B, it has one example, Advantage plan enrollees have a
an out-of-pocket limit that offers some guaranteed right to get certain Medigap
protection. Only two Medigap plans -- Plan K policies if they move out of their plan's service
and Plan L -- have out-of-pocket limits. territory.
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