The simplest answer to that question is yes. The gaps left by Medicare are substantial and may leave you with exorbitant and sometimes unexpected medical bills. But when making your final decision—not just on whether to purchase a supplemental plan, but also on which plan to purchase—there are somethings you’ll want to consider. To decide what Medigap plan is right for you, you’ll want to consider your financial circumstances, your current and anticipated health care needs, and the options available to you.
In this post, we’ll help you decide if Medicare supplemental insurance is right for you. If you’d like to speak to an agent, feel free to contact us. We also offer free price reports, so you can compare premiums for your preferred plans in your area!
The Basics: Medicare & Medigap
If you’re approaching 65 and nearing retirement, you’re probably starting to consider your health care options seriously. Medicare is the national health insurance system available to U.S. citizens or permanent legal residents age 65 and up.
Medicare coverage is comprised of three parts: Medicare Part A (hospital visit coverage), Part B (outpatient coverage), and Part D (prescription coverage). But as we all know, A, B and D aren’t the whole alphabet. Likewise, Medicare Part A, B and D don’t cover the whole spectrum of health care costs. That’s where Medicare supplement plans—or “Medigap” plans—come in.
Medigap plans are sold by private insurance companies to fill the “gaps” that Medicare doesn’t cover. Right now, 10 Medigap plans are available, each offering a different amount of coverage for a different monthly premium.
Medigap plans provide coverage for more than 800,000 providers nationwide—that’s any doctor in-network for Medicare. With a Medigap plan, you’re able to see any Medicare-covered specialist, with no primary doctor referral required. Your coverage is also guaranteed renewable, meaning it can never be canceled due to health conditions from the claims you file.
Do You Need Medigap?
Now that we understand the relationship between Medicare and Medigap plans come into play, let’s take a closer look at whether you need a Medigap plan or not. The first place to begin the discussion is your financial circumstances and your health care needs. These two factors are often intertwined, so it’s important to weigh their implications in tandem.
Financial Circumstances & Health Care Needs
A big advantage of Medigap plans is the cost savings and security they offer, especially if you have (or anticipate) more extensive or frequent medical needs. To quantify this, let’s break down costs into Medicare Part A, B and D:
- Part A: Hospital Visits. If you only have Medicare (no supplemental insurance) and you’re admitted into the hospital, you’re responsible for the first $1,216 of expenses before your coverage kicks in. If you stay in the hospital more than 60 days, you have to pay a portion of each day’s cost from then on.
- Part B: Doctor Visits & Medical Procedures. If you don’t have supplemental insurance, your deductible for these services is $147. After hitting that, Medicare provides coverage, but you continue to be responsible for 20 percent of the “Medicare-approved” amount for most services.
- Part D: Prescription Drugs. Even with Medicare coverage, you can be left responsible for 72 percent of the costs of some of your prescription drugs.
Medigap plans insulate you from the extremely high costs that could result from an unexpected accident or medical complication. These supplemental plans allow you to have some or all of these expenses covered with a relatively low, consistent monthly premium. Opting for a Medicare supplement plan can help you plan budgets with more confidence and offer you greater peace of mind.
Understanding Your Options
If you’ve decided a Medigap plan is the right option for your financial and health care needs, you’ll also want to make sure you research the various plan options available. Once you decide on a plan, you’ll want to take the time to compare premiums to ensure you are not overpaying.
What Plan Is Right For You?
You may want a plan that covers nearly every gap for a higher monthly premium. Or perhaps you’d rather trade some security for lower monthly payments. Either way, we make it easy to find the right plan for your needs.
What Will I Pay?
Medigap plans are sold by private health insurance companies. While companies must provide the same coverage for the same plans, they are free to charge different premiums for the same plans. This means that if you don’t compare premiums, you could end up overpaying.
We offer free price reports so you can compare premiums for Medigap plans in your area. Simply fill out a quick survey to receive the report. An agent can then reach out to you if you need assistance applying.