As Medicare experts, we often get asked about the benefits and drawbacks of Medicare Supplement Insurance, also known as Medigap. Understanding these can help you make an informed decision about whether this type of coverage is right for you. Today we are going to review the pros as well as the cons having Medigap.
Pros:
- Coverage of Medicare Gaps: One of the biggest advantages of Medigap plans is that they help cover the “gaps” in Original Medicare, such as deductibles, copayments, and coinsurance. This can provide you with greater financial predictability and protection against high out-of-pocket costs.
- Freedom to Choose Providers: With Medigap plans, you can typically see any healthcare provider who accepts Medicare. This can be advantageous if you want to continue seeing a specific doctor or specialist without worrying about network restrictions.
- No Referrals Needed: Unlike some Medicare Advantage plans, Medigap policies do not require referrals to see specialists. You have the freedom to visit any specialist without needing approval from a primary care physician.
- Coverage While Traveling: Many Medigap plans offer coverage for emergency medical care when you’re traveling outside the United States. This can provide peace of mind for seniors who enjoy traveling or spending time abroad.
- Guaranteed Renewable: As long as you pay your premiums on time, your Medigap policy is guaranteed renewable. This means the insurance company cannot cancel your coverage as long as you continue to pay your premiums.
Cons:
- Higher Premiums: Medigap plans typically have higher monthly premiums compared to Medicare Advantage plans. However, this trade-off can be worthwhile for those who want more comprehensive coverage and predictable out-of-pocket costs.
- Requires Original Medicare: To enroll in a Medigap plan, you must already be enrolled in both Medicare Part A and Part B. This means you’ll need to pay the premiums for Part B in addition to your Medigap premiums.
- No Prescription Drug Coverage: Medigap plans do not cover prescription drugs. If you want this coverage, you’ll need to enroll in a separate Medicare Part D plan.
- Limited Enrollment Period: The best time to enroll in a Medigap plan is during your six-month Medigap Open Enrollment Period, which starts the month you’re 65 and enrolled in Medicare Part B. Outside of this period, you may be subject to medical underwriting, which could result in higher premiums or denial of coverage.
- Plan Standardization: Medigap plans are standardized in most states, meaning the coverage for each plan type is the same regardless of the insurance company. While this simplifies comparison shopping, it also means you may not find as much variation in coverage options.
Medigap plans offer valuable benefits for Medicare beneficiaries who want greater financial protection and flexibility in their healthcare choices. However, it’s important to weigh the pros and cons carefully and consider your individual healthcare needs and budget before making a decision.
Give Karen or Matt a call with any questions at 865-203-2040 or email us at contact@seniorinsurancespecialty.com!
*We do not offer every plan available in your area. Currently, we represent 11 organizations that offer 126 products in your area. You can contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.