Choosing a Medigap policy
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Questions to ask
Before purchasing a Medigap policy, get as much information as you can. If you are considering a Medigap policy, here are some questions you should ask.
- Do you need a Medigap policy, or are you eligible for a program for people with low-incomes?
- Do you have a Medicare Advantage plan (such as an HMO, PPO, PFFS, or MSA)? If so, you can't use a Medigap policy while you are in a Medicare Advantage plan, and it would be illegal for an agent to sell you one unless you plan to leave the Medicare Advantage plan.
- Do you want to be able to see any doctor or specialist who accepts Medicare, or are you willing to be restricted to a ‘network' of doctors, hospitals and other providers in some Medicare Advantage plans or in a Medicare SELECT plan?
- How much can you afford to spend on monthly premiums for Medigap and how does that compare to premiums and co-payments you might have in an HMO, PPO, PFFS, MSA or Medicare SELECT plan?
- How might your costs change in the future?
- What is the premium? Remember, all policies with the same letter — for example all plan A or J policies — cover identical benefits, no matter which insurance company is offering them. This makes it easy for you to compare premiums for the same lettered policy, quickly and easily.
- What benefits do you need? Remember, if you can pay some predictable costs yourself — such as the Part B deductible — it may save you premium dollars to buy a plan that doesn't include that benefit
- Does the insurer file claims electronically? Insurers that accept electronic claims directly from Medicare make it easier for you and your doctors to receive payment. Doctors who do not accept assignment are not required to file your Medigap claims for you. Electronic claims will save you time and money.
- Is there a waiting period to cover pre-existing conditions? If so, how long is it? And do you have any previous coverage that may reduce or eliminate the waiting period?
For information on choosing between a Medicare Advantage plan and a Medigap policy see the sections under Deciding between a Medicare Advantage plan & Medigap.
Pre-existing conditions
A pre-existing condition is a health condition or illness for which you sought medical advice or treatment within 6 months prior to your application for a Medigap policy.
Waiting period
A waiting period is the period of time between when you sign up for a Medigap plan and the time the coverage begins for your pre-existing condition. By law, a company may have a waiting period of up to 6 months in which the insurance company is not required to cover your pre-existing condition. Some companies use a shorter time period of 30 or 60 days. If you had health insurance before you applied for a Medigap policy, the company must count those months of coverage toward any waiting period.