Medigap Insurance - Medicare Supplemental Insurance for Maryland Seniors - Frequently Asked Questions

Q What is a Medigap policy?
A A Medigap policy is a health insurance policy sold by private insurance companies to fill the "gaps" in Traditional Medicare Plan coverage. There are ten standardized policies called "A" through "J." Each plan has a different set of benefits.

Q If Medigap plans are standardized throughout the country, why do I need an agent?
A Every state has its own modifications. And insurance companies offer different ranges of plans. More importantly, an agent is knowledgeable in the ways of the system and how they work in your state. He or she can help you assess your individual needs and match them to the plan that is best for you. Also, an agent provides the personal service and continuity of contact that you are unlikely to receive from large insurance companies. There is no additional cost for the services of an agent.

Q How do I know if I need to buy a Medigap policy?
A If you, or you and your spouse, had health insurance from your employer prior to retiring, you may not need Medigap coverage.
For example, state and federal retired employees have excellent supplemental coverage. However, if you are not sure, it's best to inquire. Call your previous employer for specifics on the Medicare coverage you're entitled to. Then, you can determine if supplemental coverage is required.

Q Are preexisting conditions covered?
A Yes. Medicare provides full protection from the first day of coverage. Most Medigap plans waive preexisting waiting periods if a person enrolls when they are first eligible for Medicare.

Q Can I keep the same doctor I already have?
A Yes. Traditional Medicare allows the free and open choice of physicians and hospitals. In addition, if you wish to see a specialist, no referral is needed. This is an important distinguishing feature of Traditional Medicare: free choice as opposed to having to select a doctor, or hospital in a managed care plan.

Q Is custodial care in a nursing home or at home covered?
A Medicare does not cover custodial care in a nursing home or at home. Long term care in an assisted living facility or at home is also not covered by Medicare. Medigap plans D,G, I &J offer limited custodial care at home after discharge from hospital stay of at least 3 nights.

Q Are prescription medications covered by Medigap plans?
A At present, most Medigap insurance plans include discounts on prescriptions, at no additional cost. As of January 2006, prescription coverage will be available to all Medicare beneficiaries. Be sure to ask your agent about these important changes.

Q What kinds of things does Medigap cover?
A Coverage is dependent upon the type of Medigap plan selected. Generally speaking, Medigap will pay for out of pocket deductibles, as well as co-pays that Traditional Medicare does not cover.

Click here for detailed information on Medigap Plans A-J

Link to coverage chart of Medigap Plans A-J - page 13 of Medicare booklet (NOTE: In order to view the PDF file, you will need Acrobat Reader 5.0 or higher installed on your system. Acrobat Reader is a free software available for download. Click here to download.)

Q What is not covered by Medigap plans?
A Long term care is not covered. In addition, Medicare does not cover routine dental care, routine vision care, hearing aids, or private duty nursing. Medicare has almost no coverage outside of the United States.

Q How are claims filed?
A Most claims are filed electronically at the point of service. Typically, you visit your doctor, you show your Medicare and supplemental cards, and claims are filed for you. Later, in the mail, you'll receive documentation from Medicare and supplemental insurance as to what was paid.

Q Why is it important to consider getting Medigap coverage before turning 65?
A Medicare coverage begins on the first day of the month in which you turn 65. So, if you turn 65 on Aug 11, your coverage starts on August 1. If you should need to file a claim that month, you'd want your Medigap coverage to be concurrent with your Medicare coverage so you wouldn't have to pay out of pocket unnecessarily.

Q What does Medigap coverage cost?
A Most insurance companies price their policies based on the person's age when the premium comes due. In most instances a 65 year old will pay less for the same plan held by a 75 year old. Expect to pay $100 - $165 per month for a Medigap plan.