A Medigap policy also known as Medicare supplement insurance is sold and marketed by private insurers to supplement traditional Medicare. It means the coverage covers for health care costs that are not covered by original Medicare such as coinsurance, deductibles, and copayments. People who are enrolled in original Medicare and Medigap insurance Florida, Medicare pays for Medicare approved health care costs and then the Medigap pays for its share.
A Medigap plan differs from advantage plans such as PPO or HMO, as these plans provide Medicare benefits, whereas Medicare supplements are benefits of original Medicare. Every Medigap insurance Florida must adhere to state and federal laws in order to protect the consumer, and each policy must clearly identify as a supplemental plan.
In certain states, insurance companies are only allowed to sell the standard Medigap policy identified from letters A to N. Each policy must carry the same standard features regardless from the company that it has been sold. Cost is usually the only differentiating factor between these plans with same letter plans sold from different insurers.
Coverage provided under Medigap
Every insurer selling Medigap policies must provide Plan A. if any other Medigap Plan is also offered, they are also required to provide Medigap Plan C and F. Plans D and G purchased on or after June 2010 provide different benefits than the ones purchased before June 2010. Plans E, H, I and J are no longer available; people who are already enrolled in it are allowed to continue the plan.
Usually, Medigap plans do not provide coverage for long term care such as dental care or vision care, care in a nursing home, eyeglasses, hearing aids, or personal nursing. Coverage that look similar to but are not Medigap policies are:
- Advantage plans such as PPO, HMO or private fee for service plan.
- Prescription drug plans from Medicare
- Union or employer plans, including (FEHBP) Federal Employees Health Benefits Program.
- Long term care insurance plans
- Veterans benefits
- Tribal, Indian health service and Urban Indian health plans
Medigap Plans sold by Insurance Companies
In majority of the cases, insurers can only sell standard Medigap, for easy comparison every Medigap insurance Florida must carry certain specific benefits. It is not necessary for insurers companies to have every Medigap plan in their portfolio. However, it is mandatory to include Plan A, if they offer any of the plans.
In case the company offer any plan apart from Plan A, they are also required to offer Plan C or F. insurance companies have the liberty to choose the plans they wish to sell, however, state may have a say in the plans they offer. In certain circumstances, an insurer must sell Medigap even to people with health issues. Listed below are the instances, where person is guaranteed to have Medigap policy:
- During the open enrollment period of Medigap
- If the person has the right of guaranteed issue.
A person can purchase insurance anytime, but it is not mandatory for the insurance company to provide you coverage. In other cases, it is illegal for insurers to sell insurance to people who are already enrolled in advantage or Medicaid plan.
What a person must know about Medigap Insurance Florida?
- A person must be enrolled in Medicare Part A and B to apply for Medigap policy.
- People who are planning to return to traditional Medicare from advantage plan can apply for Medigap before the coverage ends. As long as you are leaving the plan, the insurer can sell the Medigap to you. Make sure the new coverage just after the enrollment in advantage plan ends, so that there is no break in coverage.
- Along with Part B premium one can also pay for Medigap premium every month.
- Only one person can be covered in a single Medigap policy. If you and your spouse both needs to have Medigap coverage, they are required to purchase separate plans.
- One can purchase Medigap plan from any company that is licensed to operate in your state or area.
- Plans E, H, I and J are no longer on sale, but people who are already enrolled in it can continue with the coverage.
- People who want to opt out of Medigap plan, can do so by writing to the insurance company, don’t forget to confirm if it is been cancelled. Agents do not have the right to cancel the policy.
- Standard Medigap insurance Florida has the option of guaranteed renewal even for people who have health issues. This means insurers do not have the right to terminate you policy as long as the person pays for the premium.
- Previously, Medigap plans used to provide with the benefit of prescription drugs, but policies sold after January 2006 do not provide this feature.
- In order to have prescription coverage a person is required to enroll in prescription plan offered by private insurers and approved by Medicare.
What is the most opportune time to purchase Medigap Insurance Florida?
One should purchase Medigap plan during the open enrollment period, which is there for six months starting from the first day when a person turns 65 and enrolls in Medicare Part B. some states have open enrollment period for people below the age of 65, as well. A person’s application does not go through underwriting process during this period.
An applicant can’t be made to wait for the coverage to start, he or she can, however, be made to wait for coverage pertaining to pre-existing conditions. In certain cases, the insurer can deny for out-of-pocket expenditure related to pre-existing conditions for up to six months. Insurance company may, however, deny coverage for pre-existing conditions that was diagnosed or treated during the six months period before the coverage starts under Medigap plan.