Dear Marci
I have had Original Medicare for a few years. I do not go to the doctor very often, so I have not had to pay much for coverage. I live on a fixed income, and I’m worried about future medical expenses as my health issues start to increase. I want to keep Original Medicare because I have more choice in the providers I can see. Can a Medigap help with out-of-pocket costs, and do I need one?
– Bo (Lovelock, NV)
Dear Bo,
Yes, a Medigap policy can assist with out-of-pocket costs. Below is a detailed breakdown to help you decide if you need one.
Medigaps are health insurance policies that work with Original Medicare (not with Medicare Advantage) to cover costs that Medicare doesn’t. They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain remaining costs after Original Medicare pays first.
These costs can include:
- Deductibles
- Coinsurance
- Copayments
Some Medigaps also cover health care costs that Medicare doesn’t cover at all, like limited care received when travelling outside of the country.
Given your concerns about future expenses and your fixed income, a Medigap policy could be beneficial in helping manage your out-of-pocket costs. If you decide to buy a Medigap policy, be sure to do your research. Here are some steps you should take.
- Understand the best time to buy a policy: Learn when you have the right to buy a Medigap without restriction. This is usually when you are first 65 or older and enrolled in Part B, or when you lose certain types of coverage. At other times, you may be charged more because of health conditions, or companies can refuse to sell you a policy.
- Compare policies: There are 10 different standardized policies in most states, each covering a different range of Medicare cost-sharing. Compare policies to decide which policy is right for you.
- Compare premiums: Find out how Medigap premiums are priced so you can make cost comparisons. Compare the premium cost to your monthly out-of-pocket costs without a Medigap. Medigap premiums can be high, but they can help you save money if your monthly cost-sharing expenses are higher than the premium.
- Consider prior medical conditions: Understand how a Medigap covers prior medical conditions to know if any of your medical costs may be excluded from Medigap coverage for a period of time.
- Prepare questions: Have a list of questions to ask to help you choose a Medigap.
Contact your State Health Insurance Assistance Program (SHIP) for assistance with Medigap. For additional information on Medigap policies in your state, you can also contact your State Department of Insurance.
Hope this helps!
-Marci