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Medigap advise
Apply for a Medigap policy 3 months
prior to the end of employment, with an effective date the 1st day of
retirement.
Shop carefully before you buy
Medigap plans differ in coverage and cost. Companies differ in the way they price their
plans. Companies also differ in customer service. Contact different companies and compare
before you buy.
You may not need to pay for Medigap insurance
If your income is low, you may qualify for a government program that will help pay your
Medicare costs. Ask your State Medical Assistance Office or local SHIP Program for more
information. Go to
Important
Contacts for the SHIP Program contact information for your area.
One plan is enough
Medigap plans are designed so that you do not need other similar coverage. Duplicate
coverage can be expensive and is generally unnecessary. It is illegal for an insurance
company to sell you a second Medigap plan. It is also illegal to sell you a Medigap plan
if you are in a Medicare managed care plan.
Consider your alternatives
Depending on your health care needs and finances, you may have alternatives including
health coverage from your current or former employer, joining a Medicare managed care plan
(go to
Medicare Compare to
see what plans are available in your area), or buying a Medigap plan. You should also ask
if your state helps pay your Medicare costs for persons with limited income.
Check for pre-existing conditions exclusions
When checking into a Medigap plan, you should find out whether it limits or excludes
coverage for pre-existing conditions. If you have a health problem, and the company limits
or excludes coverage for pre-existing health conditions, the insurance company might not
cover your costs for any care related to that health problem.
Be careful of replacing existing coverage
Make sure you have a good reason for switching from one Medigap plan to another--you
should only switch for different benefits, better service, or a more affordable price. On
the other hand, do not keep an inadequate plan simply because you have had it for a long
time.
Plan delivery or refunds should be prompt
The insurance company should deliver a plan within 30 days. If it does not, call the
company and ask them to put the reason for the delay in writing. If 60 days go by without
an answer, call your State Insurance Department. Go to the
Important Contacts to obtain the
State Insurance Department contact information for your area.
Prohibited marketing practices
It is unlawful for an insurance company or agent to use high pressure tactics to force or
frighten you into buying a Medigap plan, or to make a false or misleading comparisons to
get you to switch from one company or plan to another.
Medigap plans are neither sold nor serviced by the State or Federal government
State insurance departments approve Medigap plans sold by private insurance companies, but
approval only means the company and Medigap plan meet the requirements of state law.
Know with whom you are dealing
An insurance company must meet certain qualifications to do business in your state. You
should check with your State Insurance Department to make sure that any company you are
considering is licensed in your state. Go to the
Important Contacts to obtain
State Insurance Department contact information for your area.
Keep agents’ and/or companies’ names, addresses, and telephone numbers
Write down the agents’ or companies’ information or ask for a business card.
Take your time
Do not be pressured into buying a Medigap plan. Good sales people will not rush you. If
you are not certain whether a Medigap plan is what you need, ask the salesperson to
explain it to you with a friend or family member present, or talk with someone in your
local SHIP program. Go to Important Contacts for the SHIP Program contact information for
your area.
If you decide to buy, complete the application carefully
Do not believe an insurance agent who says your medical history on an application is not
important. Some companies ask for detailed medical information. If you leave out any of
the medical information requested, coverage could be refused for a period of time for any
medical condition you did not report. The company could also deny a claim and/or cancel
your plan for treatment of a condition you did not report.
Look for an outline of coverage
You must be given a clearly worded summary of the Medigap plan....Read it carefully!
Do not pay cash
Pay by check, money order, or bank draft made payable to the insurance company, not to the
agent or anyone else. Get a receipt with the insurance company’s name, address, and
telephone number for your records.
Beware of non-standard plans
It is illegal for anyone to sell you a plan and call it a Medigap plan if it does not
match Medigap standardization requirements. A "retainer agreement" that a doctor
offers you to provide non-Medicare-covered services and waive Medicare coinsurance and
deductibles amounts, may be illegal.
Get more information
Call your State Insurance Department, a counselor in your local SHIP program, and/or read
the
Guide to Health Insurance for
People with Medicare.
Go to
Important Contacts
for the SHIP Program or State Insurance Department contact information for your area.
Call 1-800-MEDICARE (1-800-633-4227) to get a free copy of the Guide to Health
Insurance for People with Medicare. |
