The federal Medicare program is a type of health insurance which provides for many of the hospital- and doctor-related healthcare costs of senior citizens. Unfortunately, there are coverage gaps which Medicare does not cover, and these gaps in coverage can become very expensive very quickly if you are relying upon Medicare alone to cover your needs. Thankfully, there’s a form of supplemental insurance called “Medigap” which provides an affordable option for seniors who want to protect their finances from these gaps.
Federal Regulations for Medicare Supplements
The Centers for Medicare and Medicaid Services (CMS) are tasked with regulating the Medigap plans that insurance companies may offer. Right now, there are ten plans: A, B, C, D, F, G, K, L, M, and N. CMS regulation guarantees that Plan F in New Mexico will provide the exact same coverage as Plan F in California. This means that the only variables which change from one state to another are price, and the insurance company providing the policy.
Medigap Enrollment In California
There are hundreds of thousands of seniors in California right now who can rest easy, because their Medicare coverage gaps are covered by an affordable, reliable Medigap policy. The chart below breaks Medigap beneficiaries down by plan, including the four plans which were discontinued in 2010:
Plan Coverage & Cost
Health insurance – and the price you pay for it – are tailored to you, the individual. Your weight, smoking habits, age, gender, and specific location will all influence the monthly premiums you pay for a Medigap policy. To get an idea of what you should expect, price-wise, take a look at starting rates for popular plans in your area.
Most Popular Medicare Supplement Plans in California
Like many other states, California residents prefer Medigap Plan F to all of the other available plans. The reason for this is quite simple: Plan F covers every single gap in Medicare coverage, and all seniors have to do to protect themselves is pay one affordable monthly premium. Rarely is any other action required on their part.
Plan J was the second most popular Medigap plan before companies ceased to provide it as an option in 2010. This was largely due to the fact that it provided affordable prescription drug coverage, which is now covered by Medicare Part D. Plans C and N are also popular alternatives to Plan F because, for some seniors, paying their Medicare Part B Deductible and excess charges out-of-pocket is cheaper than paying extra for Plan F. At the end of the day, the plan you choose will depend on what health services you will require, and what you can afford to pay.
Helpful Medigap Tips & Tricks
Seniors in California have some unique healthcare needs based on state and local laws. For this reason, we’re in the process of gathering data on plans near you to make sure you can get the plan you need at a great price.
Doctor/Provider Network Restrictions
Part of the appeal of Medigap insurance has to do with how it empowers seniors to choose their own doctors and facilities. Medigap isn’t your only option for supplementing your Medicare coverage. However, it is one of the few policies which won’t restrict your choices to a limited network of doctors and facilities which are pre-approved by your plan. Any doctor or hospital which accepts Medicare will be accessible to you with a Medigap policy. This is a great option for seniors who travel, or live far away from large cities, where most of these restricted provider networks are located.
California is home to some spectacular healthcare talent. One of the great advantages of a Medigap plan is there are no restrictions on which providers you can use so long as they accept Medicare. Other plans may limit you to doctors associated with specific networks. If your doctor isn’t in that network, you would have to change physicians. With Medigap, so long as your doctor accepts Medicare, you can continue seeing him or her. Doctors who accept Medicare agree to Medicare’s payment schedule, will file a claim on your behalf, and agree not to charge you more than your copay or coinsurance amount. Search for doctors here.
Currently, we are looking into various doctors and medical networks in California. Once we compile all of the data and find the best deals near you, this section will have a whole list of affordable and professional doctors for you to choose from. So check back often!
Drug, Vision and Dental Coverage
As mentioned earlier, Medicare Part D is now largely responsible for providing seniors with prescription drug coverage. Because of this, it is no longer necessary for Medigap policies to offer prescription drug coverage as an option. Vision and dental are additional types of coverage which Medigap and Medicare do not cover. You have the option to either get those covered privately on your own, or to pay out-of-pocket if you find it more affordable than an insurance policy.
Enrollment Options & Best Time To Enroll
Before you enroll in a Medigap policy, you must first be enrolled in Medicare Parts A & B. Only then can you start the Medigap enrollment process. The sooner you enroll, the less difficult the process will be. But if you wait, you may have to answer personal questions about your health in order to be deemed eligible for coverage.
- Initial Enrollment Period: within your first 6 months of enrolling in Medicare, you can also enroll in a Medigap policy with automatic acceptance and no health questions asked.
- Guaranteed Issue: If you are losing your employer or group plan, Guarantee Issue enrollment will get you covered by a Medigap policy regardless of your health status.
- Annual Enrollment Period (AEP): Medigap insurance is one of the few types of insurance which is not affected by the AEP. You can enroll in or change Medigap plans at any time throughout the year.
- Underwritten: The underwriting process is when your chosen health insurance company collects data about your health history and determines whether or not you are eligible for coverage under a Medigap policy.
Free Look Period
For your protection, there is a 30 day “Free Look” evaluation period for each and every Medigap policy issued. You have 30 days from your first day of coverage to decide whether your policy suits your needs. If you change your mind, you can cancel the policy and get a full refund.
How much does a Medicare supplement plan cost?
Like most insurance policies, the price of the Medigap policies available in California is determined by a number of underwriting factors. First, it’s important to know you can’t be denied coverage. If you qualify for Medicare, you qualify for Medigap insurance. The cost of that insurance will depend on your general health, gender, age, and smoking history. In addition, where you live in California, right down to the zip code, will impact the price of the policy. Comparison shopping is essential to get the most cost-effective coverage. We’ve provided a chart that shows what people near you are paying for their plans.
How do Medicare supplement plan ratings work?
The Overall Star Rating considers each plan’s quality and performance for a number of healthcare and administrative services. These six areas included screenings and tests, managing chronic conditions, member experience with the plan, member complaints, and customer service. Overall satisfaction is about much more than just premium price. The ease of doing business, specifically with claims, is exceptionally important.
What Medigap Plan is Best for Me?
The best Medigap plan for you is one that you fully understand, offers the medical benefits appropriate for your personal health condition, and is affordable. Trying to find that perfect policy on your own can be a tedious task. Medical Supplement is a competitive insurance field and there are a ton of companies offering plans in California. At Medigap.com, we introduce you to some of the best, provide the information and data about their price and performance, and make it easier for you to make an informed decision.
Just remember, the perfect plan is not necessarily the cheapest plan. Consider how easy it is to do business with the company, its financial strength, customer service an of course its reputation.