A Medicare Supplement Medigap plan is designed to cover items covered but not paid for by Medicare. If you solely relied on Medicare, your out of pocket costs could be thousands of dollars. It’s a good idea to review the Medicare and You booklet for 2013.
CA Medicare Supplement plans pay many of the doctor and hospital bills that are not covered by Medicare. The graph below compares supplement plans currently offered.
Medigap policies are a form of private supplemental insurance that pay for part or all of Medicare’s coinsurance and deductibles. Certain policies also cover health care costs that Medicare doesn’t cover, such as emergency medical care in foreign countries, and excess charges from a provider who does not accept assignment. By law, companies can only offer 10 standardized Medigap policies, known as plans A-N. (These include plans A, B, C, D, F, G, K, L, M and N. Plans E, H, I and J were dropped due to changes in federal law effective June 2010.)
Unlike certain Medicare Advantage Plans in California, Medigap plans do not restrict you to a network of providers and facilities.
Medigap policies are sold through licensed insurance agents, sponsoring groups or through the mail by private insurance companies. You only need one policy, and it is illegal for an insurer to sell you more than one.
In California, certain Medigap companies impose a waiting period before paying benefits for a preexisting condition. By law the waiting period may last up to 6 months for conditions treated 6 months prior. During this time, the company is not required to cover costs associated with your pre-existing condition. Some companies use a shorter waiting period of 30 or 60 days.
You are eligible for Guarantee Issue if:
If you have full benefits from Medi-Cal (California’s Medicaid program), you do not need a Medigap policy.
If you have Medi-Cal with Share of cost (SOC), you can buy a Medigap policy to fill in the gaps.