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Medigap plans eliminate or reduce gap in Original Medicare

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If you don't want to pay the deductibles and copays that go along with Original Medicare, you need to know about Medigap.

This is Medicare supplement insurance sold by private insurance companies and agents to fill the gap of the 20 percent copay for most Medicare Part B services.

According to retirement expert Philip Moeller, author of Get What's Yours for Medicare Maximize Your Coverage, Minimize Your Costs, about 70 percent of all Medicare beneficiaries have Original Medicare Part A for hospital expenses and Part B for doctors, medical equipment and outpatient medical costs. Fewer than 25 percent of Original Medicare beneficiaries buy Medigap policies.

And, Medicare Advantage plans now have nearly a third of the Medicare business. If you have Original Medicare and Medigap, you can't buy a Medicare Advantage plan. This is the time of year to compare and make decisions about what's right for you.

In one section, titled "Okay, Maybe Rocket Science Is Easier Than Understanding Medicare Enrollment Periods," Moeller writes:

"First, there is not one but several enrollment periods. Second, they apply differently in some cases not only to Original Medicare (Parts A and B) but also to Medicare Advantage (MA) plans (Part C) and to prescription drug plans (Part D). Oh, just for fun, there also are separate enrollment rules for Medigap policies the policies that plug many of the payment holes in Original Medicare."

Getting a Medigap plan

Once you are enrolled in Medicare Part A and Part B and you decide you want to get a supplemental insurance plan, the best time to buy one is in the six months from the first day of the month you turn 65 or older. You can buy one after this, but you may pay more and you might lose health insurance guarantees.

And, finding the best plan at the lowest price is a challenge. You have to do the research to get the coverage you want for the price you can pay. There are 10 types of Medigap policies, each offering different benefits packages. Prices vary depending on the insurance company you choose and where you live.

First you must decide which of the available Medigap plans best meets your needs. Although the coverage for all Medigap plans A, B, C, D, F, G, K, L, M and N is standardized, insurers can charge different premiums for the same option.

All plans cover 100 percent of Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used, and all Part B coinsurance and copayment (except K, which covers 50 percent, and L, which covers 75 percent); some cover 80 percent emergency medical needs during foreign travel.

You can see what all the different plans cover at tbtim.es/medigap.

You better shop around

The American Association for Medicare Supplement Insurance did a national cost analysis in April. It studied the cost of the plans, finding that more than 60 percent of buyers chose Plan F. These Medicare Supplement Insurance 2016 Price Index findings using percentages rather than actual dollars, which are subject to change show why it is important for you to shop insurance companies:

• For men age 65, it found differences as high as 68 percent between the lowest and highest price you would pay for the same plan.

• For women age 65, it found differences as high as 64 percent.

• The average price difference for men was 39 percent.

• The average price difference for women was 34 percent.

• The highest costs were in Manhattan.

• The lowest costs were in San Antonio, Texas.

You'll get help at tbtim.es/medigapsearch. You put your ZIP code into the search bar and it will bring up a list of the plans available in your area and which companies sell them. You will see a range of prices for the plans as well as the names, websites and other contact information for the companies that sell them. Then, you have to contact the carriers directly.

Searching St. Petersburg's 33710 ZIP code, for example, found prices ranging from about $75 to $500 a month, depending on the plan.

Times staff writers Jeanne Grinstead and Sharon Otts contributed to this report. Contact Patti Ewald at pagewald@hotmail.com.

FOR ASSISTANCE

The Florida Department of Elder Affairs offers a help line toll-free at 1-800-963-5337. SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the department and the local Area Agency on Aging. Specially trained volunteers can navigate Medicare's website and help find the plan best suited to you. For information, go to floridashine.org.

FAST FACTS

• To be eligible for a Medigap plan, you must already have Original Medicare Parts A and B. You cannot have both Medigap and Medicare Advantage.

• Medigap policies don't cover long-term care, vision, dental, hearing aids or private-duty nursing.

• Medigap plans are available in the same 10 standardized benefits packages in every state except Massachusetts, Minnesota and Wisconsin, where it is standardized differently.

• If you pay your premiums, Medigap policies can't be canceled and can be renewed even if you develop major health problems.

• Six of the 10 plans offer 80 percent coverage when you are outside the United States.

• The premium you pay your private insurance carrier for Medigap is in addition to the monthly Part B premium that you pay to Medicare.

• Medigap plans do not cover prescription drugs.

For more information, go to medicare.gov or call toll-free 1-800-633-4227.

Medigap plans eliminate or reduce gap in Original Medicare 10/13/16 [Last modified: Thursday, October 13, 2016 1:55pm]
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