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Medigap Plans and Paying for Long Term Care
| Definition |
Qualifications |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
| Overview of Medigap Plans | ||
Medigap policies are supplemental Medicare insurance policies sold by private companies to fill the “gaps” in Medicare plans. There are 12 standardized Medigap plans defined by federal law, referred to as Plans A – L. Not all 12 are available in every state, nor does each insurance company choose to offer all 12.
Medigap plans or policies are supplemental Medicare insurance sold by private companies to fill the “gaps” in Medicare plans. Since long term care for seniors is not covered by Medicare, this is a considerable “gap”. However, even the most comprehensive of the 12 different types of Medigap plans does not cover long term care needs for the elderly. These policies do not pay for assisted living, custodial care or adult day health care.
The exception to this is when a senior is in recovery mode following an accident or procedure. Some plans will help in limited capacity with skilled nursing care, but this is short term only. For example, Medicare pays for 100% of skilled nursing care for 20 days and they pay 80% of the cost for 80 more days. Some Medigap plans will pay for the remaining 20% for the remaining 80 days, meaning a senior can receive 100 days of skilled nursing care with very little out of pocket cost.
Medicare does not pay for any custodial care, but some Medigap policies will pay for a set number of annual medical home visits. Again, this is only following an illness, injury, or surgery. It is not a long term care option.
It is best to purchase Medigap policies within 6 months of enrollment in Medicare as during this period insurers are required to accept applicants regardless of any preexisting conditions. Most policies allow seniors to choose their own doctors.
For military retirees and family, there are two programs that offer very similar benefits to Medigap plans; these are CHAMPVA for Life and TRICARE for Life. Participation in either of these programs may make having a Medigap plan unnecessary.
Each state has a State Health Insurance and Assistance Program called SHIPs for short. These are staffed by volunteers that helps seniors with their Medicare, Medicare Advantage, Medigap and Medicaid benefits questions. Anyone with Medicare related questions can call a SHIP’s counselor even if they are not currently enrolled in Medicare. Learn more about SHIPs in your state.
Each state has a State Health Insurance and Assistance Program called SHIPs for short. These are staffed by volunteers that helps seniors with their Medicare, Medicare Advantage, Medigap and Medicaid benefits questions. Anyone with Medicare related questions can call a SHIP’s counselor even if they are not currently enrolled in Medicare. Learn more about SHIPs in your state.
Be Aware That:
Medigap plans do not cover the costs of long term care. Massachusetts, Minnesota and Wisconsin have different standard Medigap plans.
Medigap Plans are Also Known As:
-Medicare Supplemental Insurance
-Medigap Insurance
-Medigap Insurance
All Medigap policies require a senior to have Medicare, so at a minimum, seniors must meet the Medicare Eligibility Requirements.
Age Requirements
Seniors are eligible for Medicare at age 65 and can enroll for Medigap plans at that time.
Disabilities / Health Requirements
There are no disability requirements to purchase a Medigap plan however, some disabilities may be considered pre-existing conditions and coverage restrictions may apply.
If Medigap plans are purchased within 6 months of enrollment in Medicare, insurers are required to accept applicants regardless of any pre-existing conditions.
If Medigap plans are purchased within 6 months of enrollment in Medicare, insurers are required to accept applicants regardless of any pre-existing conditions.
Family Status
There is no marital status or other family status requirement to be eligible to purchase Medigap plans. It should be noted that policies are sold separately for spouses.
Financial Status Requirements
Seniors with any level of financial resources are eligible to purchase Medigap plans.
Veteran Status Requirements
Medigap plans are available to both Veterans and non-Veterans. Note that veterans enrolled in TRICARE or CHAMPVA might find Medigap plans have some overlap with those programs.
Geographic Requirements
States regulate Medigap plans according to a federal standard. Seniors must purchase a Medigap plan in the state where they reside.
Other Requirements
All Medigap policies require a senior to have Medicare, so at a minimum, seniors must meet the Medicare Eligibility Requirements. Additionally, seniors cannot be Medicaid recipients.
Types of Benefit Payout
Medigap benefits extend on the benefits of Medicare. There are 12 different plans; each offers a different level of benefit. Medical providers receive the benefit extension payments directly from the Medigap providers.
Restrictions on How Payout Can be Used
Medigap plans do not provide seniors with cash payments; instead seniors make lower payments to their medical providers.
Benefits Amounts & Limits
Medigap benefits differ depending on which of the 12 different Medigap policies a senior purchases. Plan D, Plan G and Plan I offer the greatest benefits for skilled nursing and at-home care, but no Medigap policy pays for long term care.
Medicare pays for 100% of skilled nursing care for 20 days and they pay 80% of the cost for 80 more days. Medigap plans D, G & I will pay for the remaining 20% for the remaining 80 days, meaning a senior can receive 100 days of skilled nursing care with very little out of pocket cost.
The best Medigap plans also will pay an “at-home recovery benefit” of up to $40 visit for 40 visits. This covers custodial care but only for an hourly visit and again only on a short term basis after an illness, injury, or surgery.
Medicare pays for 100% of skilled nursing care for 20 days and they pay 80% of the cost for 80 more days. Medigap plans D, G & I will pay for the remaining 20% for the remaining 80 days, meaning a senior can receive 100 days of skilled nursing care with very little out of pocket cost.
The best Medigap plans also will pay an “at-home recovery benefit” of up to $40 visit for 40 visits. This covers custodial care but only for an hourly visit and again only on a short term basis after an illness, injury, or surgery.
Time to Receive Benefits
Typically, Medigap coverage begins on the first day of the month following enrollment in the plan. Plans can be purchased in advance of Medicare coverage so that Medicare and Medigap coverage begin at the same time.
This Source Can Help For
Medigap plans help for short term skilled nursing and home recovery.
Costs will differ for each of the12 Medigap plans. The older a senior is, the more they will pay for Medigap insurance. One should expect a minimum of $100 / month for those aged 65 and $200 / month for those over 75.
Plans are sold by private companies but coverage is mandated by the state and federal laws, therefore providers are all offering very similar policies. As a result, shopping by price is a smart strategy.
Plans are sold by private companies but coverage is mandated by the state and federal laws, therefore providers are all offering very similar policies. As a result, shopping by price is a smart strategy.
Medigap plans are sold directly by private companies. Click here to find Medicare Supplemental Insurance in your area.
