Medigap Enrollment Differs by State

Most people don’t realize that Medigap Enrollment differs by state.

Kaiser publishes an analysis of availability and Medigap enrollment

For the most part, Medigap, the private supplemental insurance to Medicare Parts A and B, is regulated by each state. It turns out that there are significant differences both in availability and in enrollment among the 50 states and D.C. The Kaiser Family Foundation recently published a brief reporting on research into the topic.

Highlights of the findings

As a reminder, Medigap plans cover out of pocket costs for traditional Medicare Parts A and B, among other things. There are 10 different plans offering different coverage options.

The percentage of people who have traditional Medicare and are enrolled in Medigap differs widely by state. For instance, in Hawaii, three percent of people with traditional Medicare have Medigap. In Kansas, that figure is 51 percent. In 20 states, at least 25 percent of the Medicare population has a Medigap plan.

Kaiser reports that the highest percentage of enrollees is in the Midwest and plains states. As a country-wide average, one in four people with traditional Medicare have one of the supplemental health insurance plans.

Four states only – Maine, Massachusetts, Connecticut and New York – guarantee that you cannot be denied coverage for a pre-existing condition.

In the other 46 states, plus the District of Columbia, you risk being denied coverage for medical reasons in certain situations. For instance, if you switch to Medigap from a Medicare Advantage plan or if you have lost your employer retirement coverage and can’t prove you have had “credible coverage” for six months prior to your application.

To sum up

Traditional Medicare does not deny coverage to anyone because of gender, age, or pre-existing conditions. Medigap, which is run by private companies, has the right to deny coverage or to charge higher premiums for coverage if you are allowed coverage with a pre-existing condition.

Denial of coverage can occur if you don’t sign up during the Medigap Enrollment Period. This is the six-month period that automatically begins when you turn 65 and are enrolled in Part B.

If you sign up within the enrollment period, you have the right to enroll in any Medicare Supplement Plan. Private insurance companies offering supplemental plan insurance cannot deny you coverage or charge you a higher premium due to health reasons. But this is a one-time-only deal.

If you are accepted by a plan, with a pre-existing condition, you may be subject to what is known as the Medigap “look-back period.” This means that there is a six-month waiting period for coverage of treatment of your condition. This occurs if you have been diagnosed and treated during the six months prior to applying for a Medigap plan. During this period, you will be covered by Medicare, but will not receive supplemental coverage of co-pays, etc.

Check the Medigap coverage legislation of the state you reside in. Pay attention to the rules. You do not want to risk being denied coverage or paying more for premiums.

For a full report on the brief, visit here.


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