Sponsor This PageClick here to find out how

Medigap Insurance Plans For Stroke Survivors

Q: What is Medigap Insurance

A: Medigap Insurance, also called Medicare Supplement Plans is secondary insurance offered by private companies that is specifically meant to fill the gaps in traditional Medicare. Medigap includes coverage for things such as co-payments or coinsurance, deductibles and more.

Q: I’ve had a stroke; can I still qualify for a Medigap plan?

A: Qualifying for a Medigap plan is extremely easy to do when you are in a valid open enrollment or guaranteed issue period. 

During these time periods, there is no underwriting, no pre-existing condition restrictions or exclusions, and there is not a possibility of a company turning you down for coverage based on your health. If you have had a stroke it is best to enroll during this period to guarantee coverage.

However, when you are not in one of these enrollment periods, you do have to qualify medically by answering medical questions on the application. So what does that mean for you?

In almost all cases, Medigap plans are accept/decline applications, meaning that you go through underwriting, you are either approved or declined based on your health.


Q: When Is Open Enrollment

Accoring to Medicare.gov, the official U.S. government site for Medicare:

I’m 65 Or Older
Your Medigap open enrollment period begins when you enroll in Part B and can't be changed or repeated. In most cases, it makes sense to enroll in Part B when you're first eligible, because you might otherwise have to pay a Part B late enrollment penalty.

If You Are Turning 65
The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you're 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.

I’m Under 65
Federal law doesn't require insurance companies to sell Medigap policies to people under 65. If you're under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you're under 65.

I Have Group Health Coverage Through An Employer

If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don't need a Medigap policy.

When your employer coverage ends, you'll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap open enrollment period will start when you're ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start, and unless you bought a Medigap policy before you needed it, you would miss your open enrollment period entirely.

Q: How do I know which policy will offer the best coverage for the best rate, particularly if I have had a stroke?

A: These plans are Federally-standardized which means all insurance companies have to offer the exact same coverage plans. But not all companies offer the same policy at the same price. So, while Medigap policy A might cost $150 at one company, it could cost more or less at a different company, even though you’ll get the same benefits.

This makes reducing your premium very easy since you can easily compare rates for the exact same coverage.

Underwriting varies greatly from company to company. Some companies use very limited underwriting, accepting nearly everyone who applies and is not currently in the hospital. Other companies are more stringent on underwriting.  This is what causes policy prices to vary by company even though the coverage is exactly the same.

Q: What is covered in each Medigap Plan?

A: The chart below lists all the Coverage for Medigap Plans. Some plans fill in the gaps more completely than others. Drug coverage is not included in Medigap plans since most drugs Medigap might have covered are covered under a Medicare Part D plan.

By: Stroke-Network.com Staff Writer Amy McCraken

^ back to top

"The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you're 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November."

The three most common Medigap plans are:

  • Medigap Plan F. This is the most common and comprehensive plan. It covers everything that Medicare doesn't cover at the doctor and hospital so that you don't have any out of pocket costs.
  • Medigap Plan G. This plan is one step below Plan F. It does not cover the Medicare Part B deductible, which is $140/year (for 2012). That, however, is the only difference between those two common plans.
  • Medigap Plan N. This is a lower-tier plan that has some cost-sharing ($20 doctor's office co-pay and $50 emergency room co-pay) in exchange for lower monthly premiums. It is designed as an alternative to Medicare Advantage plans, while still giving you the flexibility and stability of a supplement plan.

Garrett Ball, owner of medicare-supplement.us

ideas logo box logo information inspiration logo box