Medigap plans are designed to cover all or part of out-of-pocket charges Original Medicare (Medicare Parts A and B) doesn’t pay for. This is necessary because Medicare Parts A and B have co-pays and deductibles that can become cost-prohibitive for seniors on a fixed income.
If you are enrolled in Medicare Parts A and B, you can enroll in a Medigap program. In order to be eligible for Medicare, there are certain criteria that you must meet, including:
Note that some insurance carriers offer Medigap to some beneficiaries under 65. Check with individual insurers for details.
The best time to enroll in a Medigap program in Minnesota is during the Medigap Open Enrollment Period. This starts the month you turn 65 and enroll in Part B coverage, then remains open for six months. For example, if you turn 65 on February 1 and enroll in Plan B on February 22, you have until August 31st to sign up for Medigap.
During the open enrollment period, you are guaranteed eligibility for any Medicare supplement available in Minnesota or in the area in which you live. You can’t be denied basic benefits due to preexisting conditions while the enrollment period is open, however, a waiting period may be imposed for coverage. It’s important to understand the enrollment period. If you miss it and later wish to enroll in Medigap plans, you could be denied benefits or charged a high premium due to preexisting conditions or other facts in your medical history.
In Minnesota, Basic and Extended Basic benefits are available to Medigap recipients when they enroll in Medicare Part B, without regard for health problems or age. You get an additional six months for open enrollment if you return to work and drop Part B to sign up for an employer’s health plan. You also get an open enrollment period following your retirement (after going back to work) when you become eligible for Part B once again.
Keep in mind that if you live in Minnesota, along with Massachusetts and Wisconsin, your Medigap plan options are unique from the rest of the United States. See the plans available to you in Minnesota below.
The two main Medigap plans available in Minnesota are Basic and Extended basic. Other plans, such as those from K-N and F, offer unique coverage options based on the percentage of covers and copays, along with other factors. The individual plans are described below.
The Medigap Basic Plan in Minnesota provides basic benefits and Part A coinsurance for skilled nursing facilities. This includes 100 days of skilled nursing care. It also pays up to 80% of foreign travel emergency costs at 50% for mental health outpatient treatment. Additionally, it helps out with preventive care covered by Medicare and 20% of physical therapy expenses. Minnesota mandates certain benefits that include routine cancer screening, diabetic equipment, and supplies, reconstructive surgery, and immunizations.
Minnesota Medigap coverage doesn’t extend to inpatient hospital deductibles covered in Part A or Part B deductibles. It also excludes usual and customary fees for care and medical coverage while traveling outside the country.
In Minnesota, Extended Basic care includes Part A inpatient hospital deductibles and skilled nursing facility coinsurance that allows up to 120 days of care. Up to 80% of foreign travel emergency care is covered under the extended basic plan, and 50% of outpatient mental health care is also covered. Additionally, this plan pays for up to 80% of usual and customary fees not covered by the Basic Plan. Seniors can receive coverage on up to 20% of physical therapy costs and receive 80% coverage while traveling in a foreign country. Like the basic plan, state-mandated benefits include routine cancer screening, reconstructive surgery, diabetic equipment, supplies, and immunizations.
In a calendar year, the Extended Basic plan covers 100% of costs after a $1,000 out of pocket maximum.
All Medigap policies have to follow federal and Minnesota State laws designed to protect seniors. Policies sold by insurance companies must be identified as Medicare Supplement Insurance. Additionally, each state defines standardized policies, which are identified by letters.
In Minnesota, versions of Medigap Plans K, L, M, N, and F are available. Insurance companies that offer Medigap can offer participants four riders attached to the Basic plan. Seniors can choose one, more than one, or all of these riders to suit their needs:
Insurance companies that offer Medigap policies have the right to choose which policies they sell. This means insurance companies don’t have to offer every Medigap plan available in Minnesota. However, insurers have to offer Medigap Plan A if they do offer Medigap policies. They also must sell Plan C or Plan F.
Compare Medigap Plans available in Minnesota (K-M and F) here. All policies offer the same basic benefits, but some offer additional perks, so you can choose which one meets your needs.
Medigap coverage has a higher monthly premium than Medicare Advantage but may have lower out-of-pocket costs. If you live in multiple states, Medigap is probably the better choice based on costs.
Medicare Supplement Insurance doesn’t pay for dental, vision or prescription costs. Medigap policies do cover some out-of-pocket costs that Original Medicare does not pay for.
For seniors who miss open enrollment, there are other periods when you can take advantage of the guaranteed issue right. You have to be 65 or older and can enroll within 63 days after you lose health insurance.
The guaranteed issue right gives you the right to a Medigap policy at the best possible rate, and you aren’t penalized for preexisting conditions.
When you purchase Medigap coverage, you are required to have Medicare Parts A and B. In addition to the Medicare Part B premium, there’s an additional monthly Medigap premium, which is determined by the insurance company. If you keep up with the premium payment, your Medigap benefits are guaranteed for renewal, so your insurance company can’t just drop you as you get older or experience declining health.