Washington MediGap Plans

 Exactly what is a MediGap Plan in Washington State?

Washington MediGap insurance policies are a product of private health insurance carriers that have the right to sponsor plans in WA state. Another term for MediGap insurance is Medicare supplement insurance.  These WA State health insurance  plans are designed to fill in the gaps or supplement the coverage of Original Medicare Parts A & B.  So if you have Medicare Parts A & B, you have out of pocket amounts in the form of deductibles, co-pays and co-insurance. MediGap plans pay for part or for all these areas.  MediGap plans may also provide coverage for expenses that Original Medicare doesn't pay at all.    

If you are on a Medicare Parts A and B, Medicare will pay for its share of the Medicare approved reimbursement rates .  Then the optional private MediGap policy will pay its share.  MediGap policies are plans in addition to standard Medicare.  You have to buy these policies separately from insurance agents or directly from the health insurance company doing business in Washington state. Medicare doesn't pay any of the costs for you to get a MediGap policy.

MediGap policies are distinct from Medicare Advantage plans.  MediGap policies cover the gaps that Medicare parts A & B alone don't.  Medicare Advantage plans on the other hand actually cover Medicare benefits and then typically supplement these benefits all together in one policy.

MediGap policies must follow Federal and Washington state laws designed to protect you and these policies must clearly state that they are "Medicare Supplement Insurance."  MediGap insurance companies  can only sell standardized insurance plans from Letters A thru L  with L plans being the strongest MediGap plans available. So an "A" plan from one insurance carrier would be identical to an "A" plan from another carrier.  The cost of the plan is usually the only difference between MediGap policies sold by various insurance companies.

Costs that MediGap Policies DO NOT Cover

Washington MediGap policies do not cover long-term care costs (nursing home care), vision, dental, hearing aids, eyeglasses and private-duty nursing.
The following are Washington Health Insurance Policies that ARE NOT MediGap policies:

• Medicare Advantage Plans (Part C).  These can be in the form of an HMO, PPO or Private Fee for Service.
• Medicare Prescription Drug Plans ( Part D)
• Medicaid
• Employer or Union Plans
• TRICARE
• Veteran benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health Plans

What MediGap policies can Washington State Medical Insurance companies sell?

As mentioned earlier, MediGap policies come only in standard formats from Plans A-L.  Each Washington State Health Insurance company decides which policies they want to sell, although state law may affect which policies are available.

 What Should I Know to Buy a WA State Health Insurance MediGap Policy?

Generally, You must have Medicare Parts A & B to buy a WA State MediGap Policy.  You pay your regular premiums to the private insurance company that sold you the policy in addition to the payment for Part B of original Medicare.

Any standard MediGap policy is guaranteed renewable, meaning the insurance company can't cancel  your poicy as long as you may the premiums.

In the past, MediGap policies had prescription drug plans attached to them.  Now a days, you must buy the Prescription Drug Plan (Part D) separately to have this benefit.  

When is the Best Time to Buy a MediGap Policy?

You should buy the MediGap policy during your open enrollment period.  This is the time from the first day of the month that you both turn 65 and have Part B Medicare coverage.  During this period the private insurance company cannot use medical underwriting to disqualify you or charge you more money because of your health conditions.

Pre-exisitng Conditions

Private insurance companies cannot make you wait for coverage to start however, they may wait before pre-exisiting conditions are covered.  MediGap polices may wait for up to 6 months.  However during these months, Original Medicare will cover you according to their schedule of benefits.

If you have had coverage prior to Medicare that is considered "creditable coverage",  its a possibility to avoid or shorten the waiting period for pre-existing condition coverage.  Prior creditable coverage is generaly any other health insurance that you had.  If you have had it for at least 6 months, with no break in coverage for more than 63 days,  there is no waiting period for pre-existing conditions to be covered.  If you had a break in coverage for more than 63 days, you can count only the time after the break.   

 Why You should buy a Washington State MediGap Policy Upon Initial Eligibility.

Health Insurance Washington State

It is very important to understand your Washington State MediGap open enrollment period.  MediGap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge for the MediGap poicy.  However, if you apply during your MediGap open enrollment period you can buy any MediGap pollicy the company sells, even if you have health problems, for the same price as people with good health.  If you try to buy  MediGap coverage after your open enrollment period, there is no guarantee that an insurance company will sell you a MediGap policy at all if you don't meet the medical underwriting requirements, unless you are eligible because of limited situations.

It is also significant to understand that your rights for MediGap coverage may depend on when you choose to enroll for Part B Medicare. If you are age 65 or over, your MediGap open enrollment period begin when you enroll in Part B and this can't be changed or repeated. In most cases it makes sense to enroll when you are first eligible for Part B, because you might otherwise have to pay a late enrollment penalty.

The exception for this is  if you have group health coverage through an employer or union, either because you are currently working or your spouse is, you may want to wait to enroll in Part B.  If your health insurance is considered creditable, then you can forego the MediGap plan and won't be penalized.  When the employer group plan ends for you, you can enroll in Part B without a late enrollment penalty and your MediGap open enrollment period will start.  Then you purchase your new Washington State MediGap policy within the enrollment period.

For more information about MediCare please click here or contact us.