The Medigap Rules that Insurance Agents Need to Know
Original Medicare has many gaps in the coverage that it provides to beneficiaries, and that’s why so many of the “baby boomers” poised to enter Medicare will also be opting for Medigap coverage. As an agent, you’ll need a thorough understanding of Medigap and its rules, and this brief overview will give you a good starting point. It can also be used to recap what you already know to prepare for connecting with your Medigap leads.
General and Eligibility Rules
The basic requirements for a Medigap policy is that the prospect should have Part A and Part B coverage. Medigap policies are not necessary if the prospect already has a Medicare Advantage policy, and therefore they cannot join a Medigap policy (i.e it is illegal for anyone to sell them one). Medicare Supplement (Medigap) policies cover only one person, so if your prospect wants to procure cover for their spouse as well, the spouse needs to take out a separate Medigap policy. If the prospect purchases a Medicare Advantage Plan when they’ve already got a Medigap policy, they need to be reminded that the Medigap policy cannot be used to pay the Part C deductibles and coinsurance.
Costs
Most of the prospects you come into contact with will be paying a Part B premium and no Part A premium. They need to be advised that if they want to join a Medigap policy they will have to pay the Medigap premium to the private insurance company providing the policy, and they will still have to pay their Part B premium. Different Medicare Supplement policies have different costs, and they can also fluctuate according to the age of the prospect in question. Depending on the state you’re working in, you can also find out if the Medigap costs are subject to any limits, as this could be an important factor when connecting with prospects.
Medigap Doesn’t Cover
Long-term, vision and dental care, hearing or seeing aids (spectacles, etc.) and private-care nursing services are not covered under Medigap policies. Furthermore, many seniors may become confused as to what Medigap actually is. Medigap is a supplemental insurance that covers the gaps in Part A and Part B – Medicare Advantage, PDP’s, Medicaid and all the other state benefit programs are not Medigap.
If you would like to find out more and take advantage of the Medigap leads we have to offer, feel free to complete the form on this page.