How’s Your Health?

But that’s not always the case with Medicare supplemental insurance, commonly known as Medigap policies. These private plans help you pay for out-of-pocket costs not covered by Original Medicare. For example, they would pay the 20 percent of your doctor bill and lab tests, screenings and other outpatient services that Original Medicare doesn’t cover. They also pay for the Part A deductible you are charged each time you’re admitted to the hospital. Some Medigap policies also have an out-of-pocket limit so once you’ve spent a certain amount on your health care in any year, the policy picks up 100 percent of any subsequent charges.

In order to make sure these policies cover your preexisting condition, you have to sign up at the right time. The window to purchase them is within six months of enrolling in Part B. If you don’t, the insurance companies offering Medigap policies can refuse to sell you one, charge you a higher premium because of your medical problems, or refuse to cover any medical problems you had before you bought their insurance.

Keep this in mind as you enroll in Plan B, but also if you decide later to switch from Original Medicare to a Medicare Advantage plan. While the government has created a specific program allowing Medicare beneficiaries to try out a Medicare Advantage plan on a short trial basis — between Jan. 1 and March 31 of each year — if you opt to return to Original Medicare you may have difficulty getting a Medigap policy.

“Generally, people may not be able to switch Medigap plans, depending on where they live, or will have to pay more, depending on their age, medical requirements and/or other factors,” says Fred Riccardi, vice president of client services at the Medicare Rights Center. “For instance, companies can refuse to sell you a Medigap policy or impose certain medical requirements.”

There are some circumstances when beneficiaries who want to switch from Medicare Advantage to Original Medicare can purchase a Medigap plan without worrying about their preexisting conditions:

• If you leave Original Medicare and buy a Medicare Advantage plan for the first time and revert back in less than a year.
• If you select a Medicare Advantage plan when you first enroll in Medicare but decide within the first year that you want to switch to Original Medicare.