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Medigap policies allow you to see any doctor who accepts Medicare

Medigap policies are very good supplemental coverage, but they are also expensive.
One of their chief benefits is that they do not have any network restrictions. That means policyholders have coverage if they go to any doctor or hospital that accepts Medicare (as long as they are going for a Medicare-covered treatment).

Another strong feature of Medigap policies is that they are convenient, since the doctor sends Medicare the bill and it forwards the balance to the insurance company. In addition, the four comprehensive plans have little or no cost-sharing. Medigap policies do not include prescription drug benefits, and people who choose them must also enroll in stand-alone drug plans.

There are ten Medigap plans, all of them are standardized. That means that a particular plan (Plan F, for example) has the same benefits regardless of the insurance company selling it. Three states — Massachusetts, Minnesota, and Wisconsin — do not have the nationally standardized plans, but have plans that are standardized within their states.

The ten plans are designated by letters of the alphabet – Plans A, B, C, etc. There are some gaps in the lettering since Plans E, H, I, and J are no longer sold. This chart shows the Medigap plans that are currently sold, and they are grouped according to the comprehensiveness of their benefits.

Medigap chart

When people decide they want to purchase a Medigap policy, they should first choose the plan they want (A, B, etc.). Then they should look for insurance companies that have low premiums for that plan. Most state insurance websites lists the companies that sell Medigap policies in their states as well as each company’s premiums.

These online comparisons are good places for people to begin their search to find a company that has lower premiums. Still, people should get current quotes, since occasionally the state information is out of date. Shoppers should call three or more insurance companies with low premiums, according to the website. Then they can choose the company they want to buy their policy from. A few states do not list premiums online, but do list names and phone numbers of the companies that sell Medigap policies in those states.

State Medigap Premium Comparisons

Click on a state’s link to see its Medigap premium comparisons.

Massachusetts, Minnesota, and Wisconsin do not have nationally standardized plans, but have plans that are standardized statewide.

*Georgia, Hawaii, Mississippi, and New Mexico do not have online premium comparisons for Medigap policies. Click on this Medicare web site link and enter your zip code to get a list of Medigap insurers in your area as well as their phone numbers. The Mississippi and New Mexico links show the insurance companies that sell Medigap policies in the state.

**Illinois has separate comparison lists for three areas in the state. Select the link to the area you’re interested in.

***These states list the names and phone numbers of companies that sell Medigap policies in the state. New Jersey’s web site has separate links for finding premiums for men, women, and for people under 65. Utah’s site has separate links to each insurance company’s Medigap premiums.

Managing Medicare’s Costs

  • Using your computer to find the right Medicare Advantage plan

    Sometime later this year, Medicare Advantage plans will pass employer retiree plans as the most widely held type of Medicare insurance. Currently there are 20 million people in Advantage plans, more than twice the number ten years ago.

    While total Medicare enrollment has grown at slightly more than 3% a year during the last decade, Advantage plan enrollment has increased twice as fast.

    To keep pace with the influx of new enrollees, insurance companies have been rolling out additional Advantage plans. There are 283 more this year than last year, or a total of 2,317 plans, according to a report by the Kaiser Family Foundation.

    That’s the most since 2009, when generous government subsidies encouraged insurers to flood the market with plans.

    This year’s expansion has a potential upside. As the newer Advantage plans vie for market share, they need to offer attractive benefit packages. And that might put pressure on older plans to follow suit.

    The downside is that even before this year’s additions, in most parts of the country there were already too many Advantage plans. Retirees often complain in surveys that they are overwhelmed by having so many choices. This year, for instance, the average Medicare beneficiary can choose among 21 Advantage plans, according to Kaiser Family Foundation data.

    How do you sort through so many plans to identify the one that’s best for you? If you live in an urban area, your chances of finding an excellent plan are good. But if you live in the country, that may not be the case. This year there are 149 counties that do not have any Advantage plans and another 45 counties with only one plan. And more than one-fourth of U. S. counties have five or fewer plans.

    Even if you live in a remote outpost where there’s only one Advantage plan, you need to do some homework to avoid unpleasant surprises later. If you are computer savvy, you can easily find out quite a bit about a plan online. Or if you don’t want to do the research yourself, you can contact your nearest Medicare counseling agency for assistance.

    To do your own research, you’ll use the Medicare web site’s Plan Finder. There you can rank your area’s Advantage plans in various ways – by monthly premiums, costs for the prescription drugs you take, quality ratings, and so on. And by clicking on a plan’s name, you can see its benefits in greater detail. Here are the steps to follow:

    First, rank the plans by their costs for the Rx drugs you take

    Using Medicare’s Plan Finder and these step-by-step instructions, enter the names, dosages, and monthly quantities of the drugs that you take. If you do not take any prescription drugs, skip the drug entry and go directly to a list of the Advantage plans in your area. Then you can begin the sorting process.

    Let’s say you live in Atlanta, Georgia, and do not take any prescription drugs. When you sort the list of the 21 Advantage plans in the Atlanta area by their drug premiums, you see that 8 of them have annual premiums exceeding $400. That is too much to pay if you do not take any Rx drugs, and so you disregard these 8 plans and concentrate on the remaining 13.

    Within a couple of minutes, you can probably trim the remaining list down to 2 or 3 plans based on what you want in a plan. Possibly one of your doctors told you she is not in any Advantage plan networks. That leaves as your only choice an Advantage PPO plan. And among the 13 remaining Atlanta-area Advantage plans on your list, only two are PPO’s.

    Or maybe you want to consider only the plans that have at least a four-star quality rating from Medicare. In that case, only 4 of the 13 plans meet that standard. Perhaps you want a plan that has an out-of-pocket under $5,000, which will eliminate all but 3 plans.

    Examining the networks

    After you’ve weeded out most of the plans, the next step is to find out if your doctors are in the networks of the plans that are still on your list. Because the online provider directories for Advantage plans are often out of date, the most accurate way is to call your doctors’ offices. And if your doctors are in the network of only one of your finalists, it is likely to be your best option.

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