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6 questions to help your parent choose a Medigap insurance plan

helping your parent choose a Medigap planYou want to know that your parents are eating well and paying their bills on time. You should also know whether they are choosing appropriate health insurance. Relying solely on Medicare to pay health care bills could put your parents in a deep financial hole. Medicare supplement policies, known as Medigap plans, are available from private health insurance companies and provide coverage for expenses that your parents would otherwise have to pay out of pocket.

Navigating the Medigap road requires asking the right questions. Below are starting points for helping a parent evaluate the need for a Medigap plan.

Does my parent need Medicare supplement insurance?

According to the Kaiser Family Foundation (KFF), approximately 20 percent of the 47 million Medicare beneficiaries have purchased a Medigap plan. If your parents selected original Medicare, they should consider buying a Medigap plan.

For example, in 2010 Medicare Part A coverage has a $1,100 deductible that covers the first 60 days of a hospital stay. Beyond the initial 60 days, Medicare beneficiaries are responsible for a coinsurance amount of $275 per day for hospital stays between 61 and 90 days. Without a Medigap plan in place, a prolonged hospital stay could send seniors on a downward financial spiral.

To begin, evaluate your parent’s current health needs by writing down the health care services he’s received in the past 12 months. Include visits to the family doctor, annual checkups, preventive care and any visits to a specialist.

In addition to current health care needs, consider future needs. For instance, if one of your parents has made frequent visits to a specialist for arthritis or osteoporosis in the past few months, those visits may increase over the next year.

Which Medigap plan would fit my parent?

Consult a Medigap benefits grid that outlines the available benefits options. There are 10 Medigap plans that are differentiated by letters A through N. The plans are standardized, so benefits don’t vary among the same “letter” plan.

With your list of health care services in hand, highlight the ones your parent might use.

If your parent is relatively healthy and needs only basic benefits, he might select Medigap Plan A. But if international travel is a major part of his retirement, foreign travel emergency coverage may be important and he should select a Medicare supplement insurance plan that includes that benefit.

When should my parent enroll in a Medigap plan?

If one of your parents wants to buy a Medigap plan, she should buy one during her open enrollment period, which is a period of six months beginning on the first day of the month in which she is 65 and enrolled in Medicare Part B.

While your parent can buy a Medigap policy any time, open enrollment is the ideal time to enroll because the Medigap company cannot refuse to sell your parent a policy that it offers, it cannot charge your parent more due to their health and it can’t make her wait for coverage to start (although it may require a waiting period for coverage of pre-existing conditions).

Open enrollment (Nov. 15 - Dec. 31) for Medicare Advantage plans and Medicare Part D coverage is a good time to evaluate a parent’s existing and future health insurance needs.

Which company should my parent buy from?

Contact your state health insurance assistance program (SHIP) or the department of insurance in your state to find out which companies are licensed to sell Medigap plans in your state.

How much will my parent pay for a Medigap policy?

Medigap premiums are determined using a number of factors, including geographical rating and – depending on when you buy one -- medical underwriting. Some health insurance companies will offer discounts to people who are married or non-smokers.

Ask which rating system the company uses to determine premiums. There are three rating systems:

  • Community-rated: Premiums won’t rise with age but they might rise due to factors like inflation.
  • Issue-age rated: Premiums are lower for people who buy at a younger age and the price doesn’t rise with age, but it could rise due to other factors.
  • Attained-age rated: Premiums go up as you get older and may also rise due to other factors.

What should I watch out for?

The National Association of Insurance Commissioners (NAIC) warns that it is illegal for anyone to pressure your elderly parent to purchase a Medigap plan. You should also be wary of anyone from a private health insurance company who claims to work for Medicare or who says that a Medigap policy is "approved" or "recommended" by Medicare.

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