Medigap: A Primer

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Will Medicare cover expenses if I end up in a care facility? Medicare does not cover Custodial care, assisted living, adult daycare, or reimbursement for family members. If you are concerned about one day requiring such health care, you should visit with a professional advisor to review your options and plan appropriately. Some people transfer this risk to an insurance company by purchasing long term care insurance. Others plan to self-insure and hope that they do not have to use their assets to pay for their care. Still others plan to manage their assets in a manner that will allow them to qualify for government assistance.

When do I enroll for Medicare? You have a six-month window to enroll for Medicare that starts three months before your 65th birthday and ends three months after.


But if not and you enroll more than three months after your 65th, you may be subject to a late enrollment penalty. This is the name for the federal program — and corresponding state programs — that pick up healthcare costs for indigent children and adults. Treasury Secretary Timothy Geitner reported this spring that Medicare will run out of money in This is just 8 years from now.

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While Congress is expected to address the solvency of Medicare in the context of broad health care reform, Americans would be well advised to plan to pay more for health care in their senior years. When combined with supplemental Medigap coverage it provides quality health care for retirees. A change already in place—called for by the prescription drug law passed in under George Bush and by the ACA, and thus supported by both Democrats and Republicans—requires people with higher incomes to pay more for their Medicare Part B benefits doctor visits, lab tests, and outpatient hospital services , as well as for their Part D benefits prescription drugs.

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Some proposals call for changing the way the income thresholds for the higher premiums are determined. That would mean people who do not have high incomes now would be considered having high incomes for the purposes of paying more. As I recently explained, about 5 percent of seniors now pay an income-related premium for Part B; by the end of the decade 10 percent will.

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For drug, or Part D benefits, the proportion of seniors paying higher premiums would grow from 3 percent today to 8 percent by if these changes are enacted. Look for some politicians from both parties to support this one. If Republicans take the White House and both houses of Congress, seniors on Medicare who have higher incomes may find themselves subject to means testing, a step that would also radically change Medicare.

Medicare is social insurance: People are obligated to pay into the system while they are working and, in turn, they have a right to benefits later when they turn The budget discussion is sure to include the notion of means testing Medicare too. The counterargument: With means testing, these programs will turn into welfare programs, like Medicaid, and lose popular support. It calls for converting the matching payments the federal government makes to the states into block grants of fixed dollar amounts.

A state could use that money as it saw fit.

Where to Find the Facts about Medicare

Republicans and some Democrats support using block grants for Medicaid. The health reform law expanded eligibility for Medicaid, but the Supreme Court decision upholding the law allows states to opt out of the expansion. Meanwhile, block granting would move far away from the goals of the ACA, which envisioned 17 million more people added to the program. The CBO also reported that block grant financing could also mean less extensive coverage for recipients and lower payments to doctors and hospitals.

Health providers may not like that, and may try blocking congressional attempts to change the program. In , year-old policyholders bought more than a third of all new Medigap policies. Among them, Plan F was the most popular, representing slightly more than 46 percent of the total sales premium.

Medigap Primer – What You Need to Know – Full Medicare

Content prepared by Kara Stefan Communications. July 31, Accessed Sept. Kaiser Health News.

July 26, Accessed Sep. PBS Newshour. July 18, July 19, Medigap plans fall short on protections for pre-existing conditions. August