Commonly asked questions about Medigap

Q: Can the insurance company increase my premiums as I get older?
A: No. Medigap policies in California are issued on an "issue age basis" which means that premiums will NOT automatically increase as you get older. HOWEVER, the company can raise the price of all policies like yours. Rate increases require approval by the Office of Commissioner of Insurance.

Q: What if my employer offers a continuation or conversion from my Employer Group Health Plan?
A: Many employers offer continuation or conversion as a "retirement benefit," allowing retirees to continue the group coverage or convert to a plan that acts like a Medicare supplement; but it is not subject to federal and state minimum standards for "Medigap" policies. Therefore, make sure you compare the benefits offered by a retirement plan to the standardized Medigap plans before making a decision.

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Q: Can I buy a Medigap policy if I am under 65 and disabled?
A: In California, companies will insure you only if you meet their health standards.

Q: What happens if I become eligible for Medicaid, but already have a Medigap policy?
A: If you have a Medigap plan already and then become eligible for Medicaid, your insurance company must suspend coverage and waive the premiums during the time you are eligible for Medicaid, not to exceed a period of 24 months. If you lose your Medicaid benefits, the company will reinstate an equivalent policy without any new preexisting waiting period.

Q: Is a company required to sell me a Medigap policy if I already have one and then decide to drop it and switch to another company?
A: No, you are not guaranteed a Medigap policy if you have already bought one, are beyond your Medigap open enrollment period, and decide to drop your current policy to purchase a new one from a different company. You should make sure the company you are thinking of buying from will actually write you a policy before dropping your current one. If you do decide to switch policies, the new company cannot impose a waiting period on treating any pre existing conditions because you have already satisfied this requirement under your old policy.

Q: What effect does a pre-existing condition have on purchasing a Medigap policy?
A: If you choose to purchase a policy when you become 65 a Medigap insurer cannot refuse you. The insurance company may choose to impose pre-existing restrictions for no longer than six months if a person has not had health care coverage prior to becoming eligible for Medicare. In California Medigap insurance companies may refuse to cover beneficiaries who are under the age of 65.

If you switch from one Medigap plan to another you will have full coverage for all health problems if you had the previous policy for at least six months.

If you join a Medicare HMO, stop your Medigap policy and then disenroll from the HMO, you will have 63 days to purchase a Medigap policy and NOT face a new six-month period of non-coverage for a pre-existing condition.

Q: What is Medicare SELECT and is it different from Medigap policies?
A: Medicare SELECT is a type of of standardized Medigap insurance policy. If you buy a Medicare SELECT policy, you are buying one of the 10 standardized Medigap plans. The only difference between Medicare SELECT and a standardized Medigap insurance plan is that each Medicare SELECT insurance company has specific hospitals, and in some cases doctors, that you must use, except in an emergency, to be eligible for full benefits. Because of this requirement, Medicare SELECT policies generally have lower premiums.

All rights reserved. Copyright © Craig Casey 1999.