MEDIGAP details and need

[neville clynes]

I am a physician , not an insurance expert but will give my best shot here. This site describes the basics.

https://www.medicare.gov/health-drug-plans/medigap/basics

Medicare Part A covers hospitalization generally. Medicare Part B covers outpatient services. Part D covers outpatient medications.

There are 10 available MEDIGAP PLANs noted as PLANS "A,B.C.D.F.G,K,L,M,N".

Differences shown here:

https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits

MEDIGAP is essential in my opinion unless food , medicine or shelter is being paid for instead. 

The reason is that a severe sudden medical illness, could conceivably keep you in hospital for more than 60 days. Without MEDIGAP , you would be at risk for 400/day for the next 30 days and 800/day after that.  In addition, a skilled nursing home stay may be necessary after a prolonged hospitalization. Without MEDIGAP , after day 20, the cost may be 1500/day !.

The more common benefits of MEDIGAP are outpatient doctor's coinsurance bills (20 % of the  approved charge).  Part B pays for the 80 percent. This is the same for outpatient radiologic tests in my experience.  A person who sees very few doctors and has very few tests , in a given year , may very well receive less "benefits" from MEDIGAP compared to the premiums, but the catastrophic coverage mentioned above makes it more than reasonable to get the MEDIGAP coverage. This is what insurance is for in my opinion. Note, MEDIGAP pays for some other 

There are ways to pick a MEDIGAP plan that cover the catastrophic case but have lower premium costs. These PLANS (such as K,L, high deductible F and G) will reimburse  less on the doctors visits and outpatient tests but still will cover the catastrophic loss potential. Note K.L PLANS have out of pocket annual limits. High deductible plans  F and G are discussed by Eli Noam in his reports.

 Medicare Advantage programs are some combination of above . I have very little knowledge about them, have not looked into them because I am very concerned that only some doctors are in each plan and stories about more difficulties getting some procedures, medicines approved.  Medicare advantage plans obviate the need for MEDIGAP. See Medicare Advantage comments label to left for discussion.

That is a start . Others will comment.  I cannot find a calculator that allows yo to put in factors like doctors visits per year, radiologic tests, chance of hospitalization, ER visits etc and then picks the best PLAN for you. This is a good spot for Artificial intelligence . 

 

One thing is for certain, if you do not have a Medicare Advantage plan, every Columbia retiree SHOULD  pick a MEDIGAP plan this year.   There are  cheap plans available from VIA given the HSA subsidy of 900  (in 2024) that will run 0-350/annum  depending on your age and state. These plans will at least cover the catastrophic costs should they occur.  Some people may be better off getting their MEDIGAP outside of  VIA this year depending on different factors but in my opinion there  is NO REASON not to have  MEDIGAP coverage given the availabilty of the 900 subsidy . REMEMBER, the deadline is the first week of DECEMBER. Finally remember that the Columbia subsidy is only available if you go through VIA.