Questions to Ask Your Medigap Agent

So, you’re ready to shop for a Medigap policy. You’ve done your research and are about to call a licensed agent to discuss your options.

Before you pick up the phone, read through these questions to ensure you get the information you need to make the right decision.

What will the premium be each month? What is it based on?

If you sign up for Medigap during your open enrollment period (six months after you are both 65 and enrolled in Medicare Part B), you have guaranteed-issue rights to purchase a Medigap plan without being charged extra because of any pre-existing conditions.

Nothing about your past or present health status should affect your premium at this time.

If you are signing up outside of this window, however, you should ask the agent how your premiums will be calculated (or if the insurance company can deny your application altogether). In this case, Insurance companies can base their premium rates on various personal factors, including your gender, marital status, tobacco use and more.

Find out how much more you could be paying for your policy outside of open enrollment.

How is the plan priced? Will the premiums increase as I age?

Insurance companies price (or “rate”) their Medigap policies in one of three ways:

• Attained-age rated
  The premiums will increase as you get older.
  
  
• Issue-age rated
  The premium is based on the age you were when you go your policy. It will not increase because of your age, but may increase due to inflation or other factors.
  
  
• Community rated
  The premium is based on what Medigap policyholders in your area pay (everybody pays the same thing).

Ask your agent which pricing strategy companies are using in your area. If your premiums will increase as you age, ask for an estimate of what your premiums will likely be in five, 10, 15 or 20 years.

What are the most popular plans in my area?

A large number of people enrolled in one plan can sometimes lower the premiums for that policy.

Ask your agent about the most popular plans in your area and how they compare in cost and benefits to the plan you want.

Is there a waiting period before the policy will cover my pre-existing conditions?

In certain situations, yes. If you’ve been diagnosed with a medical condition within the previous six months before you buy a Medigap policy, you may have to wait up to six months before your Medigap plan will cover out-of-pocket expenses related to that diagnosis.

If you have a guaranteed-issue right, insurers can’t enforce the waiting period.

Talk to your licensed agent to see if the plans you are considering will require a waiting period.

When will my Medigap coverage begin?

This will depend on when you buy your policy.

The agent should be able to tell you exactly when your Medigap coverage will start.

Is the plan I want available in my area and to people my age?

Depending on where you live, certain Medigap plan options may not be available for purchase. States have different rules for whether or not insurance companies must offer Medigap plans to under-65 beneficiaries.

Ask your agent which plans are available to you before you set your sights on one particular plan.

Are there similar plans available for lower premiums?

Even if you think you’ve decided on the plan you want, ask your agent if similar plans are available and how much they cost. It is possible that you could end up saving money by dropping benefits you don’t actually need.

If you require a Medigap plan with comprehensive coverage but are concerned about costs, it may be beneficial to ask your agent about High Deductible Plan F, which has lower monthly premiums than standard Plan F (in exchange for a high deductible).

What are the out-of-pocket costs associated with this plan?

Your agent can help you better understand what you’ll likely pay out of pocket with the plan you are considering. This can help you ensure you won’t be caught with unexpected charges down the road.

Once you pass your open enrollment period, signing up for a new policy could end up being more expensive, so it is important to feel confident about your plan from the start.

You’re Ready to Speak to an Agent!

Once you’ve gone through the questions above and made note of what you want to ask, it’s time to speak to a licensed agent. You can compare plans for yourself online, or you can call to speak directly with a licensed insurance agent.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.