The world of Medicare and Medical Insurance can often be a complicated and confusing one, but SBHIS Insurance Services offers expert advice and guidance. Ania Chrostowska from SBHIS shares her expertise and dives into some of the current aspects of medical coverage, and discusses the opportunities offered by Medi-Gap Policies.
According to a 2023 AHIP report, 33% of Californians who use traditional FFS Medicare have a Medi-Gap Policy. In San Diego, that comes to almost 70,000 people! Most of them are high income retirees, but almost half of them have income between $50,000 and $300,000 a year.
For a monthly premium, Medi-Gap covers deductibles and co-insurance and allows patients the freedom to see any provider who accepts original Medicare. The most popular Supplements are Plans F (41%), G (32%) and N (10%).
For many, Medi-Gap is part of a retirement package offered by a former employer, but a majority purchase a policy from a local agent or financial planner and pay their own monthly premiums. If you are one of those members you should know a few things:
- The biggest mistake is not to review Medi-Gap policy every few years. All Supplements cover the same benefits but have varying monthly premiums. Those premiums are always lower for new members than existing clients. One change without underwriting is allowed every year under California Birthday Rule.
- The most common misconception lies in underwriting. The law states that applicants must go through underwriting, unless they qualify for guaranteed-issue periods, which is the time when insurance companies must sell Medi-Gap policies at the best price for applicant’s age, without a waiting period or health screening. Many people believe that “Guaranteed- Issue” is only available during the first 6 months after the Part B effective date. That is not true! Some of the SEP’s (Special Election Periods) that allow for easy enrollment at a later time are SEP65 for Medicare Advantage members who have been with a plan for less than a year, SEP for MAPD Plans leaving the county, or SEP for Advantage Plans making substantial changes to their network. All of these trigger “Guaranteed-Issue” for members who otherwise would have to go through the underwriting process.
As you can see, the requirements and opportunities are quite varied! For more information about underwriting, plan benefits or other questions related to Medicare, please contact Ania Chrostowska, Director of Business Development at SBHIS Insurance Services at (619) 888-8189.
www.sbhis.net
