July 2023

Why You Need a Medigap Policy and How To Find One

June 30th, 2023
by Catherine Read
A common mistake among Medicare recipients is to believe that Medicare is the only the health insurance they need. This belief is false and dangerous. For most expenses, Medicare only pays a portion. This creates “gaps” in medical coverage where the Medicare beneficiary must pay the other portion of their expenses. These gaps add up quickly, and can cripple the finances of a senior citizen who is struggling to make ends meet or, as is often the case, has the money to pay, but is saving that money in case other big expenses arise in the future, such as long-term care in a nursing home, assisted living facility, or the home. The senior and his or her family is left scratching their heads as to how the senior could be hit with such a big medical bill, for example, after a rehabilitation facility stay following hospitalization, when they thought the senior was fully covered by Medicare.

Medicare Supplement Insurance, also called Medigap, can help cover the gaps. A Medigap policy is private health insurance that is designed to supplement Medicare, by helping to pay gaps such as copayments, coinsurance, and deductibles, which can be substantial. The Delaware Department of Insurance regulates Medigap policies. Here is a link to the Delaware Department of Insurance: https://insurance.delaware.gov/.
A Medigap policy differs from a Medicare Advantage Plan, which is a way to get Medicare benefits, while a Medigap policy supplements Medicare.

Timing is key on buying a Medigap policy.

The best time to buy a Medigap policy is during your Medigap open enrollment period, which is a 6-month period beginning on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. The important benefit of this 6-month window is that during that time you are protected in how the insurance company treats you. Specifically, in that window, the insurance company can’t do the following because of your health problems:
  • Refuse to sell you any Medigap policy it offers
  • Charge you more for a Medigap policy than they charge someone with no health problems
  • Make you wait for coverage to start except for certain conditions.

The terms are technical in this area and often overwhelming for a consumer.

The longer you wait to apply for Medigap after you turn 65 and start receiving Medicare, the more difficult it is for you to obtain coverage, and if you do obtain coverage, the more you might have to pay for it. If you apply for Medigap coverage after your open enrollment period, there is no guarantee that an insurance company will sell you a Medigap policy if you do not meet their medical underwriting requirements, unless you are eligible for select protections not listed here, and they can charge you more premium.

This article is intended to alert you and your loved ones to the importance and timeliness aspect of Medigap, not to describe the many complicated intricacies, including that persons under 65 can receive Medigap policies if they are receiving Medicare due to a disability.

If you or a loved one do not have a Medigap policy and are receiving Medicare, please, promptly, take advantage of free resources to learn your options. Following are easy places to turn to, with trained volunteers and experts whose job it is to educate you on your options:
  1. Delaware Medicare Assistance Bureau (DMAB): https://insurance.delaware.gov/divisions/dmab/. Per the DMAB website, the DMAB provides free health insurance counseling for people with Medicare, including those under 65 years of age. Call DMAB at 1-800-336-9500 or (302) 674-7364 to set up a free counseling session with a trained volunteer at a convenient site. DMAB’s stated goal is to empower people with Medicare to better understand their options and enable them to make the best health insurance decisions for themselves. Per the DMAB website, Counselors provide in-person and telephone assistance in the following general areas:
  • Medicare Prescription Drug Coverage Program (Medicare Part D)
  • Medicare supplement insurance (Medigap Plans)
  • Assistance for disabled Medicare beneficiaries (under age 65)
  • Medicare Advantage Plans (HMOs, preferred provider organizations)
  • Long Term Care Insurance
  • Medical Assistance programs
  • Assistance for low-income beneficiaries
  • Billing problems
  • Volunteer counselor opportunities
  • Prescription Savings for those who qualify
  • Free community presentations and more

For a very informative Medigap resource published by the Delaware Department of Insurance, titled The Delaware Medicare Supplement Insurance Guide 2023, scroll down on the DMAB webpage, see the section on Medicare Supplement Insurance, and see this link:
  • www.Medicare.gov has a section and search engine to find Medigap policies. Of note is a link to an informative resource published by the Centers for Medicare and Medicaid Services, 2023 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare, which is an official government guide about Medigap: 
Reading the above guides and scheduling a free counseling session with a DMAB representative are quick and easy ways to begin vetting your or your loved one’s options about Medigap, before unexpected substantial charges start piling up after, for example, a hospital or rehabilitation stay. Learn your options early and take action to protect yourself.

July 19th, 2023

The No Surprises Act is a federal law enacted to protect patients from unexpected medical bills incurred on or after January 1, 2022. It aims to address the issue of surprise medical billing, which can occur when patients receive unexpected charges for their medical care. The Act applies to out-of-network emergency services, out-of-network air ambulance services, and certain out-of-network care received at in-network facilities.

Help for Seniors

The Act is important for all patients, but especially for seniors. Seniors are especially vulnerable to surprise medical billing because they often need more health care than other populations. They are more likely to be seen by out-of-network providers. The Act protects them from unexpected charges and provides a much-needed safeguard for their medical expenses.
Under the Act, patients are not responsible for surprise medical bills beyond their in-network cost-sharing amount. This means that patients will only be responsible for paying the same amount they would have paid if an in-network provider provided the care. The Act also prohibits balance billing, which is when providers bill patients for the difference between their charges and the amount paid by the patient’s insurance.

This can be relevant in a variety of settings seniors encounter, including emergency room visits, second opinions, surgical procedures, and even skilled nursing care where independent contractors provide services. Under the Act, providers must accept the Medicare-approved amount as payment in full. This prevents patients from being surprised with large balances and protects them from unexpected financial hardship.

Exceptions to the Act

There are some providers and services that are exempt from the Act’s billing protections (although your state may have a similar law that does not exempt them). These include:
  • Ground ambulance services, which can charge you out-of-network rates
  • Vision-only and dental-only insurances, which are not subject to balance billing protections
  • Indemnity plans such as hospital indemnity insurance, which are exempt from the Act