Why Should You Get Medigap Even If You Are Not Sick?


Slide4Unfortunately, people do not always “get while the getting is good,” as my father would say.  Below is a question that I was asked yesterday by a person who decided to take his chances and not get a Medigap when “the getting was good.”

Now that he is older, and in need of insurance to help him pay his bills, he is willing to look at his options.  Unfortunately, he has waited so long that his options are severely limited.

QUESTION

I am a US citizen living in [country other than the U.S.]. I have had Medicare Parts A & B for 8 years and, fortunately, have not had to use it yet.

In May I am traveling  to [one of the states] to visit family and would like to have surgery to correct painful varicose veins in both legs. Medicare will probably cover 80% of the out-patient costs of the procedure, however would it be worthwhile to buy a supplemental policy to cover the additional 20%? If so, when should I buy the policy?

ANSWER

I hate being the person who has to break bad news.  However, here it goes.  Your guaranteed issue opportunity for Medigap was when you first turned 65.  It was called your Initial Enrollment Period.  It lasted for 7 months.  After it was over, unless you qualify for a Special Election Period, your planned surgery would be considered a pre-existing condition.  You will be subject to medical underwriting.  I do know that most Medigaps have a “Pre-existing Clause” that covers anything that is done within 6 months of getting covered.
In light of that, your options are pretty few and time-table is pretty tight.  My recommendation is for you to locate an independent insurance agent in Ohio, who is familiar with [state] laws.  My experience, in Texas, is that the only Medigap plans you can get, until after your surgery, is what is offered through AARP.  I will not work with AARP because of the rules they have for agents.  I used to be appointed with them but they suspended my contract because I did not place the majority of my business with them.  Since I require my clients to choose what insurance companies they want rather than “sell” them any insurance company, AARP does not want me.  (The feeling is mutual.)
However, they are the only Medigap company, that I know of, who will accept people with pending surgeries.
Since you want to have your surgery in May, you will need to get an AARP Medigap by the end of November.  If you select an agent in [state], who is not already appointed with AARP, he has several “hoops” to jump through before he is able to take your application.  They could take him a couple of weeks to navigate and order material.  Your best bet is to engage an insurance agent who is already “Authorized to Offer” AARP Medigap products.
Keep in mind that one of the criteria for getting AARP Medigap is that you must be a member of AARP.  If you are not already, your agent in [state] will help you enroll.
If you maintain a residence in [state], there is another option called Medicare Advantage.  It is guaranteed issue.  The good news is that the enrollment period is October 15 – December 7.  The bad news is that you must be in the U.S. and reside in the network area to join.
As you probably know by now, Medicare does not cover health-care outside of the U.S.  You are on your own while you are in [country].  Some of the Medigap plans have coverage for emergency treatment while oversees.  Ask your agent in [state] about that.
However, if you are interested in getting an “expatriate health insurance plan” that will provide health insurance to people living outside of the U.S., please let me know.  I may be able to help you with that.
MORAL
The experience this gentleman is having should be a lesson to all people who are about to enroll in Medicare.  If you anticipate that you will need help to pay for the portion of your health-care that Medicare does not, do not wait until you are already sick to get the coverage.  Get it during your Initial Enrollment Period if you do not get health insurance from work.  If you do, get it within 63 days of cancellation of your group membership.
If you apply during either one of those times, your acceptance is guaranteed.  If you wait until you are already sick, you are subject to medical underwriting.  Depending on what your physical problems are, you may not even be able to get Medigap.
Even if you are able to get a plan, the pre-existing condition clause will mean that the Medigap plan will not help you for the first 6 months of the policy.
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