| Does Your Health Status Matter When it Comes to Medigap Coverage?

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It’s sometimes difficult for people to decide whether they need Medigap coverage, and our latest post will help you navigate accordingly.

Does health status matter for Medigap coverage

When you’re fortunate enough to enjoy good health, paying extra for healthcare coverage can seem like a waste of money. You might only visit the doctor once per year for your annual checkup, and perhaps you don’t need any prescription medication.

When you turn 65, you become eligible not only for Original Medicare, but also for Medigap coverage. This supplemental insurance fills in the gaps not covered by Original Medicare, which means you’ll have fewer out-of-pocket healthcare costs.

Consider these factors when deciding whether or not to buy Medigap coverage upon retirement.


Do healthy seniors need Medigap coverage?

Medicare Supplemental insurance begins with a six-month initial enrollment period, which starts the month you turn 65. During those 180 days, you can apply for any Medigap policy that’s offered in your zip code.

If you turn 65 on January 20, you can apply for Medigap coverage between January 1 and June 30. As long as you have Original Medicare Parts A and B, you’re eligible for coverage.


As of 2018, there are 10 Medigap Plans: A, B, C, D, F, G, K, L, M, and N. Each offers a different level of coverage, but they’re all standardized in the same way. The only exceptions are for people who live in Massachusetts, Minnesota, or Wisconsin because those states have different standards.

Medigap Plan F, for instance, remains the most popular Medigap coverage option year after year. It’s so comprehensive that it eliminates nearly every out-of-pocket healthcare cost one could incur, which means it helps beneficiaries feel safe from unexpected expenses.

It’s also the most expensive plan. You can reduce your monthly expenses by choosing a supplement like Medicare Plan K, which has a much lower premium. The best Medigap plan for you depends on your budget, risk tolerance, and health status, so consider all of those factors carefully before deciding on healthcare coverage.


Regardless of which plan you choose, no insurance company that offers your desired plan in your zip code can deny you coverage during the initial enrollment period. Additionally, all insurance companies must offer you their lowest rates.

If you have a pre-existing condition, the insurance company might enforce a six-month waiting period for coverage of that condition. However, it can’t raise your premium, and after the six months elapse, the company must cover your pre-existing condition.

As long as you pay your premium, you get to keep your coverage. You’ll enjoy peace of mind knowing your insurance stays in place during your retirement years.

Your rights change if you wait until after you initial enrollment period. Unless you have guaranteed issue rights, an insurance company can charge you a higher premium or deny you coverage entirely. That’s why it’s important to apply for Medigap coverage during the initial enrollment period.


Guaranteed issue rights come into play when you lose your Medigap coverage through no fault of your own. For instance, if your insurance company declares bankruptcy and goes out of business, you’ll no longer have Medigap coverage. At that point, the law allows you to seek another Medigap plan if you desire.

You can also received guaranteed issue rights if you move into an area not covered by your insurance company, if you have Medicare Part C and decide to drop it within one year, you’re enrolled in Original Medicare and your group coverage ends, or your Medigap coverage provider fails to follow the rules.

Since you have no way of knowing whether or not you’ll receive guaranteed issue rights, you don’t want to use them as a reason to postpone applying for a Medigap plan.


As you get older, you might experience new health problems that never existed before. Certain diseases and conditions are associated with aging, according to the National Institute of Health (NIH), including the following:

  • Dementia
  • Osteoporosis
  • Arthritis
  • Vision and hearing quality
  • Gastrointestinal health

The NIH illuminates several ways in which seniors can stave off these conditions, such as by exercising more frequently, getting high-quality sleep, eating a healthy diet, and seeing their physicians regularly.

People have become more health-conscious as information becomes available on how to combat disease and deteriorating health, but that doesn’t mean you can avoid all healthcare issues entirely.

While it’s essential to do everything you can to stay healthy at home, you might need medical intervention at some point. Many of the NIH’s recommendations for aging adults involve seeing a physician or undergoing some form of treatment.

Medigap coverage, as an insurance policy, guards against future costs. Since you can’t know what the future holds, you might feel more secure with a supplemental policy. It’s there if you need it, whether you develop a chronic illness or suffer an unexpected injury.


Original Medicare and Medigap plans work together to reduce your healthcare costs. For instance, several Medigap plans cover foreign emergency care. If you’re injured or ill in another country, those plans cover 80 percent of your expenses related to treatment.

Medigap coverage also reduces or eliminates other types of healthcare costs:

  • Copayments: Depending on the Medigap coverage you choose, your plan might eliminate the copayments you would otherwise pay to physicians and hospitals. A copayment is a fixed fee that’s due at the time of service, such as the $10 you might have to pay your general practitioner for a standard visit.
  • Coinsurance: Some healthcare services require the beneficiary to pay a certain percentage of costs. For instance, Original Medicare may pay 80 percent, leaving you responsible for the remaining 20 percent. If you choose a Medigap plan that eliminates coinsurance, Medicare will pay 100 percent of your fees.
  • Deductibles: A deductible tells you how much money you must pay out-of-pocket before insurance kicks in. Some Medigap coverage plans eliminate your deductible, such as for Original Medicare Parts A or B.


Even if you’re in excellent health, consider each Medigap plan and weigh its benefits against the premiums charged by insurance companies. You can use Ensurem’s Medigap Quoter to get free quotes based on your zip code, age, gender, and tobacco use.

Examine your monthly budget to figure out how you might incorporate Medigap coverage premiums into it. You may find that you feel more comfortable with insurance on top of Original Medicare because of the gaps it leaves.

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