Medicare supplemental insurance, nicknamed Medigap, has become an increasingly important part of the health-insurance landscape, along with enhanced Medicare Advantage plans, and the decisions seniors make on such coverage also have become more complex and crucial, industry representatives say.


Medigap policies are federally regulated plans that consumers can purchase to help pay out-of-pocket health costs that arent covered by Medicare Parts A and B, such as co-payments and deductibles. The gaps in Medicare coverage can be costly to seniors who dont have additional coverage, which has spurred increasing demand for Medicare supplemental insurance.


The alternative to a Medigap policy is a Medicare Advantage plan, also known as Medicare Part C. These plans, approved by Medicare and offered by private companies, often provide benefits not available in Medigap plans, including vision and hearing exams, dental, and prescription drug coverage.


Ninety percent of people choose to supplement Medicare in some way, says Shannon Fuhrman, manager of Medicare sales for Asuris Northwest Health, in Seattle.


Currently there are 12 different types of Medigap insurance plans, labeled A through L. The last two, K and L, were added in 2006. Each Medigap plan covers differing amounts of out-of-pocket expenses associated with the various services covered under Medicare. The Medigap system is designed so that the various plans can be compared easily. The benefits included in each plan are the same no matter what insurer offers it, though the prices they charge can vary greatly and not all insurers offer all Medigap policies.


Fuhrman, whose company offers four Medigap plans, says its important for people interested in the coverage to get enrolled as soon as they become eligible. Spokane State Farm Insurance agent Jack Praxel also emphasizes the need to enroll as soon as one can, saying, That window of opportunity is pretty important.


The Medigap-open enrollment period lasts for six months after a person who is age 65 or older becomes enrolled in Medicare Part B. A person must already be enrolled in Medicare Part A, which is most easily described as hospital insurance, before they can enroll in Part B, which generally helps pay for doctors visits and other types of outpatient services.


During the open-enrollment period, an insurance company cant refuse to sell applicants any Medigap policy that it offers, make them wait for coverage, or charge them more due to pre-existing conditions. After that period, though, a company can use medical underwriting methods to decide how much to charge and whether it will accept certain applications.


Kathy Dugan, a statewide health insurance benefits adviser for Aging & Long-Term Care of Eastern Washington, says people should do their homework and be ready to act when the open-enrollment period arrives. Applicants who get into a plan when they become eligible for open enrollment often can change their Medigap policies later to match their changing needs, but if they wait for their health to decline before they attempt to enroll, theres no guarantee that an insurer will pick them up, she says.


Praxel says that a policyholder always can switch to scaled-back coverage, but will have to undergo some medical underwriting before obtaining a higher coverage plan.


According to the Washington state Insurance Commissioners office Web site, Medigap plans generally cost between $90 and $200 a month for an individual.


Dugan encourages people to evaluate the options closely before choosing a policy.


You want to fully understand the planwhether its a supplemental or Advantage plan, she says. The biggest problem when shopping for this insurance is that there are so many insurers.


Dugan says there are 16 Medicare Advantage insurers and 23 Medigap insurers in Spokane County, with each insurer offering a multitude of different policy options. Dugans organization offers information and assistance to consumers looking for coverage from volunteers trained by the state insurance commissioners office.


We are the one place where you can get unbiased insurance information, she asserts. Aging and Long-Term Care of Eastern Washington is a publicly-funded organization whose mission is to promote well-being, independence, dignity, and choice for elderly individuals in Eastern Washington.


Fuhrman and Praxel say Medicare Advantage plans are gaining in popularity. Fuhrman says that a lot of carriers have begun offering more comprehensive Medicare Advantage plans in the last several years. She says one reason is that people can couple their prescription-drug, vision, and dental coverage into one policy with many Medicare Advantage plans.


Medicare Advantage plan monthly premiums in Spokane County range in cost up to about $200, with most less than $100, and most include prescription drug coverage, according to information on the insurance commissioners Web site.


A Medicare Advantage plan often is set up like a managed-care plan, such as an HMO or PPO, says Praxel. Thus, one reason someone might choose a Medigap policy over an Advantage plan is that the latter can limit an individuals choice in choosing a doctor, while a Medigap policy holder can see any doctor that accepts Medicare. This decision can be quite important to seniors who have been with the same doctor for a number of years. Availability of approved physicians also can be a concern.


People can enroll in a Medicare Advantage plan when they become eligible for Medicare, at age 65, or during an annual open-enrollment period that runs from Jan. 1 to March 31 each year.


Praxel says that in some cases Medicare Advantage plans are a good solution, and the premiums for them are lower on average than Medigap policies, but Advantage plans also can be more expensive in the long run.


As with Medigap coverage, it is in the prospective policyholders best interests to investigate a plan thoroughly before committing to it.


Dugan warns that not every drug is covered by prescription drug plans, and says people need to make sure that the plan they choose is going to be able to meet their needs.


The biggest pitfall, she says, is people not taking their time to look at different options.


Contact Ben Rascoff at (509) 344-1260 or via e-mail at benjaminr@spokanejournal.com.