Reg Jones Expert's View

Because they know that I write about retirement and insurance matters, people I run into at the post office or grocery store often ask me, “Should I enroll in a Medigap policy?” Before I answer, I always ask them three questions: “Are you covered by Medicare? Are you a federal retiree? Are you enrolled in an FEHB plan?” My answer depends on what they tell me.

A Medigap plan is designed to fill in benefit gaps in Medicare coverage. While every state has a standardized Medigap plan, each plan has a different set of benefits. Nothing is ever simple, is it? Fortunately, each standardized Medigap plan has to cover certain basic benefits, for example, Medicare coinsurance and copayments. However, they don’t cover such things as long-term care, vision and dental care, hearing aids, private-duty nursing or unlimited prescription drugs.

Although the cost of these plans varies by state and locality, the cost of a particular plan may be much lower if you are willing to use specific hospitals and, in some cases, doctors. Plans that offer this more restricted access to medical care are called Medicare Select plans. While a Medicare Select plan will not pay for care that you receive from non-plan providers, Medicare will pay its share of any regularly covered expenses, leaving you with the responsibility of paying any deductibles or coinsurances.

With that as background, it’s time for me to answer the question, “Do you need to buy a Medigap policy?” If you are a federal retiree who is covered by Medicare and enrolled in a Medicare managed care plan or a fee-for-service plan, the answer is “no.” That’s the conclusion the Department of Health and Human Services reached because it determined that a Medigap policy won’t provide you with any coverage that you don’t already have.

Since FEHB plans generally are far superior to most Medigap policies, annuitants who have Medicare and FEHBP coverage have little need for any type of extra health plan, and those who do purchase additional policies likely are wasting money on duplicate coverage.