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Senior Citizen's Guide to Philadelphia
Q & A: Medigap Policies

Q. If I already have a Medigap policy, will I be able to buy one of the standardized plans?
A. Maybe. You can apply for a policy. However, unless you are eligible for open enrollment or guaranteed issue when disenrolling from a Medicare+Choice plan, companies may reject your application because of your current health condition. If you are accepted for coverage, you should not have to meet any pre-existing condition waiting periods to have continuous coverage.

Q. I will turn 65 within the next few months. What should I do about Medigap insurance?
A. First, learn what Medicare covers and what gaps you want covered with a Medigap policy. Don't forget to ask your employer if your current policy will convert to a supplement after you are eligible for Medicare. If you or your spouse do not have employer or union group coverage, then select one of the ten plans that offers you the benefits you want at the best price. If you apply for Medigap insurance within six months after you enroll in Medicare Part B, or qualify for guaranteed issue when disenrolling from a Medicare+Choice plan, companies must accept you regardless of any health conditions you have, and they cannot charge you more than they charge others of the same age.

Q. I am a retired federal, state or municipal employee with benefits through Medicare and my federal, state or municipal benefit plan. Should I change to one of the standard plans?
A. You probably have better benefits through your plan than you can get through any of the standardized Medigap plans. You should carefully review your current benefits with a representative from your group. It is unlikely that you need to replace your coverage.

Q. I plan to continue working after I am 65. What do I need to do?
A. If you work for an employer with 20 or more employees and are covered by health insurance, or you are married to someone who does, you probably have comprehensive coverage. The employer plan pays first and Medicare pays second. You should not enroll in Medicare Part B until you stop working. When you stop working, you may be able to convert your employer plan to a Medicare supplement. Otherwise, you can purchase one of the standard plans.

Q. I cannot afford a Medigap policy. Is there anything I can do to protect myself?
A. Depending on your income, you might be eligible for Qualified Medicare Beneficiary, a special Medicaid program that pays for the Part B monthly premium, and covers your hospital deductible plus your 20 percent co-payment and deductible for physician charges. Check with the Pennsylvania Department of Public Welfare at 1-800-842-2020.

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