Medicare Plan Producer Group Finds Coverage Review Gap

Medigap plans fill in many of the gaps in standard Medicare Part A inpatient hospitalization coverage and Medicare Part B outpatient and physician services coverage. For many clients, combining Medigap coverage with “Original Medicare” coverage serves as an alternative to signing up for Medicare Advantage plans.

Users of Medigap policies face little active insurer management of their use of care, and they do not face incentives to go to doctors and hospitals within a managed care plan’s provider network.

Because Medigap issuers can use medical underwriting in most states when policyholders switch plans, clients with Medigap policies who have health problems and who do not qualify for special enrollment opportunities may have a difficult time shifting to different Medigap policies.

But AAMSI found that 42% of the participating agents said the primary reason their clients switch plans is cheaper Medigap policies. About 41% said the primary driver is a shift from Medigap policies to Medicare Advantage plan coverage.

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