Does a Medigap policy make sense for my mother?

A fellow caregiver asked...

I'm wondering whether a Medigap policy makes sense for my mother. My mother is 70 years old with a mental illness. She has a very limited monthly income from Social Security which doesn't cover her monthly living expenses. Her asset position will prevent her from qualifying for Medicaid for another 10 years or so. I always felt that she would not be able to afford a Medigap policy. Should she be drawing from her assets to pay for a Medigap policy?

Expert Answer

Whether it's a good idea at this point for your mother to buy a Medigap supplemental insurance policy depends on several factors. One is the question of what Medigap policies she's now eligible for. Because she didn't buy a Medigap policy within the first six months after she first signed up for Medicare Part B, she may be severely restricted in the policies she could buy now. Medigap rules say that insurance companies are not required to sell her a policy now. And if a company does agree to sell her a policy, the premiums may be much higher than they would have been if she'd signed up years earlier. This is particularly true because of your mother's existing illness.

If you can find some Medigap policy for your mother, the next question would be whether the high premium is worth the coverage she gets from the policy. If your mother's mental illness requires lots of acute medical attention of the kind -- doctor visits, hospitalization -- Medicare and Medigap cover, then the extra coverage from the Medigap policy may be worth the high premium. But if what you're most concerned about is the potential, because of her mental illness, for your mother to need long term home care, assisted living, or nursing home care, a Medigap policy is not going to be of much use. Medigap policies pay a portion of the costs that Medicare covers, but neither Medicare nor Medigap pays for long-term home or residential care.