Payers can play a key role in helping consumers understand their Medigap benefits and policy options through greater benefit and price transparency.
Bonnie Burns, a training and policy specialist at California Health Advocates, has been advocating for consumers in the Medicare space for over four decades, including in the area of Medigap benefits. She was involved in the lawsuit that initiated standardization of Medigap policies in the 1990s.
Her job, she told HealthPayerIntelligence, is to help consumers understand their Medicare coverage options.
“I’m coming at this from a very different point of view,” Burns explained. “Our goal is to make sure that people understand what those benefits are and how to use them and what it’s going to cost.”
She plays a crucial role because, for the average consumer, understanding Medigap policy options is no simple task.
As consumers navigate decisions about Medicare coverage, payers can support them by understanding why consumers choose Medigap, the challenges that consumers face in comprehending their coverage options, and by actively moving toward greater benefit and price transparency.
WHAT ARE MEDIGAP POLICIES AND WHAT DO THEY COVER
Medigap policies provide coverage for areas of care that Original Medicare does not cover. For modern-day policies, according to Medigap rules, Medigap coverage includes:
- Part A hospital coinsurance for days 61 through 90
- Part A hospital lifetime reserve coinsurance for days 91 through 150
- 365 lifetime hospital days beyond Medicare coverage
- Parts A and B three-pint blood deductible
- Part B 20 percent coinsurance
Source: Healthpayer Intelligence