The Ins and Outs of Medigap Coverage

Filling in the Medicare gaps can be tricky business for seniors, but it can be done with a little help from your California Health Insurance Agent.

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Esther Sirica, 68, was planning to have a surgery performed on her left foot’s hammertoe. She had joined a swim club for seniors and wanted to show off her feet. “I’d always wanted to be a foot model when I was younger,” she explained, “in my day; a well-turned ankle was just the beginning.”

But she wasn’t independently wealthy, and there were gaps in her Medicare coverage that she didn’t understand. “When I asked my primary care physician about the surgery, he said that I wouldn’t be covered. “It’s elective surgery on a pre-existing condition,” he asserted. But Esther wasn’t convinced. “Men used to find my feet lovely,” she told her physician, “except for THAT one.” She was pointing to her hammertoe, not the photo of President-elect Obama on the nearest wall.

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Esther quietly demurred amid the usual pleasantries, and begged her leave. A moment later she was off to find a second opinion. Her second opinion, an elderly physician who at least comprehended the surgery’s potential significance to the woman if not its urgency, did recommend the surgery, and perfunctorily checked out Esther’s Medicare coverage. “The surgery will cost $1,750,” he informed her.

“That’s not so much,” she said, assuming it was entirely covered except for her co-pays.

 “But Medicare will approve only about half of that, $825.00,” he added.

“Oh,” she said, with sadness suddenly re-encroaching upon her entire being, including the deformed toe.

Fortunately, Esther’s next visit was to her California health insurance agent, a valuable source for information on Medicare Supplement coverage for the past year or two. The nice young agent there had mentioned something called Medicare Supplement Insurance policies as a way to plug the disturbing Medigaps.

A month later, Esther was in the pool with the seniors, literally a new woman. A gentleman swimmer named Tony was looking at her foot when he noticed it. “Didn’t you used to have a hammertoe?” he remarked.

Esther Sirica flashed a big smile, her dentures clicking.

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