Healthcare becomes increasingly important as we age. For many older Americans, Medicare is the primary source of health insurance. However, Medicare doesn’t cover everything. There are still costs that can add up quickly, such as deductibles, copayments, and coinsurance. That’s where Medigap insurance comes in. Also called Medicare Supplement Insurance, Medigap is a way to reduce out-of-pocket expenses and make healthcare more affordable and predictable.
What is Medigap?
Medigap is a type of private insurance policy designed to work alongside Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). It helps cover the costs that Medicare doesn’t fully pay for. These costs can include hospital stays, doctor visits, medical equipment, and other healthcare services.
Unlike Medicare Advantage (Part C), which is an alternative to Original Medicare, Medigap does not replace your Medicare coverage. Instead, it supplements it. You must have both Medicare Part A and Part B to be eligible for a Medigap policy.
How Medigap Works
When you have Medigap, Medicare pays its share of the approved healthcare costs first. Then, your Medigap policy pays its portion. Depending on the plan you choose, this could cover all or most of the remaining costs. This can significantly reduce the financial burden that often comes with health care.
Medigap policies are standardized in most states. That means a Plan G from one insurance company will offer the same benefits as a Plan G from another company. The only difference is the price. This makes it easier to compare plans and shop for the best value.
What Medigap Plans Cover
Medigap plans are identified by letters, from A to N. Each letter represents a different set of benefits. Some cover only the basics, while others offer more comprehensive protection.
Here are some common benefits Medigap plans may include:
– Coinsurance and hospital costs after Medicare Part A coverage ends
– Copayments and coinsurance for doctor visits and outpatient services under Part B
– The first three pints of blood needed for a medical procedure
– Part A hospice care coinsurance or copayments
– Skilled nursing facility coinsurance
– Medicare Part A deductible
– Foreign travel emergency coverage
Plans F and G are among the most comprehensive. However, Plan F is only available to people who were eligible for Medicare before January 1, 2020. Plan G has become a popular choice for new Medicare enrollees because it offers similar coverage, except it does not pay the Part B deductible.
What Medigap Does Not Cover
Even the most complete Medigap plans do not cover everything. Medigap does not pay for:
– Prescription drugs (you’ll need a separate Part D plan)
– Long-term care or custodial care
– Routine dental, vision, or hearing services
– Eyeglasses or hearing aids
– Private-duty nursing
If you need coverage for these services, you may want to look into other insurance options or stand-alone plans.
When to Enroll in Medigap
The best time to enroll in a Medigap policy is during your six-month Medigap Open Enrollment Period. This starts the month you are both 65 or older and enrolled in Medicare Part B. During this time, insurance companies must sell you a policy, cannot deny you coverage, and cannot charge you more because of health problems.
After this period ends, you may still be able to buy a Medigap policy, but it could be more expensive or you could be denied based on your medical history. That’s why it’s important to plan ahead and act within the enrollment window.
Choosing a Medigap Policy
When choosing a Medigap plan, think about your current and future healthcare needs. Consider how often you visit doctors, whether you travel often (some plans include emergency coverage abroad), and how much you can afford to pay in monthly premiums.
Also, compare prices from different insurance companies. Since the benefits are standardized, you’ll want to find the best price for the plan that fits your needs.
It’s also helpful to talk with a licensed insurance agent or a Medicare counselor. They can help you understand your options and guide you through the enrollment process.
Final Thoughts
Medigap can play an important role in helping seniors manage healthcare expenses and avoid surprise medical bills. By filling the gaps in Medicare coverage, it gives peace of mind and greater financial protection.
While Medigap doesn’t cover everything, it does make healthcare more affordable and predictable. If you’re turning 65 or already have Medicare, now is the time to learn more about Medigap plans and decide if one is right for you. With the right coverage, you can focus more on your health and less on your bills.