Medicare is a government health insurance program for people aged 65 and older, as well as for certain younger people with disabilities. While Medicare helps cover many health care costs, it doesn’t cover everything. That’s where Medigap, also known as Medicare Supplement Insurance, comes in. It’s designed to fill the gaps in Original Medicare and help pay for some of the out-of-pocket costs like copayments, coinsurance, and deductibles. In this article, we’ll explain what Medigap is, how it works, and why it might be important for you or a loved one.
What is Medigap?
Medigap is private health insurance that supplements Original Medicare (Part A and Part B). It’s offered by private insurance companies and is meant to cover certain costs not paid by Medicare. These policies can help reduce the amount you pay out of your own pocket when receiving health care.
It’s important to note that Medigap only works with Original Medicare. It cannot be used with Medicare Advantage Plans (Part C). If you have a Medicare Advantage Plan, you’ll need to leave that plan and return to Original Medicare before you can buy a Medigap policy.
What Does Medigap Cover?
Medigap policies are standardized, meaning that each plan with the same letter offers the same basic benefits, regardless of which insurance company sells it. There are currently 10 standardized Medigap plans available in most states: Plans A, B, C, D, F, G, K, L, M, and N.
Here are some of the things Medigap can help pay for:
– Part A coinsurance and hospital costs
– Part B coinsurance or copayments
– The first three pints of blood needed for a medical procedure
– Part A hospice care coinsurance or copayments
– Skilled nursing facility care coinsurance
– Part A and B deductibles (depending on the plan)
– Foreign travel emergency coverage (in some plans)
Plan F and Plan G are among the most popular options because they offer more comprehensive coverage. However, Plan F is only available to people who were eligible for Medicare before January 1, 2020.
What Isn’t Covered by Medigap?
While Medigap can help reduce many out-of-pocket costs, it doesn’t cover everything. Most Medigap policies do not include:
– Long-term care (like extended nursing home stays)
– Vision or dental care
– Hearing aids
– Eyeglasses
– Private-duty nursing
– Prescription drug coverage
If you want coverage for prescription drugs, you’ll need to enroll in a separate Medicare Part D plan.
Who Can Get Medigap?
To buy a Medigap policy, you must have Medicare Part A and Part B. The best time to purchase a Medigap policy is during your Medigap Open Enrollment Period. This is a one-time, six-month period that starts the first month you’re 65 or older and enrolled in Part B. During this time, you can buy any Medigap policy available in your state, even if you have health problems, and insurance companies cannot charge you more based on your health history.
If you try to buy a Medigap policy outside of this enrollment window, you might be denied coverage or charged higher premiums, depending on your health.
How Much Does Medigap Cost?
The cost of a Medigap policy varies based on several factors, including the plan you choose, the insurance company, your location, and your age. There are three common ways companies set their prices:
1. Community-rated – Everyone pays the same premium regardless of age.
2. Issue-age-rated – Premiums are based on your age when you first buy the policy. They don’t go up as you get older.
3. Attained-age-rated – Premiums are based on your current age, so they increase as you get older.
It’s a good idea to compare Medigap plans and prices from different companies before making a decision.
Why Choose Medigap?
Medigap can give you peace of mind by reducing your out-of-pocket health care costs. It also gives you the freedom to see any doctor or specialist who accepts Medicare, without the need for referrals. This can be especially important if you travel frequently or want access to a wide range of medical providers.
For many people, the cost of Medigap is worth it because it helps protect against large, unexpected medical bills. It can also simplify your health care expenses by reducing the number of separate bills you have to manage.
Final Thoughts
Medigap is an important option for people who want more predictable health care costs and additional coverage beyond what Original Medicare offers. Before choosing a policy, be sure to compare the different Medigap plans, consider your current and future health needs, and explore what’s available in your state.
Understanding your choices can help you make the best decision for your health and your wallet. With the right Medigap policy, you can feel more secure about your medical care and focus on enjoying life.