Medigap, also known as Medicare Supplement Insurance, is private health insurance designed to help cover the gaps (or “gaps”) in coverage left by Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). These gaps can include copayments, coinsurance, and deductibles that beneficiaries would otherwise be responsible for paying out of pocket.
Here are key points to understand about Medigap:
- Complements Original Medicare: Medigap policies work alongside Original Medicare to provide additional coverage. They do not replace Medicare; instead, they help fill in the financial “gaps” in coverage.
- Standardized Plans: Medigap plans are standardized and labeled with letters (A, B, C, D, F, G, K, L, M, N). Each plan offers a different set of standardized benefits, but the coverage for a specific plan type is the same, regardless of the insurance company selling it. For example, Plan F from one insurance company provides the same benefits as Plan F from another.
- Coverage Consistency: Regardless of the insurance company, the benefits provided by a specific type of Medigap plan are standardized by Medicare. This makes it easier for beneficiaries to compare plans and understand the coverage they are purchasing.
- Pays for Part A and Part B Costs: Medigap policies generally help pay for certain out-of-pocket costs associated with Medicare Part A and Part B, including copayments, coinsurance, and deductibles. Some Medigap plans may also cover emergency medical expenses incurred during foreign travel.
- Does Not Include Prescription Drug Coverage: Medigap plans do not cover prescription drugs. If you need prescription drug coverage, you can enroll in a stand-alone Medicare Part D prescription drug plan.
- Monthly Premiums: Beneficiaries with Medigap coverage pay a monthly premium to the insurance company in addition to the premium for Medicare Part B. Premiums can vary based on factors such as the type of plan, the insurance company, and the location.
- Guaranteed Issue Rights: During certain periods, beneficiaries have guaranteed issue rights, which means that insurance companies must offer them a Medigap policy regardless of their health status. These periods include the six-month Medigap Open Enrollment Period, which starts when a person is 65 or older and enrolled in Medicare Part B.
- Renewable Coverage: As long as beneficiaries pay their premiums, Medigap policies are guaranteed renewable. This means that the policy cannot be canceled as long as premiums are paid on time.
When considering Medigap coverage, it’s important for individuals to compare the available plans, understand the benefits they offer, and choose a plan that aligns with their healthcare needs and budget. I can help you understand this more and help you choose the right plan for you.