What is Medigap (Medicare Supplement Insurance)?

Understanding Medicare Supplement Insurance

Medigap, also known as Medicare Supplement Insurance, is a type of health insurance policy designed to complement your Original Medicare coverage. These policies are sold by private insurance companies and help fill the “gaps” in Medicare coverage, such as copayments, coinsurance, and deductibles.

Key Features of Medigap Policies

Medigap policies offer several important features that make them valuable for Medicare beneficiaries:

1. Standardized plans
2. Guaranteed renewability
3. Coverage for Medicare-approved services
4. Portability across states

Standardized Plans

Medigap policies are standardized in most states, offering plans labeled A through N. Each plan provides a specific set of benefits, allowing consumers to compare policies easily across different insurance companies.

Guaranteed Renewability

Once you purchase a Medigap policy, it is guaranteed renewable as long as you pay your premiums. This means the insurance company cannot cancel your policy even if your health condition changes.

How Medigap Works with Original Medicare

Primary vs. Secondary Coverage

Original Medicare (Part A and Part B) serves as your primary insurance, while Medigap acts as secondary coverage. Here’s how it works:

1. Medicare pays its share of approved costs
2. Medigap then pays its share, according to your policy’s terms

What Medigap Covers

Medigap policies typically cover:

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayments
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayments

Some plans may also cover:

• Skilled nursing facility care coinsurance
• Medicare Part A and B deductibles
• Foreign travel emergency care

Eligibility and Enrollment

Who Can Get Medigap?

To be eligible for Medigap, you must:

1. Be enrolled in Medicare Part A and Part B
2. Be 65 or older (in most states)

Medigap Open Enrollment Period

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which:

• Starts the month you turn 65 and enroll in Medicare Part B
• Lasts for 6 months

During this period, you have guaranteed issue rights, meaning insurance companies cannot deny you coverage or charge higher premiums based on your health status.

Costs and Considerations

Premiums and Pricing Methods

Medigap premiums vary based on:

• The type of plan you choose
• Your location
• The insurance company

Insurance companies use different pricing methods:

1. Community-rated
2. Issue-age-rated
3. Attained-age-rated

What Medigap Doesn’t Cover

It’s important to note that Medigap policies do not cover:

• Prescription drugs (you’ll need Medicare Part D for that)
• Long-term care
• Vision or dental care
• Hearing aids
• Private-duty nursing

Choosing the Right Medigap Policy

When selecting a Medigap policy, consider:

1. Your healthcare needs
2. Your budget
3. The available plans in your area
4. The insurance company’s reputation and financial stability

Comparing Medigap Plans

Use the Medicare.gov website to compare Medigap plans in your area. Look at:

• Coverage details
• Premium costs
• Customer reviews

Conclusion

Medigap (Medicare Supplement Insurance) can provide valuable additional coverage to complement your Original Medicare benefits. By understanding how these policies work, their costs, and what they cover, you can make an informed decision about whether Medigap is right for you. Remember to explore your options during your Medigap Open Enrollment Period to secure the best possible coverage and rates.