What is Medigap Coverage? Do I Need it if I Have Original Medicare?
A Medicare Supplement Insurance plan is also known as a Medigap policy and is sold by private insurance carriers. A Medigap plan can help pay some, most or all of the health care costs that Original Medicare doesn’t cover, for instance, co-payments, coinsurance, and deductibles depending on which plan you purchase.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, for instance, medical care when you travel outside the United States borders.
If you have Original Medicare Parts A & B and you buy a Medigap policy, Medicare will pay its portion of the Medicare-approved amount for covered health care costs and services. After those original Medicare costs are paid to the providers, your Medicare supplement policy then pays its required portion.
A Medigap policy works entirely different from a Medicare Advantage Plan. Advantage plans take over for Medicare and has an outline of cost sharing and rules outlined for your health care. For example, Advantage plans have copays, deductibles for medical services provided, out of pocket maximums, and you are usually required to use providers in the plan network.
A Medigap policy only supplements your Original Medicare benefits Part A & B, with no referrals required and has an open network throughout the United States. Any provider who accepts Medicare must accept your Medigap plan because Medicare will cross bill to your Medigap plan.
To be able to purchase a supplement policy you are required to have Medicare Part A and Part B. This is also the rule is you want to purchase a Medicare Advantage Plan. If you have a Medicare Advantage Plan, you may apply for a Medigap policy during AEP which starts every October 15th and ends December 7th.
You can also apply for a Medigap policy during the Medicare Advantage Dis-Enrollment period which starts every January 1st and ends February 15th. If you are accepted for the Medigap plan you applied for you must dis-enroll from your Medicare Advantage Plan before your Medigap coverage begins.
When you purchase a Medigap policy, you pay the private insurance company a monthly premium for your Medigap coverage (prices vary from carrier to carrier) in addition to the monthly Part B premium that Medicare requires you to pay whether you pay it quarterly, or you have it deducted from your Social Security. A Medigap Policy like an Advantage Plan will only cover one person.
If you and your spouse both want to purchase a Medigap policy, you’ll each have to buy separate policies. In some instances, there are private carriers who offer a marriage or household discount. Medicare recipients can purchase a Medigap policy from any insurance company that’s licensed in your residing state to sell one.
Any standardized Medigap policy will be guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium and also cannot raise your premium due to poor health. In other words, you cannot be singled as an individual for premium increases.
Medigap policies sold after January 1st, 2006 do not include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan also known as Part D coverage.
A person enrolled in a Medicare Part D plan may incur a late enrollment penalty if he/she goes without Part D or creditable prescription drug coverage for a continuous period of 63 days or more at the end of his/her Initial Enrollment Period for Part D coverage.
Medigap policies only cover what original Medicare covers. They do not cover everything, for example, long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
You can drop your Medigap policy at any time if you want to purchase a completely different Medigap policy. However, you need to be careful to keep your Part D drug coverage in place.
This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make available Plan “A” and “B” and “C” or “F.” Some plans may not be available in your state.
Basic Benefits for 2017-2018
Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits ends.
Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or, copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of coinsurance or copayments.
Blood: First three pints of blood each year
Hospice: Part A coinsurance
|Plan A||Plan B||Plan C||Plan D||Plan F/F*||Plan G||Plan K||Plan L||Plan M||Plan N|
|Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance||Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%||Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%||Basic, including 100% Part B coninsurance||Basic, including 100% Part B coninsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER|
|Skilled Nursing Facility Coinsurance||Skilled Nursing Facility Coinsurance||Skilled Nursing Facility Coinsurance||Skilled Nursing Facility Coinsurance||50% Skilled Nursing Facility Coinsurance||75% Skilled Nursing Facility Coinsurance||Skilled Nursing Facility Coinsurance||Skilled Nursing Facility Coinsurance|
|Part A Deductible||Part A Deductible||Part A Deductible||Part A Deductible||Part A Deductible||50% Part A Deductible||75% Part A Deductible||50% Part A Deductible||Part A Deductible|
|Part B Deductible||Part B Deductible|
|Part B Excess (100%)||Part B Excess (100%)|
|Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency||Foreign Travel Emergency|
|Out-of-pocket limit $4960; paid at 100% after limit reached||Out-of-pocket limit $2480; paid at 100% after limit reached|
*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.