What is Medigap Insurance?

Original Medicare does not pay for all the costs associated with enrollees’ medical treatment and some may find that they still receive bills from their healthcare provider even after Medicare pays its share of the bill. It’s in these scenarios that Medicare Supplement coverage, also known as Medigap Insurance can fill the “gap” in coverage and help pay some of the remaining costs for medically necessary services and supplies after Original Medicare pays its portion.

Is Medigap Insurance the Same as a Medical Advantage Plan?

Medigap is not the same as a Medical Advantage Plan. An Advantage Plan takes the place of Original Medicare and may offer you benefits that Original Medicare does not. If you have an Advantage Plan, you cannot purchase Medigap Insurance.

In fact, it is illegal for someone to try to sell you a Medigap policy if you have an Advantage Plan unless you are dropping your Advantage Plan and switching back to Original Medicare.

Medigap only supplements Medicare by paying what you would be required to pay after Original Medicare has paid its share.

What Does Medigap Cover?

When you receive medical services or supplies, Original Medicare pays its share of the Medicare Approved Amount for covered healthcare costs. After Original Medicare pays its portion, your Medigap policy steps in to pay its share. The qualification guidelines, coverage and cost parameters include the following:

  • You must have Original Medicare Part A (hospital insurance) and Part B (medical insurance) in order to purchase Medigap Insurance.
  • You purchase Medigap Insurance through a private insurer that is licensed to sell insurance in your state. You then pay the insurance company a monthly premium. There is no governmental assistance plan to help with the premium costs for Medigap. You are on your own and must pay the premium yourself.
  • Each person must buy their own policy. For example, if you and your spouse both want to purchase Medigap Insurance, you have to buy separate policies and pay separate premiums.
  • Once you have Medigap Insurance in place, as long as you pay your premiums on time, it cannot be canceled even if you develop a debilitating disease. However, that can change if you fail to pay a premium and your insurance lapses. You may then be required to answer medical questions in order to have it reinstated. It is not guaranteed that it will be reinstated.
  • Medigap covers copayments, coinsurance, and deductibles, among other things. Note though, that if you first enrolled in Original Medicare after January 1, 2020, your Medigap Insurance may pay for deductibles, but it will not pay for your Plan B deductible.
  • If a service is not covered by Part A and Part B of Original Medicare, your Medigap Insurance likely will not cover it either.
  • Some Medigap Insurance policies do cover you if you are traveling out of the country.
  • If you are using Original Medicare with your Medigap Insurance, you generally will not need a referral to a specialist.
  • Read carefully all information about a Medigap Insurance Policy that is being offered to you. There are 10 different types of Medigap policies, and they are all different. Be sure you are purchasing the coverage that will best suit your own personal needs.

What is Not Covered by Medigap Insurance?

There are some medical expenses that are generally not included with your Medicare Supplement Coverage. These include, among other things:

  • Long-term care in a non-skilled nursing home.
  • Private-duty nursing.
  • Dental care.
  • Vision testing and eyeglasses.
  • Hearing testing and hearing aids.

The best time to buy your Medigap Insurance policy is during your Open Enrollment period. For more information visit Medicare Supplement (Medigap) Enrollment

Sources:

  1. What’s Medicare Supplement Insurance (Medigap)?, Medicare.