Understanding Medigap: The Supplemental Insurance

Medigap insurance is sold by private firms and helps individuals pay for any costs that their Medicare does not cover, such as deductibles and copayments. This type of supplemental insurance is only available to those people who already have both Parts A and B of Original Medicare.

If you settled for a Medicare Advantage health plan, which is Part C, you’re also ineligible to buy a Medigap policy. While you do have certain out-of-pocket expenses with your Advantage plan, they are normally not as much as those with the Original Medicare insurance.

As a general rule, if you are below the age of 65 and are on Medicare because of disability, you cannot enroll in a Medigap plan. There are, however, certain exceptions that exist. You can get in touch with your insurance advisor to learn about them.

In most states, 11 standard Medigap polices are available, with each lettered from A through G and from K through to N. Each of these policies offers varying sets of benefits to fill the gaps left by Original Medicare Part A and Part B. All Medigap policies that have the same letter offer the same types of benefits.

Legally, you can only select one plan from all the available Medigap options. If your spouse has Medicare and also wishes to get covered by Medigap, then he or she would have to purchase a separate policy altogether.

Standard Medigap policies tend to cover some or all of the expenses of the following:

• Your Medicare Part A deductible and coinsurance (the 20 percent that Medicare doesn’t cover) for any hospital stays
• Some portion of your physician bills for services in Part B
• The initial three pints of blood each year, if required
• Hospice care coinsurance.

On the other hand, Medigap does not cover the following:

• Private-duty nursing
• Vision care, hearing aids, eyeglasses or dental care
• Long-term care to assist you with bathing, dressing, eating or using the restroom
• Prescription drugs or additional costs for your Part D plans.

What You Should Know Before You Purchase a Medigap Policy

Before even starting your search for a Medigap policy, determine what kind of health insurance you already have alongside Medicare — if any.

If you already possess a retiree health plan as a supplement to your Original Medicare, you might not need a Medigap plan. If your retiree policy offers more generous benefits or benefits not offered by either Medicare or Medigap, then think twice before letting go of this healthplan for a less costly option.

Would you be fine with a few restrictions on your health care? If yes, then Medicare Select is one Medigap policy that limits the number of healthcare providers you can see. The associated costs are lower than those with standard Medigap policies due to the fact that Medicare Select offers coverage for services at only at a limited number of hospitals.

In the end, the type of supplemental insurance you choose depends on your particular needs.