What Is Medigap & How Does It Work?

Original Medicare (Parts A & B) covers many of the costs associated with your healthcare. However, that’ doesn’t mean it covers everything. That’s where Medigap can help.

What Is Medigap?

Medigap, also known as Medicare Supplemental Insurance, is sold by private companies to help pay for some of the costs that aren’t covered under Original Medicare. Things like copays, coinsurance, and deductibles can be lowered (or fully covered) by a Medigap plan. These plans can be a useful compliment to Original Medicare.

There are 10 types of Medigap plans organized by letter: A, B, C, D, F, G, K, L, M, and N. Each plan letter is standardized, meaning all of the same plan letters have the same coverage. However, the coverage between plan letters will differ. For example, all Plan As have the same coverage and can only differ in the premiums. Plan As will have different coverage than Plan Bs, and they can also differ in premiums.

As a note, some plans (C & F) are only available to those eligible for Medicare on or before January 1, 2020. If you have or had comprehensive coverage before that date, you might still purchase these plans.

What Does Medigap Cover?

Medigap coverage varies by plan but can include:

• Part A coinsurance and hospital costs
• Part B coinsurance and copayments
• Blood (up to 3 pints)
• Part A hospice care coinsurance and copayments
• Skilled nursing facility care coinsurance
• Part A deductibles
• Part B deductible (only for Plans C & F)
• Part B excess charge
• Foreign travel exchange
• Out-of-pocket limit

Medigap generally does not cover items such as prescription drugs, long-term care, vision care, dental care, hearing aids, eyeglasses, or private-duty nursing. If you need this coverage in addition to a Medigap plan, you have the option of purchasing stand-alone plans like Medicare Part D prescription drug coverage and other additional coverage plans.

Who Is Eligible for Medigap?

If you are eligible for Medicare Part A and Part B, you are more than likely eligible for Medigap. You can enroll as soon as you have Original Medicare, or you can wait until later. If you choose to wait and buy a Medigap plan, a medical screening and physician’s statement might be required.

The best time to check your Medigap options is during your 6-month Medigap Open Enrollment Period (OEP), which begins the month your Part B starts and you’re 65 or older. This period allows you to enroll in guaranteed-issued coverage, meaning you won’t need a medical screening before purchasing a plan. Because there is no medical screening, you will likely get your best price available during your Medigap OEP.

What Is the Difference Between Medigap and Medicare Advantage?

Medicare Advantage and Medigap differ because they are opposite ends of the Medicare coverage spectrum. Medicare Advantage combines Original Medicare with additional coverage options and services, but Medigap works side by side with it. While Medicare Advantage is sometimes considered an all-in-one plan, Medigap is considered an optional addition to Medicare Parts A and B.

Medicare Advantage plans tend to work best for people who enjoy the convenience of getting all their medical coverage from one source, prefer potentially lower monthly premiums, and don’t mind using the plan’s network of doctors. Medigap plans offer enrollees the flexibility to visit any physicians or facilities they want as long as Medicare is accepted.

Important note: you cannot have a Medicare Advantage plan and a Medigap plan at the same time. If you choose one option and find that it doesn’t suit your needs, you can change your coverage during the Medicare Annual Enrollment Period.

Are You Searching for a Medigap Plan?

HealthMarkets has licensed insurance agents nationwide who can help you sort through your options so you can find a Medigap plan that’s right for you. Best of all, our help is available at no cost to you. Call an agent today at (800) 827-9990, or find a Medicare agent near you.