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Medigap – Plugging Holes in Original Medicare

By Peter Keers December 25, 2022 Health and Fitness

As I mentioned in my earlier Sixty and Me blogs, Original Medicare (Part A and Part B ) covers most costs for hospital and doctor fees. However, there are some “gaps.” Most importantly, under Original Medicare, there are no limits on out-of-pocket expenses from copayments and coinsurance.

Medigap Fills In

A popular way to cover the gaps is through a Medicare Supplement Insurance policy (a.k.a. “Medigap.”) Sold by private insurers, Medigap policies come in various versions specified by rigorous government requirements.

Medigap Coverage

Aside from capping out-of-pocket expenses, a Medigap policy can also cover all or part of some other costs:

  • Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance or copayment
  • Blood (first 3 pints)
  • Part A hospice care coinsurance or copayment
  • Skilled nursing facility care coinsurance (for limited stay, not long-term care)
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergency care

However, Medigap plans typically don’t pay for things like vision or dental services, or hearing aids.

Medigap policies are categorized by letter (A-D, F, G, and K-N.) Each type offers differing coverage and levels of coverage. The table below shows coverage differences between Medigap plan C and plan G:

BenefitsPlan C CoveragePlan G Coverage
Part A coinsurance and hospital costs100%100%
Medicare Part B coinsurance/copayment100%100%
Blood (first 3 pints)100%100%
Part A hospice care coinsurance/copayment100%100%
Skilled nursing facility care coinsurance100%100%
Part A deductible100%100%
Part B deductible100%No coverage
Part B excess chargesNo coverage100%
Foreign travel emergency care80%80%

Plans differ from state to state in terms of price and companies offering policies. Also, Massachusetts, Minnesota and Wisconsin handle Medigap policies differently. More information can be found in the Medicare publication Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

The Medigap Process

When a supplemental Medigap policy piggybacks on Original Medicare, Medicare will first pay its part of covered costs. After that, the Medigap policy pays all or a portion of the rest, depending on the type of policy purchased.

Medigap only supplements Original Medicare. Those with Medicare Advantage plans cannot also have Medigap coverage. (I’ll cover Medicare Advantage plans in another Sixty and Me blog.)

How to Buy a Medigap Policy

Buying a Medigap policy takes four steps and must occur during the Medigap Open Enrollment Period. This period extends six months, beginning when a person turns 65 and is enrolled in Medicare Part B. Buying Medigap coverage may not be possible outside this period and may cost more if it is.

First Step: Choose the Type of Medigap Coverage

Official Medicare publications or conducting web research will yield helpful information. Also, calling 1‑800‑MEDICARE (1-800-633-4227) will provide information on coverage options. Health insurance brokers can also offer assistance in understanding Medigap options.

Second Step: Identify Insurers Who Offer Your Chosen Type of Medigap Policy

Information sources are:

  • The Medicare website
  • State Health Insurance Assistance Program (SHIP)
  • State Insurance Department (Ask about complaints against companies selling Medigap in the state so you can avoid those insurers.)
  • Online research
  • Recommendations from trusted family, friends or advisors

Third Step: Obtain Quotes and Compare Policies

It’s essential to confirm you’re comparing the same type of policies.

Fourth Step: Make Your Purchase Within the Six-Month Medigap Open Enrollment Period

Don’t forget that in addition to your Medigap policy premium, you will still need to pay your Medicare Part B premium and, if applicable, your Medicare Part D (optional drug coverage) premium.

You can learn more about Medigap by visiting the Medicare website or downloading the latest Medicare and Me handbook. Also, look for my future blog posts on Sixty and Me for more valuable Medicare information. For an even deeper dive, check out my Medicare eBook at Cantissimo Senior Living.

Let’s Have a Conversation:

Are you insured by Medigap? Which plan have you purchased? Are you happy with it, or will you try a different plan?

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Carla

My husband is on a Medicare Advantage Plan and all is good…although, from so many sites I see people saying to never go on an Advantage Plan. I am still a couple years away from getting Medicare. —- There has to be a better way than read, study and compare what plan will be the right one for you! We can be healthy and active today and next month need a hip replacement, get hurt from a fall, develop a serious illness, or whatever and that plan will not be the right plan. Medicare, Medigap, Medicare Advantage…..Ugh – this is sad that there isn’t a plan that takes care of all of us — this pick and choose and hope that everything will work out for us is crazy!…..As ironic as it is looking for a health care plan makes me sick!

Last edited 1 month ago by Carla
jen

I am lucky to live in Australia—with free (public) health insurance. It is straight-forward, easy to use, & if you prefer to be treated as a private patient, you can pay (thousands of dollars a year) for private health insurance.🇦🇺

Linda

I am very happy with my Traditional Medicare and a Medigap supplement. I advised my 3 younger siblings to get the same policy I have, and they also have been very happy. I have no deductible and no co-pay. I would strongly advise against any Medicare Advantage plan as there are numerous complaints surrounding it. Stick with traditional Medicare plus a medigap co-pay. People think hey will save using Medicare Advantage but they are wrong. You must do your homework when turning 65.

karen

My brain glazes over when I read about/try to figure out health insurances and all the many variations thereof. It literally makes my head spin. I inevitably think about all the countries that have this covered for their citizens. What a relief that must be and a huge burden lifted off an older persons shoulders, after a lifetime of work, paying into a system that then skims off a considerable amount for Medicare. Doctors offices then charge huge amounts in order to make up for what Medicare will not cover. “The richest country in the world” needs to do better.

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The Author

Peter Keers is a writer and video blogger focusing on topics for the over-55 audience. Defining himself as a curious seeker, Peter’s interests range across both the art and the science of living an authentic and fulfilling life in the 21st century. See Peter’s recent posts at www.cantissimoseniorliving.com and www.concisioncomm.com. He can be contacted at peter@cantissiomoseniorliving.com.

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