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.
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.
Aside from capping out-of-pocket expenses, a Medigap policy can also cover all or part of some other costs:
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:
|Plan C Coverage
|Plan G Coverage
|Part A coinsurance and hospital costs
|Medicare Part B coinsurance/copayment
|Blood (first 3 pints)
|Part A hospice care coinsurance/copayment
|Skilled nursing facility care coinsurance
|Part A deductible
|Part B deductible
|Part B excess charges
|Foreign travel emergency care
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.
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.)
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.
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.
Information sources are:
It’s essential to confirm you’re comparing the same type of policies.
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 Living50+.
Are you insured by Medigap? Which plan have you purchased? Are you happy with it, or will you try a different plan?