Medicare Medigap Insurance
Medigap is extra health insurance the help pay for some costs not covered by Original Medicare Part A and Part B. You buy Medigap coverage from a private insurance company to pay costs such as copayments and deductibles. You pay a monthly premium for a Medigap policy.

Two requirements to getting Medigap is having Medicare Part A and Medicare Part B. Medicare Part A helps pay for hospital services while Medicare Part B covers the cost for doctor services.

Also, people who have a Medicare Advantage plan (medicare Part C) cannot get a Medigap plan.

Types of Medigap Insurance

There are currently 10 standardized Medigap plans as well as one high-deductible plan available in most states. Each plan is named with a letter. There is: Plan A, B, C, D, F, G, K, L, M, N, and a high-deductible version of Plan F. Picking the right plan for you can take a lot of research.

Medicare Part A costs covered by Medigap policies

  • The cost of hospital coinsurance for up to a year after your Medicare Part A hospital benefits end
  • Medicare supplement plans also cover Part B coinsurance / copayments
  • 50-100% of Skilled nursing facility stay coinsurance.
  • Medigap plans might cover up to 50-100% of your hospice care coinsurance/copayment
  • Medigap plans can cover up to 50-100% of the Medicare Part A deductible costs.

Medicare Part B costs covered by Medigap policies

  • 50-100% of your Medicare Part B copay/coinsurance can be covered by Medigap.
  • Medigap Plan C and Plan F are the only plans that help pay for Medicare Part B deductible
  • Plan F and Plan G Medigap policies cover the Medicare Part B excess charges.

Foreign travel

Medigap Plans C, D, F, G, N, or M provide coverage if you go abroad.

Things not covered by Medigap policies

Long-term care (care in a nursing home)

  • Routine vision or dental care
  • Hearing aids
  • Eyeglasses
  • Private-duty nursing

When you buy a Medigap plan, you get your benefits from Original Medicare (Part A and Part B), and the Medigap plan covers the out-of-pocket costs associated with Original Medicare benefits.

When you are part of a Medicare Advantage (Part C) plan, you get your benefits from that plan instead of the federal Medicare program. These plans must provide at least the same amount of coverage as Original Medicare (Part A and Part B), but may offer additional benefits.

Medigap Pros and Cons

If you have Medigap insurance you are able to visit any provider that allows Original Medicare patients. Medigap policies may have low monthly premiums, additional benefits like dental or vision, doctor supervision, and are available to all entitled individuals.

The benefits of a Medicare Supplement plan can include

  • Minimal to no cost for Medicare-covered services, depending on the plan
  • Freedom to use the plan nationwide (except for Medicare SELECT plans)
  • No medical underwriting if the plan is purchased during the Medigap Open Enrollment Period.

The Disadvantages of a Medicare Supplement plan can include

  • Drug coverage isn’t included, but you can add this through a separate Medicare Part D plan.
  • Medical underwriting can be required, except during the Medigap Open Enrollment Period, with some exceptions.
  • Depending on the state, plan choices may be limited and more expensive for individuals under 65

Medicare Advantage (Part C) Pros and Cons

These plans must provide at least the same amount of coverage as Original Medicare (Part A and Part B), but may offer additional benefits. Plan benefits and pricing vary widely.

The Advantages of a Medicare Supplement plan can include

  • Drug coverage is included with most of these plans
  • Managed care, such as supervision of doctors by the plan, possible case management, sometimes a 24-hour nurse hotline
  • Availability to all individuals entitled to Medicare Part A and enrolled in Medicare Part B who reside within the service area.
  • Possible additional benefits, such as routine dental and vision, and health club membership

The Disadvantages of a Medicare Supplement plan can include

  • Cost sharing and copayments for most many services
  • Physician network restrictions
  • Possible geographic restrictions
  • Possible requirement of referrals for specialist visits

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