What is Medigap?

What is Medigap? – Overview

Those who sign up for Medicare must surely have heard about Medigap. You must be wondering what is Medigap?

These are special insurance policies aimed to cover some out-of-pocket costs relating to your Medicare insurance plan.

You can choose from a variety of Medigap policies so it is imperative to do your research. Find the plan which suits you best, in terms of medical coverage and financial expenses.

In this article, we’ve explained Medigap, Medigap coverage, the cost of Medigap, and Medigap insurance plan prices.

What is Medigap Health Insurance?

What is Medigap – What is Medigap Health Insurance

Medigap is a supplemental insurance plan within Medicare. It is sold my private insurance carriers to help cover the original Medicare costs, such as copayments, deductibles and coinsurance.

Sometimes, Medigap also covers emergency medical charges if you need emergency medical care when traveling outside the United States.

Medigap insurance pays out only after both Medicare and you have paid your share of expenses for the medical services.

Today, you can choose from 10 Medigap plans – Plans A, B, C, D, F, G, K, L, M and N.

What is Covered Under Medigap Insurance Plans?

Most Medigap plans differ only in terms of coinsurance, copayments and miscellaneous medical fees that they cover.

However, the common aspects covered by all Medigap insurance plans include:

Medicare Part A (hospital fees and coinsurance)

Medicare Part A (copayment costs and hospice coinsurance)

Medicare Part B (copayment and coinsurance costs)

Blood transfusion costs (for the first 3 pints)

Medicare Part A deductible

Medicare Part B deductible

Medicare Part B excess charges

Skilled nursing facility costs

Emergency medical costs (during foreign travel)

Remember, Medigap and Medicare Advantage are two different insurance plans. Medicare Advantage offers coverage in addition to that provided by the original Medicare.

In contrast, Medigap plans are meant to pay the charges for coverage you qualify for.

Medigap insurance is supplemental insurance for those with original Medicare. It is not an additional insurance cover.

Though Medigap plans will cover some of the Medicare costs, the plan will not cover the cost of:

Hearing, dental or vision care
Health perks (transportation services, fitness memberships, etc.)
Prescription drugs

How much do Medigap insurance plans cost?

The specific costs associated with original Medicare and Medigap vary from plan to plan. Let’s check out the tentative cost of Medigap insurance cover:

Monthly Premium

Medigap policyholders still have to pay the original Medicare premiums, which include:

US$ 259 – US$ 471 per month for Medicare Part A

US$ 148.50 per month for Medicare Part B

Apart from these, you may also have to pay an additional premium for Medigap coverage.

Deductibles

It is important to meet your deductible amounts before seeking the benefits of Medicare Part A or Medigap insurance plans. The deductible amount for Medigap is around:

US$ 1,484 for Medicare Part A

US$ 203 for Medicare Part B

Several Medigap insurance plans may also pay for some (or all) of these deductible amounts.

Copayments and Coinsurance

Once you meet your deductibles, Medicare will pay its portion of the cost. Still, you may end up owing some coinsurance and copays fees, including:

Up to US$ 742 coinsurance per day (for Medicare Part A coverage)

Around 20% of the Medicare-approved amount (for items covered under Medicare Part B)

According to the specific Medigap policy, the copayment and coinsurance amounts are borne by your Medigap insurance plan.

Out-of-Pocket costs

Only Medigap K and Medigap L plans have restricted out-of-pocket costs. In contrast, Medicare Part A and Medicare Part B have a specific out-of-pocket limit.

If you buy Medigap that doesn’t cover Medicare fees you will still need to pay the out-of-pocket costs.

When to enroll in Medigap?

There are several enrollment periods for Medicare plans, but you can join Medigap only at certain times. These are the Medigap enrollment periods:

Initial enrollment period – You can apply for a Medicare plan, including the Medigap policy, in the first 3 months before, after, and during the month of your 65^th

Open enrollment period – In case you miss the initial enrollment period, you can still apply for a policy during the Medigap open enrollment period. If you are already 65 years of age, you can start by enrolling in Medicare Part B.

Insurance companies may not sell you a Medigap insurance plan if you are less than 65 years old. Make sure to apply for Medigap insurance during the initial and open enrollment period.

You may find it extremely difficult to find another way. Once you enroll in Medicare Part B, you can also apply for Medigap benefits.

Conclusion

Medigap insurance plans are supplement insurance options if you are enrolled in Original Medicare and looking for extra insurance coverage.

Once you enroll in a Medigap plan, it will provide coverage for certain costs, such as deductibles, coinsurance and copayments.

Still, you should be prepared to pay some out-of-pocket costs, even with Medigap insurance plans.

Shubham Grover

I am a dedicated healthcare researcher and an enthusiast specializing in medical grants, medical education and research. Through my articles, I aim to empower healthcare professionals and researchers with valuable insights and resources to navigate these critical aspects effectively.

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