What is Medigap ā Overview
Those who sign up for Medicare must surely have heard about Medigap. You must be wondering what Medigap is.
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 that best suits you in terms of medical coverage and financial expenses.
In this article, weāve explained Medigap, Medigap coverage, the cost of Medigap, and Medigap insurance plan prices.
What is Medigap Health Insurance
Medigap is a supplemental insurance plan to Medicare, sold by private insurance carriers, to help cover 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 Medicare and you have paid your share of expenses for the medical services.
As of 2021, there are 8 Medigap plans available for new enrollees ā Plans A, B, D, G, K, L, M, and N. Plans C and F are not available to new Medicare enrollees who became eligible after January 1, 2020.
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 is an alternative to Original Medicare, providing coverage through private insurance companies and includes all Part A and B benefits.
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, designed to fill gaps in Original Medicare coverage.
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. Letās check out the tentative cost of Medigap insurance cover:
Monthly Premium
Medigap policyholders still have to pay the original Medicare premiums, which include:
- Most people do not pay a monthly premium for Medicare Part A if they have worked and paid Medicare taxes for a certain amount of time.
- The standard monthly premium for Medicare Part B is subject to change annually. For the most current rates, refer to the official Medicare website.
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.
- Plan C and Plan F cover both Part A and Part B deductibles. However, as of January 1, 2020, Plans C and F are unavailable to new Medicare enrollees who became eligible for Medicare on or after this date.
- Plan D and Plan G cover the Part A but not the Part B deductible.
- Plans K, L, M, and N offer partial or no coverage for the Part A deductible and do not cover the Part B deductible.
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 copay 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, your Medigap insurance plan bears the copayment and coinsurance amounts.
Out-of-Pocket costs
Medigap Plans K and L have annual out-of-pocket limits. Medicare Part A and Part B do not have an out-of-pocket limit, so many choose Medigap for additional coverage.
If you buy Medigap that doesnāt 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 ā You can apply for a Medicare plan, including the Medigap policy, in the first 3 months before, after, and during the month of your 65th
Open enrollment period ā 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, you can start by enrolling in Medicare Part B.
Some states require insurance companies to sell Medigap policies to people under 65 eligible for Medicare due to disability or certain conditions. 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 for people enrolled in Original Medicare who are looking for extra 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.
See Also
Does Medicare Pay for Nursing Homes
Does Medicare Cover Home Healthcare
Federal Home Care and Family Support
Dental Insurance for Senior Citizens
