A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.
Below is a list of a few basic facts about Medigap. For further and more in-depth information, call 800-331-9221 and we’d be happy to assist you directly.
- What Medigap Policies cover
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit and you may pay the rest.
* Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything.
**For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015), the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits
and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
- What Medigap Policies don't cover
Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing.
(Limited vision coverage is provided for medical conditions such as cataracts, glaucoma, and macular degeneration, etc.)
- Types of coverage that are NOT Medigap policies
• Medicare Advantage Plans (Part C), like an HMO, PPO, or
Private Fee-for-Service Plan
• Medicare Prescription Drug Plans (Part D)
• Employer or union plans, including the Federal Employees Health
Benefits Program (FEHBP)
• Veterans’ benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans
• Qualified Health Plans sold in the Health Insurance Marketplace
A Medigap/Medicare Supplement policy is guaranteed renewable as long as you pay your premiums.
You cannot have both a Medigap/Medicare Supplement policy and a Medicare Advantage plan at the same time. If you drop a Medicare Supplement policy to join a Medicare Advantage plan, you may not be able to get your Medicare Supplement back.
Since each case is unique, we recommend that you call us directly at 800-331-9221 so that we can discuss your best options and help you make the right decisions.
Note: Medicare doesn’t pay any of your costs for a Medigap policy. All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.
Information above was taken from 2016 Choosing A Medigap Policy: A Guide to Health Insurance for People with Medicare, the official government booklet regarding Medigap policy.