What Is Medigap – Medicare Supplemental Insurance?

If you have Medicare health insurance, but the original policy doesn’t cover everything you need it to, there are ways to make sure you can still afford extra health insurance to make up for gaps in your coverage. Medigap is a kind of private insurance that can supplement your Medicare coverage if you need it.

Medigap, or supplemental Medicare, is an extra amount of insurance that can be purchased if you need insurance coverage. It covers the gaps in your coverage if you have an original Medicare policy. It is a private insurance policy that can help with co-pays, your health insurance deductibles, and additional health care costs, especially if you are traveling outside of the United States.

Medigap details

Medigap health insurance plans come in plans labeled A through N. All the health plans offer different levels of coverage, so you can make sure your preferred plan fills in coverage holes in your main insurance before you make a decision. People who want a Medigap policy pay a monthly premium, which varies depending on what insurance company you buy your policy from.

No matter what insurance company you purchase Medigap from, each plan remains the same. However, the standard plans do differ in Massachusetts, Wisconsin, and Minnesota. If you think you qualify for Medigap, you can enroll for the program six months after the start of the month of your 65th birthday, or six months after you sign up for a Medicare Part B health insurance plan. If you choose to enroll outside of this six-month period, your rates may increase, and you may have difficulty purchasing an insurance plan.

People with pre-existing health conditions may have to wait up to six months for their Medigap coverage to come into effect. After this six-month period, your insurance agency cannot refuse claims for care for a pre-existing condition. If you have continued health coverage for a pre-existing condition and apply for Medigap, that insurance agency will likely honor your pre-existing condition with insurance coverage.

Medicare Supplement – Medigap Plan Comparison Chart

The chart below provides a summary regarding each type of Medigap Plan, ranging from Plan A to Plan N. Note that if a cell says “yes”, this indicates that the Medigap policy covers a percentage of the benefit. If the cell says “no”, it means that the Medicare supplement policy does not cover that particular benefit.

Medigap Benefits Medigap Plans for Most States
A B C D * G K L M N
Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Medicare Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes**
First three pints of blood Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Medicare Part A hospice coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes
Skilled Nursing Facility (SNF) coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes
Medicare Part A Deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes
Medicare Part B Deductible No No Yes No Yes No No No No No
Medicare Part B Excess Charges No No No No Yes Yes No No No No
Foreign Travel Emergency (Up to Plan Limits) No No 80% 80% 80% 80% No No 80% 80%
Out-of-Pocket Limit*** None None None None None None $4,940 $2,480 None None

Quick notes from Medicare.com (also the source of the chart):

  • *Plan F is also available in a high-deductible version. With the high-deductible Plan F, you pay for all Medicare-covered costs until you reach the deductible of $2,180 in 2016 before your Medigap plan pays anything.
  • **Plan N pays 100% of the Medicare Part B coinsurance. There are a few exceptions: Certain office visits may require a copayment of up to $20; and emergency room visits that don’t result in your being admitted as an inpatient may require a copayment of up to $50.
  • ***Once you have reached the annual out-of-pocket spending limit and your Medicare Part B deductible, your Medigap plan pays 100% for Medicare-covered costs for the remainder of the calendar year.

The benefits of Medigap

Medigap is an insurance policy that can benefit people who currently have Medicare Part A and Medicare Part B. Those two Medicare policies help you cover hospital services and doctor services. If you are having difficulty with co-pays, co-insurance, or other health care needs, getting a supplemental Medigap policy could be helpful for filling your coverage gaps and helping you financially with the cost of your health care.

If you want to check to see if you qualify for a Medigap insurance policy, you can go online to the Medicare website or contact your individual state’s department of insurance. Take a look at your existing insurance plan, what you are paying, and see where improvements could be made in your overall health insurance coverage.

Your Medigap plan is renewable as long as you have paid your premiums on time. These plans can be used to help pay Medicare co-pays, co-insurance costs, and other services. Make sure you shop around to see what each insurance company is offering you, as premiums can vary depending on your location, age, general health, and other factors.

What Medigap doesn’t cover

Medigap is supplemental to your main insurance policy, which means health care like dental, vision, hearing, and other services won’t be covered. Medigap isn’t a comprehensive medical insurance policy, but it can be very helpful for adding a little extra protection where you need it the most. Additionally, most Medigap policies don’t cover the costs of prescription medications. Individuals who have a Medicare Advantage plan do not qualify for Medigap insurance coverage.

Some Medigap coverage plans are no longer available for people looking to sign up for Medigap. However, you can keep those plans if you have been enrolled with them previously. Some of these plans do cover prescription medications and will continue to do so if you are enrolled in that Medigap insurance policy.

Choosing your Medigap coverage

If you are struggling to pay for your co-pays, hospital visits or other health care needs you have, supplementing your existing Medicare insurance with Medigap may be a beneficial option for you. Each plan gives you different benefits and has varying costs associated with it, so make sure you know what you can afford and what kind of coverage you are looking for while you are looking at your options.

Medicare policyholders may be able to benefit greatly from an additional, supplemental insurance policy like Medigap. Visit their website today or call your state insurance representative with any questions you may have about how Medigap can affect your health insurance coverage.