Standardized Medigap policies are sold by private insurance companies to help cover healthcare costs that Original Medicare doesn’t, such as copayments, coinsurance and deductibles. Many people like to buy this type of supplemental health insurance for added coverage — and this post will help you to determine if it’s right for you.
Medicare.gov lists several important things to know about Medigap health plans, including how you need to have Medicare Part A and Part B before you can purchase and benefit from Medigap insurance. If you choose to purchase a Medigap plan, you’ll pay a private insurance company that’s licensed in your state a monthly premium while also paying your Medicare Part B premium.
If you have Medigap health insurance, Medicare will pay approved amounts for covered costs, and then your Medigap policy will pay what it covers. Some Medigap health plans actually cover services that Medicare doesn’t — for example, needing services while traveling outside of the United States.
If you’re married, note that these standardized Medigap policies only cover one person. If both spouses want coverage, then each of you must purchase a policy. These policies are renewed, even if you have health issues, as long as you keep your monthly premium current.
What Medigap Policies Don’t Cover
In general, these policies don’t include vision care or dental benefits, meaning that they wouldn’t pay toward eyeglasses or hearing aids either. They typically don’t cover long-term care needs or private-duty nursing. Although some of these policies provided prescription drug coverage in the past, this is no longer permissible. If you want prescription drug coverage, you can participate in a Medicare Prescription Drug Plan, Part D.
Medigap Coverage Versus Medicare Advantage Plans
Yes, this can get confusing. To help, Investopedia provides clarification about Medicare coverage for Americans ages 65 and older:
- Medicare Part A provides hospital care
- Medicare Part B covers doctors visits, medical procedures and equipment
- Medicare Part C is also known as the Medicare Advantage Plan
- Medicare Part D provides prescription drug coverage
The Investopedia article also provides comparisons between Medigap and Medicare coverage, both of which help to protect you against incurring huge medical expenses; here are some highlights. First, it isn’t legal for an insurance company to sell you both of these policies.
- Medigap insurance plans:
- typically have a larger monthly premium
- often result in less that you need to pay out of pocket
- tend to be a better choice if you travel, as some plans cover all 50 states and sometimes travel abroad
- Medicare Advantage plans:
- usually cost less in monthly premiums
- typically cover more services, which ultimately may have a more positive effect on your budget
- generally limit facilities and doctors, typically not covering out-of-network visits
- are often only useable in a specific geographical area, which may not be a good choice if you travel
For more information about insurance plan coverages, you can read the rest of the article.
Choosing Medigap Coverage
First, you can find information about health coverage options in this government publication.
Next, note that monthly premiums vary, based on numerous factors including age, gender and geographic location. In some states, whether you smoke also plays a role in the premium.
According to Kaiser Health News, after you’ve enrolled in Medicare Part B, insurers must offer you a Medigap policy, no matter what health issues you may have, and this offer is good for six months. After that period lapses, if you haven’t purchased a Medigap policy, you can be excluded from coverage or be charged a greater amount because of your health status.
Times when you can still purchase a policy, despite health issues, include “if your Medicare Advantage plan withdraws from the area where you live or is found guilty of fraud; if you move out of your plan’s service area; or if your retiree health coverage is canceled by your former employer.” Some states provide even more times in which you can buy Medigap policies.
You can find helpful charts, answers to frequently asked questions and more at MyMedicareMatters.org.