What Is Medigap Insurance?

What Is Medigap Insurance

What Is Medigap Insurance? A Medigap insurance policy is also known as a Medicare Supplement Plan. Medigap policies are offered by private insurance companies and they are designed to pay for costs NOT covered by Original Medicare.

Depending on which plan you get, they can cover some of your co-payments, coinsurance, deductibles and they even offer coverage when you travel outside the U.S.

Understanding Medigap Insurance

Original Medicare will not cover all expenses when you go to the doctor or hospital. Under Original Medicare, you would pay 20% of the cost of approved Par B expenses regardless of the amount. You are also responsible for $1408 if admitted to a hospital.

If you buy a Medigap policy, it would cover all or a portion of those extra charges depending on the plan you choose. 

There are 10 standardized Medicare Supplement Insurance (Medigap) plans that are available. These plans are labeled Plan A, B, C, D, F, G, K, L, M and N

What Is Medigap Insurance Plan Chart

Please don’t let that confuse you, most of these plans are not available in all areas or they are plans that you would never want to buy anyway. When you are looking at the chart, if you see a check-mark in a box that means that the Medigap plan covers that gab left behind by Medicare.

However, for those who become newly eligible for Medicare in 2020 and after, plans C, F, and F-High Deductible will no longer be offered. That’s because these plans cover the Medicare Part B deductible. In 2015 Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), which became affective on Jan 1st 2020. That law says that matter what plan you choose, you will have to pay the $197 Part B yearly deductible. 

Are you Confused? Don’t worry I’ll make simple coming up. 

What Medigap Covers

You have to pay a private insurance company a monthly premium for your Medigap policy. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies

Any standardized Medigap policy is guaranteed renewable, even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.

Some Medigap policies sold in the past cover prescription drugs. However, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

Medigap policies are NOT stand alone insurance plans, they work with Original Medicare. So if Original Medicare does not pay for it neither will your Medigap policy. 

When you go to your doctor or hospital, they will send the bill to Medicare. If Medicare approves it, they will pay there portion of it. Then if you have a Medigap policy they will send it to them. 

Original Medicare does NOT cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

When Can You Buy A Medigap Policy?

The best time to buy a Medigap policy is during your six-month Medigap open enrollment period

During that time you can buy any Medigap policy sold in your area, even if you have health problems, the insurance company is not allowed to ask you any health questions. This period automatically starts the month you’re 65 and are enrolled in Medicare Part B

After this enrollment period ends, you may NOT be able to buy a Medigap policy if you can’t pass the medical underwriting requirements of that insurance company. 

If you are past your six month enrollment period but you are interested in a Medigap Policy, I can still help you. Together we can go over some of the medical questions to see if we can get you qualified. You can Click Here to schedule a time with me. 

Which Policy Should You Buy?

From my years of doing this everyday day, I can tell you that most people only need to look at plan G, High Deductible G or N.  

Plan G: This policy will cover everything just not the Part B yearly deducible. The average price for G in my area (Tampa Bay area in FL) is between $150 and $225 per month. 

High Deductible G: This policy is perfect for people who do not use doctors and hospital that often. You get a low monthly premium in exchange for that you have to pay the first $2340. This is a great way to have protection if something bad happens but if nothing happens you safe a lot of money. 

Plan N: This plan is the middle of G & High G. Your monthly rate will be somewhere between $100 to $150. Again that’s in my area, your area might be completely different rate. With Plan N you will have to pay a $20 co-payment for office visits and up to $50 for emergency room visits. 

You are also responsible for the Part B excess charges but to avoid those all you have to ask your doctor is if they accept Medicare payment as full payment. 

My Rates Are Going Up!

If you already have a Medigap Policy (Medicare Supplement Plan) and your have had a rate increase, it might be time for a review to see if you qualify for a policy with a lower rate. You have no idea how many people I talk to who are overpaying. 

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