What To Know About Medigap Policies


Medicare is one of the most robust insurance programs available to seniors. Medicare is divided into four separate categories, each intended to provide different coverage. While you can get the majority of your healthcare needs covered by Medicare, there are some gaps in the program, even if you invest in multiple plans. Medigap, also known as Medicare Supplement Health Insurance was created to provide coverage for any areas not covered under the original Medicare plan. Unlike the common Medicare plans, Medigap policies are offered through private insurance companies.

Medigap is also considered a separate program from Medicare. This means both programs use their own premiums, deductibles and copays. You are required to have either Medicare Part A or B to qualify for a Medigap plan. In addition, Medigap plans only apply to individuals and cannot be shared among family members.

Different Medigap Plans

Like Medicare, Medigap is divided into separate plans, known as parts. There are many more parts for Medigap than Medicare. Medigap has the traditional Parts A-D, but there are also plans for F, G, K, L, M and N. Many of these plans offer the same level of coverage, with only minor differences. For example, all of the plans cover general hospital costs once your Medicare Part A benefits are used up. Not all states offer each Medigap plan. The federal government has an online search tool you can use to find what Medigap policies are available in your state.

Reasons to Purchase Medigap Insurance

There are four primary ways Medigap insurance helps you. The biggest reason seniors choose to use Medigap is it can eliminate the majority of out of pocket expenses associated with Medicare Parts A and B. With a basic Medicare plan, you are normally required to pay out of pocket for any costs after the initial deductible. Once you are done with your Medicare deductible, Medigap insurance kicks in and covers a large portion of coinsurance or copayments you owe.

Medigap also has benefits for long-term care. Normal Medicare coverage only provides a limited number of days you are allowed to stay in a hospital or skilled nursing facility. In more severe cases, such as recovering from surgery or needing rehabilitation services after a bad fall, you quickly burn through your Medicare coverage. You are responsible for paying the rest of these expenses out of pocket. This is especially difficult for seniors, since these services are often quite expensive. Medigap offers additional time in these facilities, and also provides extra coverage for hospice care.

All the Medigap plans provide hospice care assistance, but Parts A and B do not have coverage for skilled nursing facilities. Additionally, for both hospice and skilled nursing care, Parts K and L only cover 50 and 75 percent of the costs respectively.

If you plan on traveling after you retire, Medigap is important to have. Medicare coverage does not extend to overseas visits, but there are several Medigap plans specifically for traveling outside of the United States. Parts C, D, F, G, M and N all cover 80% of your medical expenses when you travel to a foreign country.

Finally, Medigap policies are accepted by most doctors, hospitals and medical specialists. Normally, if you want additional coverage outside of Medicare, you must purchase a private plan, which only applies to a select number of doctors. In most cases, if Medicare insurance is accepted, Medigap policies are also acceptable, so do you do not have to look around for a new doctor.

When to Enroll in Medigap Coverage

Buying Medigap is more complicated than buying Medicare. Both of the plans use the same open enrollment period, which begins on October 15th and extends to December 7th. You can also apply during the general enrollment period, which starts January 1st and goes until March 31st.

However, the rules are different outside of your first open enrollment period. When you are about to turn 65, you are presented your first opportunity to buy Medicare and Medigap insurance. You cannot be denied Medigap insurance based on preexisting health conditions or other issues. After the initial enrollment period, private insurance companies are not required to sell you Medigap insurance. Many companies also increase the price if you purchase Medigap insurance outside of your first open enrollment period.

Recommended Insurance Companies

There are several large private insurance companies selling Medigap coverage across the United States. The exact prices vary depending on where you are applying as well as your medical history. The type of plan also influences the price. Because Medigap plans are more customizable, you have an easier time selecting a plan that covers policies specifically for your health needs. For example, if you do not plan on traveling outside of the United States, you can ignore plans offering those options.

Some of the top 2020 insurance companies offering Medigap insurance plans include: