Medicare Supplement Plans: Discussing Medigap

As now understood, Medicare pays for a lot of health care services, however there are still many it does not cover. The Traditional Medicare Plan does not provide 100% coverage for medical expenses such as deductibles, co-payments, and co-insurance. For this reason, Medigap was designed to help pay the costs that Medicare does not cover. Medigap is also referred to as ‘Medicare Supplement Plans.’

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Medigap is additional health care insurance provided by private insurance companies to cover the gaps in the Medicare Plan. Medigap policies are regulated by Federal and State Laws in order to protect you as a beneficiary. Medigap policies have to be clearly labeled as “Medicare Supplement Insurance”, and the policies are standardized for each State.

Medigap coverage works only in conjunction with a Medicare Plan. Typically, you must have Medicare Part A and Part B in order to be eligible for Medigap. Acceptance of your application is guaranteed if you are 65 or older and apply within six (6) months of your initial enrollment in Plan B of Medicare. Under certain circumstances pre-existing conditions might be waived. As Medigap policies only cover one person per policy you and your spouse must each purchase separate policies.

In some states, you may be able to select from up to 12 different standardized policies (Medigap Plans A through L). Each plan offers a different set of basic and additional benefits and is the same for every insurance company. Each Insurance company can decide which policies they want to sell and set their own prices, so research carefully in order not to overpay.

If you have a Medigap plan in addition to your red, white, and blue Medicare card, this Original Medicare is your primary coverage. They pay your medical bills first. Then, your Medicare Supplement Insurance will pay the gaps that Medicare doesn’t pay for. And voila! If you have Original Medicare and a good Medicare Supplemental Plan, you now have complete, comprehensive coverage with little or no out of pocket expenses.

Medigap policies no longer cover prescription drugs. You cannot have both Medicare Part D and Medigap drug coverage at the same time. If you have a Medicare Prescription Drug Plan (Part D) and a Medigap policy that covers drugs, then you need to tell your Medigap insurance provider to remove the drug coverage from your policy. In essence, the aim is to ensure a total coverage for every senior.