Medigap Plans – Filling in the Gaps in Medicare

Medigap Plans – Medicare as we know it is one of the largest insurance companies in United States. However, we also know about Medigap supplement Plans that they pay for only about half of the medical costs for American senior citizens.

The solution? Medigap Plans. Yes, Medigap Plans offer to “fill the gaps” and pay much of the balance that is not covered by Medicare.

Medigap Plans are available in ten tiers, starting from Part A and ending in Part N. Parts E, H, I and J are no longer sold, however if you already have any of these plans, you can keep it. The idea of the different tiers is that each letter or category has a varied combination of benefits, which allows you to choose the best tiered plan for your individual needs. It is important to remember that the more Medigap coverage you purchase, the higher your premiums will be.

Every Medigap Plan will provide the following core benefits:

  • Co-insurance for days 61 to 90 of a hospital stay
  • Co-insurance for days 91 to 150 of a hospital stay
  • Hospital approved costs from day 151 to day 365

Location matters

Basic plan coverage is built into most states. However certain states are limited with benefit lists. States such as Wisconsin, Massachusetts and Minnesota all have varied types of Medigap plans available. This can be checked online by simply entering in your zip code when retrieving a quote. This effective and user-friendly tool allows you to check:

  • Which plans are offered in your state
  • Which insurers fall in your state
  • If the plans offered are to persons over 65 or under 65 with disabilities
  • Pricing plans

Medigap Plans do not fill in all the gaps

It is vital to note that Medigap Plans are not there to fill in every single Medicare gap. For example, custodial care in a nursing facility is not covered. In order to gain this benefit, you will have to purchase long-term insurance. Other elements not covered include vision care, hearing aids and dental care. It is advisable to chat to your insurance company to be clear of what is not covered. Remember to also consult your insurance agent on prescription drugs, as these are no longer covered in the Medigap Plan. However, there is the Medicare drug program that is available for prescribed drug cover.

We can help you and you can visit the Center of Medicare Advocacy for more information on the Medigap Plan and how it can benefit your individual needs.

Medigap versus Medicare – Is there a Difference?

We often hear these two words in one conversation and more often than not, it can be rather confusing. When you have Medicare, what does this cover? Does this help with paying for prescription drugs or hospital stays? What about emergencies?

The questions can get quite diluted and draining. So here are the main differences in Medigap Plans and Medicare:

Medicare consists of four parts namely:

  • Part A – hospital insurance
  • Part B – health insurance
  • Part C – Medicare Advantage
  • Part D – prescription drugs (for those who do not purchase Medicare Advantage)

Medigap on the other hand, is a private health insurance and assists with helping you pay for what the traditional Medicare policy isn’t covering. This includes elements like co-payments at a doctor’s office and co-insurance at skilled nursing facilities.

Medigap plans are varied into ten types and named according to the letter of the alphabet e.g. Part A. Premium prices vary depending on benefits offered as well as the insurance provider. Premiums are also set out separately to your normal Medicare premiums.

How to get the Medigap Plan?

You have to already have Medicare Part A and Part B in order to qualify for the Medigap Plan. This is the main link between these two plans. Medigap Plans are renewable, even if you develop health issues, provided that your monthly premiums are paid. Pricing also varies depending on your age and location. It is also vital to know that Medigap Plans are purely for the individual, so if your spouse needs a plan he/she will have to get a separate Medigap Plan.

What is the biggest advantage to getting a Medigap Plan?

You have a large network of insurance providers to choose from. With a decent premium price, especially if you already have a health problem, Medigap Plan is a wiser choice as you save a great sum of money in the long run. This is especially true if you require extensive medical care.

Like any other insurance policy, the Medigap Plan will have large amounts of paperwork to read through. So before getting a Medigap Plan, chat to your friends, family and neighbors about what benefits mean a lot to them and what to ask your broker when signing up. Remember, you have 6 months after you turn 65 to sign up for the Medigap Plan. Take the plunge and explore this policy for your future benefit.


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