What is Medigap?

what is medigap

There is Medicare, Medicare Advantage, and then there is Medigap. What is Medigap? How does it compare to other coverage? Is it the same? Is it for you?

The answer is that Medigap is separate from both Original Medicare and from Medicare Advantage plans. Medigap is a different group of Medicare Supplement Insurance plans — with its own systems and guidelines.

So What Is Medigap Insurance?

Medigap covers costs not covered in original Medicare: copayments, coinsurance, and deductibles. It does not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty and nursing. Medigap also does not cover prescription drugs, unless you have a policy issued before January 1, 2006, when the regulation changed.

Medigap has a number of plans: A, B, C, D, F, G, K, L or M. Each offers different coverage.

How It Works

When you incur a healthcare cost for service, traditional Medicare will first pay the approved amount as long as the service is covered. Then, Medigap will pay its share. Its job is to supplement your traditional Medicare benefits.

Enrolling In Medigap

You must already have Medicare Part A and Part B in order to enroll in Medigap. The open enrollment period is from the first day of the month you turn 65 for six months. You cannot be refused enrollment because of prior health issues and you cannot be canceled as long as you pay your premium.

A Medigap premium is separate from the one you pay for Medicare Part B. Each policy covers one person only. If a husband and wife want coverage, they would have to have two policies.

Medicare Advantage may offer similar coverage to Medigap but companies offer their own portfolio of services based on their own decisions. Medigap is sold by private companies as well, but these companies are required to offer a standardized list of basic services. Three states, Massachusetts, Minnesota, and Wisconsin, have a different Medigap system from the other states. (We will cover this in the next blog.)

Planning to Switch?

If you plan to switch from a Medicare Advantage plan to Medigap – you can’t have both – you must be sure to leave Medicare Advantage before the Medigap policy begins.

We will look into the alphabet of Medigap plans next time to help you understand the benefits of each. We will also explain how Massachusetts, Minnesota, and Wisconsin plans are different from the rest of the country.


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