What is Medigap?
Medigap is additional private medical insurance that covers the “gaps” in your current Medicare plan. Medigap helps to pay for deductibles, co-payments, and some plans also cover unexpected health costs that may arise if you travel out of the country.
Why do you need it?
Although not an essential part of insurance, Medigap helps cover costs that you may not be able to afford otherwise with a limited income and helps alleviate the costs of a hospital stay or co-payments.
What benefits are offered under Medigap?
Depending on which plan you select benefits can include: co-insurance, co-payments, hospital costs (after Medicare benefits are paid), blood, hospice care co-insurance or co-payments, skilled nursing facility care co-insurance, deductibles, excess charges, and travel-related health costs.
All insurance companies are required to offer Medigap A but may also offer other plans as well.
The below are the basic benefits that Medigap must cover:
- Part A Hospital Coinsurance
a. Medicare pays up to 60 days only once; Medigap is required to cover days 61-90 of a Medicare benefit period and days 91-150 of a hospital stay.
b. Additional 365 days of inpatient hospital care are also included after Medicare hospital benefits have been utilized.
- Part B Coinsurance
a. Medigap may cover part or all of your coinsurance after your yearly deductible is met.
- Medigap will cover some or all of the first three pints of blood each calendar year.
- Medigap will cover some or all of your hospice coinsurance after your Medicare Part A benefit is utilized.
- Some prescriptions are also covered if they are approved on the “Medicare covered” Part B list.
How do you get a Medigap plan?
In order to apply for a Medigap plan, you must already be enrolled in Medicare Part A and Medicare Part B. You may also apply for Medigap if you have a Medicare Advantage Plan; however, you must leave the Medicare Advantage Plan before your Medigap policy begins.
Who pays for Medigap?
Medigap plans are paid by you, the individual, to the private insurance company that is covering your Medigap plan. This monthly premium is different from the monthly Medicare Part B plan and must be paid separately.
Who is covered by Medigap?
You must buy individual policies for Medigap. Couples who wish to apply for Medigap must apply separately.
How do you compare the different Medigap policies?
Medicare.gov has an excellent comparison chart that highlights the differences in plan information and can help guide you in selecting the Medigap policy that fits your exact needs.
What is not included in Medigap?
Long-term care, dental, vision, hearing aids, eyeglasses, and private on-call nursing are not typically included in Medigap plans.
Where can you buy Medigap?
Since Medigap is offered by private insurance companies you may select a plan from your insurance provider who is licensed to sell this policy in your state. Be wary of scams and frauds by going directly to the Medicare government website.
Medigap can be an excellent crutch for unexpected life events and can help protect you and your loved one financially.
A great resource that you may download to help you in selecting and purchasing Medigap may be found here.
For more information on finding the plan that’s right for you, speak with your current insurance company or call Medicare directly at: 1-800-MEDICARE (633- 4227). This Medicare line is open 24 hours a day, seven days a week.
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