What Is Medigap and When Is It Right for the Medicare Senior?

What Is Medigap and When Is It Right for the Medicare Senior?

A look at Medigap and its coverage, how it works, and why Medicare seniors should supplement Original Medicare.

You’ve decided to go on Medicare – congratulations! You’ll join more than 55 million Americans on what many of them claim  is the best health insurance they’ve ever had. So, you call Social Security and sign up for Medicare Parts A and B. But then you discover that A and B don’t pay all your hospital and doctor bills; they provide you only partial coverage and leave some big gaps in those bills for you to pay.

Some of Original Medicare’s coverage gaps for seniors include:

This is where Medigap comes into play. But what is Medigap and why should you get it?

What Is Medigap?

Simply, Medicare leaves big gaps in its coverage for your hospital and doctor bills, and those gaps in coverage could add up to a huge amount of money out of your pocket. Medigap is a specific type of health insurance policy that pays some (or all) of the gaps in Medicare Parts A & B. By spending a little each month on a Medigap policy, you secure yourself from those coverage gaps. Make sense so far?

Why Is It Called a Medicare Supplement?

Medigap policies are also called “Medicare Supplements”, even though they don’t supplement or add anything to Medicare. They just pay bills for you (bills not covered under Original Medicare).

What Are the Benefits of Buying a Medigap Plan?

Have you ever seen a hospital bill in detail? Perhaps you had some routine surgery and spent only two or three days in the hospital for it. Chances are your hospital bill was much larger than what you were expecting. On top of that, you likely received a separate set of doctors’ bills listing things like the surgeon’s bill and anesthesiologist’s fee. Since Medicare Parts A & B don’t fully cover all these hospital and doctor bills, millions of people buy Medigap policies to help pay the remainder. Medigap policies afford Medicare beneficiaries with several benefits. When deciding whether a Medigap plan is right for you, here are some things to know:

  • It puts a limit on your maximum out-of-pocket expenses for copays and deductibles;
  • It’s a good choice if you have chronic illnesses that require frequent or expensive treatments. That means that if you have a medical condition that will likely require hospital stays every year, or frequent, expensive medical treatments, a Medigap policy will save you money as opposed to buying an Advantage Plan. The copays under an Advantage Plan could be far greater than your monthly premium for a Medigap policy;
  • You don’t need referrals to see specialists;
  • You have a greater choice of doctors. There is no network of providers like with HMOs. Instead, Medigap coverage is “coast-to-coast.” Any doctor, hospital and medical provider who accepts Medicare assignment (that means they bill Medicare directly) has to take your Medigap insurance, regardless of which company you bought it from;
  • Medigap works automatically and usually without any input from you, working together with your Medicare plan and filling in the coverage gaps after Medicare has paid for your pre-approved treatments. This ease-of-use is a big appeal of owning a Medigap policy; and
  • It allows you to have a separate policy for your prescriptions, which you have the freedom to change yearly (to always have the lowest possible prescription prices) without affecting your doctor and hospital insurance. More specifically, if you want prescription drug insurance to go with your Medigap policy, as most people do, you would purchase a separate policy for that called Medicare Part D (think: D is for Drugs).

Types of Medigap Policies: Medigap A to Medigap N

Medicare Supplement Plans, Medigap Plans

You’ll notice that all Medigap policies have alphabet names, from the letters A through N. The most popular Medigap policies are Plans F, G and N. The only difference among the plans is how much of the coverage gaps they will pay for you. For instance, Plan F will pay 100% of all gaps in hospital and doctor bills for you; therefore, you would have no copays at all, just your monthly payment for the insurance. That’s perfect for people who don’t like dealing with copays.

Plan G is almost identical to the Plan F, but is a little more economical because it doesn’t pay your annual Part B deductible. Plan N covers even less of the Part B gaps for you, and lets you handle some reasonable copays in exchange for a lower monthly price. You can check out the other Medigap policies (and what they cover) below. Keep in mind, though, that these other plans come with larger copays.

Medigap policies are identical among insurance companies. For example, Medigap Plan G will have identical coverage and benefits, no matter which company you buy it from. The only difference among companies is price.

Also, note that Medigap Plan F will not be sold after December 2019, but people who purchase one before then can keep their policy, as long as they continue to pay for it.

How Do You Buy a Medigap Plan?

Medigap policies are sold by private health insurance companies (which is why you get so much advertising from them when you turn 65 and first become eligible for Medicare). Medigap plans can only be purchased individually, meaning that any Medigap plan you buy will cover only you. Your spouse or partner has to purchase their own individual Medigap policy. Some companies, though, will give you a discount for having two people in the same household as their customers.

You can purchase a Medigap policy online, by mail, by phone or in person from a licensed insurance agent. The prices will vary among different insurance companies. Shop around.

When Can You Buy Medigap?

As soon as you can. The best time to purchase your Medigap policy is when you first sign up for Medicare Part B. The government says that every insurance company that sells these policies must give you 6 months from that time to buy a Medigap policy without having to answer any health questions.

After that 6-month period has passed, you will have to answer a long list of health questions (including having to provide your prescription history) when you apply to buy a Medigap policy. You risk being denied coverage by waiting to sign-up. You can read more here about when’s the best time to buy Medigap. Be safe, not sorry.

The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.

Bud Scannavino

About Bud Scannavino

Bud earned his MBA at Yale. He works with seniors, helping them with the financial issues of retirement, and especially Medicare. His practice is in the Atlanta, Georgia area. He's a regular contributor to HealthCare.com.

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