Medigap

Medigap is a type of health insurance policy designed to cover the areas of noncoverage under Medicare, including deductibles, coinsurance, and medical expenses that exceed Medicare's approved amounts.
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What is Medigap?

Medigap is supplementary health insurance intended to fill the coverage gaps left by Medicare. These gaps may include deductible payments, coinsurance, medical charges exceeding Medicare’s approved amounts, and various other medical services and supplies not covered by Medicare.

Key Areas Covered by Medigap

  1. Deductibles: Medigap policies can help pay for the deductibles under the Medicare insurance policy.
  2. Coinsurance: It covers the coinsurance amounts specified in the Medicare insurance policy.
  3. Excess Charges: Medigap helps with medical charges that exceed Medicare’s approved amounts.
  4. Noncovered Services: It covers various medical services and supplies not paid for by Medicare.

Examples

  • Plan F: Covers Medicare Part A coinsurance and hospital costs, Medicare Part B coinsurance or copayment, the first three pints of blood, Part A hospice care coinsurance or co-payment, skilled nursing facility coinsurance, Part A deductible, Part B deductible, Part B excess charges, and foreign travel emergency care.
  • Plan G: Similar to Plan F but does not cover the Medicare Part B deductible.
  • Plan N: Covers Part A coinsurance and hospital costs, Part B coinsurance or copayment, the first three pints of blood, Part A hospice coinsurance or copayment, skilled nursing facility coinsurance, Part A deductible, and foreign travel exchange, but may require copayments for certain office visits and emergency room visits.

Frequently Asked Questions (FAQs)

  1. What does Medigap cover?
    Medigap policies cover out-of-pocket costs like deductibles, copayments, and coinsurance, as well as medical expenses that exceed Medicare-approved amounts.

  2. What does Medigap not cover?
    Medigap does not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

  3. Do I need a Medigap policy if I have Medicare Advantage?
    No, it is illegal to sell a Medigap policy to someone who has a Medicare Advantage Plan.

  4. How much can Medigap cost?
    The price varies based on the plan type, location, age, and insurance company.

  5. Can I buy Medigap at any time?
    The best time to buy is during the Medigap Open Enrollment Period, which starts when you’re 65 and enrolled in Part B.

  • Medicare: A federal health insurance program for people 65 and older, and some younger folks with disabilities.
  • Medicare Part A: Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B: Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Advantage (Part C): An “all in one” alternative to Original Medicare, this plan wraps in Part A, Part B, and usually Part D.

Online References

Suggested Books for Further Studies

  1. Medicare For Dummies by Patricia Barry
  2. Retire Secure: A Guide to Getting the Most Out of What You’ve Got, Third Edition by James Lange
  3. Social Security, Medicare & Government Pensions by Joseph Matthews

Fundamentals of Medigap: Insurance Basics Quiz

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