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A Guide to Medigap and Medicare Supplement Insurance for Seniors

Seniors that become newly eligible for Medicare or that want to consider their options likely heard of Medigap insurance. When seniors read about the various coverage terms and programs related to Medicare, some seniors possibly have little to no idea about what type of coverage best suits their needs. Informed seniors likely understand whether they need a Medicare Supplement Insurance plan.

The Senior List provides this comprehensive guide for seniors that helps define Medigap. The Senior List goes into detail about what Medigap is, who is eligible, and how seniors obtain Medigap coverage, along with some considerations when deciding whether a Medigap policy is an ideal option.

What is Medigap?

Medigap is a type of Medicare Supplement Insurance. Seniors do not have to distinguish between the two because as the official Medicare website explains, Medicare Supplement policies are Medigap policies.

Seniors likely heard the term Medicare Advantage Plan used along with Medigap. These two types of coverage for eligible seniors are not the same plan.

A Medigap policy helps pay some costs that your Original Medicare plan does not pay for, whether you receive care from a private physician or in a hospital or other healthcare settings where Medicare pays for some of your medical costs.

A Medicare Advantage plan is a plan where eligible seniors purchase coverage through an insurance company that administers the Medicare benefits, rather than the Original Medicare. Seniors still have coverage, just not through Original Medicare. Seniors with a Medigap plan have Original Medicare and purchase a Medigap policy from a private company.

Seniors that struggle to pay deductibles, co-payments, and some other healthcare costs, possibly consider a Medigap policy that fills the ‘gaps’ of coverage not paid for by Original Medicare.

What Does Medigap Cover?

Seniors that purchase Medigap policies have coverage for some things that Medicare does not cover, and possibly have some extra coverage options, depending on the insurance company providing the Medicare Supplement policy. Some Medigap policies cover your healthcare needs when you travel outside of the United States. If you travel, this is something you likely want to ask insurance company representatives about when discussing their Medigap plan options.

There are various Medigap plans, each identified by a letter, similar to Original Medicare identifying each type of coverage by a specific letter. The private insurance company representative goes over each type of coverage with potential Medigap policyholders.

Make sure that you understand each plan before making a final decision regarding which is the right plan for you.

Your Medigap policy does not cover your spouse. Each person purchases his or her own Medigap policy. The right plan for you is not necessarily the right plan for your spouse. Discuss each of your needs with the Medigap agent.

Medigap does not cover prescription drugs. Make sure you consider whether you want to have Medicare Part D prescription drug coverage.

One important fact for seniors to remember is that you have to have Medicare Part A and Medicare Part B to purchase a Medigap, or Medicare Supplement policy. You continue paying your premiums for these, and pay a separate premium to the private insurance company that you choose to provide your Medigap policy. Once Original Medicare pays what it covers, your Medigap plan then pays for the coverage provided in your specific Medigap policy.

How Do I Compare Medigap Plans?

One important fact that Medicare points out is that Medigap policies are required to meet federal and state laws designed to protect seniors. There is a requirement that insurance companies selling Medigap coverage identify every Medigap policy as “Medicare Supplement Insurance.”

No private insurance companies that sell Medigap plans have to sell all Medigap plans. There are other certain requirements when a company offers Medicare Supplement plans.

Every company has to offer Plan A when they sell Medigap. Private insurance companies also have the requirement that they offer Plan F if they offer Plan C Medicare Supplement plan.

There are changes coming to Medigap in 2020, where Plan F is being phased out, along with Plan C, but it only affects new enrollees. If you decide that one of these plans is the best choice for you, discuss your options with your Medigap insurance representative.

Another important change coming to Medigap in 2020 is the fact that the Medigap plans will not cover the Part B deductible costs. Compare and choose your Medigap plan wisely by considering the changes, if you are new to Medigap.

Medicare provides a chart on the official Medicare government website that explains each Medigap plan and the coverage offered by each lettered plan. One example is that some plans provide 100 percent coverage for skilled nursing care co-insurance coverage, while other plans provide a percentage of the coverage or no coverage. All Medigap plans cover the first three pints of blood should you need it, except for Plan K and Plan L, which provide only a percentage of coverage.

When Do Seniors Enroll in Medigap?

Seniors sometimes choose to enroll in Medigap when first eligible, during the Medigap open enrollment period. The period starts the month that you turn 65 years of age and have active Medicare Part B insurance. Throughout the Medigap six-month open enrollment period, you have the option of purchasing any Medicare Supplement plan available in the state where you reside, even if you currently have health problems.

This is likely the best time to enroll in Medigap for seniors. Insurance companies have the requirement of selling you a Medigap policy for the same price as seniors that are in good health.

Seniors that do not meet underwriting requirements when attempting to purchase a Medigap plan outside the open enrollment period face the fact that insurance companies are not required to sell you a Medicare Supplement policy.

How Do Seniors Enroll in Medigap?

Once you have Medicare coverage, you have the ability to enroll in a Medigap plan. Contact insurance companies in your area that sell Medigap plans for seniors.

Some seniors get recommendations for ideal Medigap providers from family members or friends. You also have the option of visiting the Medicare website, which offers a ‘Medigap Policy Search’ page. You simply enter your zip code, and answer one or two quick questions.

You do not have to re-enroll in Medigap each year. Standardized Medigap policies are guaranteed renewable. This is true even for seniors that have health issues. If you pay your Medigap premiums on time, the insurance company cannot cancel your Medigap policy.

Other Important Facts About Medigap

It is important that seniors considering purchasing a Medigap plan understand that like Original Medicare, the plan does not provide coverage for everything. Medigap does not provide coverage for long-term care or private duty nursing. Medigap policies also do not cover prescription eyeglasses, vision care, dental care, or hearing aids.

If you have general questions about Medigap, or have questions regarding any facts about coverage, or specific Medigap plans, ask the insurance representative. Ask a trusted loved one or friend to help if you need assistance making Medigap decisions.

Do not sign any policy unless you completely understand it. When seniors fully understand Medigap, there is likely a better chance of choosing an ideal plan that meets their individualized Medicare Supplement insurance needs.