Medical bills are a concern as we age. Getting older brings with it greater risks of illness or accidents such as slips and falls. That means it’s more important than ever to make sure your insurance is in order.
Medicare is the Federal insurance option for seniors age 65 and over (and some younger people who qualify due to a disability.) Medicare generally covers inpatient care, skilled nursing facility care, hospice care, at-home care, medical equipment, ambulance services, and mental health care. Exact coverage varies by state and according to your situation, but those are the basics.
However, there are some gaps in Medicare insurance. For example, it doesn’t cover copays or coinsurance, deductibles, or emergency care while traveling abroad. These costs can add up and place a financial strain on seniors, which is why some older adults opt for a Medigap insurance plan in addition to their Medicare plan.
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What Is Medigap?
Medigap, also known as Medicare Supplement Insurance, covers some of the costs that aren’t covered by Medigap. You purchase Medigap through a private insurance company, and unlike Medicare, there is no central body that administers Medigap. Although the basics are the same across the board, costs vary according to the provider you sign up with.
Who Is Medigap For?
Medigap is for anyone who is enrolled in Medicare and is concerned about out of pocket expenses they might incur as a result of hospital stays, doctor visits, in-home care, nursing facility stays, or any other medical situation.
What Does Medigap Cover?
Medigap plans are standardized plans, each with a designated letter. The plans are A, B, C, D, F, G, K, L, M and N. What is covered by each lettered plan remains the same no matter where you purchase your Medigap insurance from.
- Medicare part A coinsurance and hospital costs up to 365 days after Medicare coverage insurance is exhausted is covered by all plans.
- Medicare part A hospice coinsurance or copayment is covered in full by all plans, apart from K (covers 50%) and L (covers 75%.)
- Medicare part A deductibles are covered in full by plans B, C, D, F, G and N, and in part by K (covers 50%), L (covers 75%), and M (covers 50%).
- Medicare part B coinsurance or copayment is covered in full by all plans, apart from K (covers 50%) and L (covers 75%.)
- Medicare part B deductibles are covered in full by plans C and F only.
- Medicare part B excess charges are covered in full by plans F and G only.
- Skilled nursing facility coinsurance is covered in full by plans C, D, F, G, M and N, and in part by K (covers 50%) and L (covers 75%.)
- The first three pints of blood needed in a treatment are covered in full by all plans, apart from K (covers 50%) and L (covers 75%.)
- Foreign travel emergencies are covered up to 80% by plans C, D, F, G, M and N
- Plans K and L also come with out of pocket spending limits ($5,240 and $2,620 respectively) that mean Medigap covers the rest of your expenses for the calendar year after you’ve reached the spending limit.
Please note that Massachusetts, Minnesota, and Wisconsin have their own standardized plans. If you live in one of those states, your local state’s Department of Insurance can advise you on what’s available (you can find your local Department of Insurance here).
Does Medigap Cover My Partner?
No – your partner will need their own Medigap plan.
Where Can I Use Medigap Insurance?
You can use Medigap in all places that accept Medicare. However, if you sign up for a Medigap Select plan, you will only be able to use doctors and hospitals in a pre-approved network (so do be careful that you’re not signing up for one of those unless you’re sure that won’t be a problem.)
How Do I Buy Medigap Insurance?
You buy Medigap Insurance through a private insurance company, just as you would buy private health, house, or auto insurance. In most cases you enter your state on the website to see what is available in your area, and you can call or apply online for a quote.
Remember, what is covered by each plan remains the same no matter where you buy your Medigap insurance. What varies is the premium you pay to each insurer, any copays or deductibles and, of course, the customer service you receive.
Do I Have To Have Medicare First?
Yes. You can only purchase Medigap insurance if you already have Medicare parts A and B.
Is There A Right Time To Enroll?
Absolutely! Enrollment at the time is important as it can affect your coverage and premiums.
Original Medicare has an initial enrollment period, which is the time during which you’re eligible to enroll in Medicare. The initial enrollment period is seven months and lasts from three months before the month in which you turn 65, till three months after that month.
The best time to start your Medigap policy is during the six months following the month in which you turn 65. Outside of this period you might find that your coverage options are more limited, and also more costly. Some states do have additional open enrollment periods but we highly recommend purchasing your Medigap policy during the initial period to save yourself worry, and money.
How Is Medigap Different From Medicare Advantage?
Medicare Advantage is a health plan similar to a private health insurance plan. Medicare Advantage is an alternative to Medicare where you enroll through a private insurance company. In most cases you’re covered for what would have been covered by Medicare parts A and B, plus a range of other benefits, which vary from provider to provider. You will usually pay your Medicare Advantage premium along with your Medicare Part B premium.
You cannot enroll in both Medicare Advantage and a Medigap insurance plan.
How Do I Decide On A Medigap Provider?
Choosing a Medigap provider is much like choosing any other private insurance – it’s best to shop around. Your state’s local Department of Insurance can give you information on what’s available in your area. You can also enter your zip code on the Medicare site to find Medigap policies in your area. The plan you choose depends on your medical needs, both current and projected, and on your income and ability to pay out of pocket expenses.
It’s always a good idea to check out reviews on the web for any insurance company to find out what their customers are saying.
Of course, in all cases you can search online and / or call to get a quote for your area. As always, we recommend you read the fine print and be sure you know exactly what is covered, what you’re expected to pay, and when.