Fill in the Medicare Coverage Gaps with a Medicare Supplement/Medigap Policy
Seniors with Original Medicare usually get a Medicare Supplement Insurance Policy (also known as Medigap coverage) to reduce medical bills and get coverage that is not covered by Original Medicare by itself.
Medicare Supplement Plans help cover expenses Original Medicare doesn’t, and they can only be bought through private insurance companies.
Medigap policies are like extra health insurance. They can help with co-payments and deductibles.
Supplement plans have other benefits, but they don’t include prescription drug coverage.
To qualify for a Medigap policy, you need to have Medicare Part A (covers hospital services), plus Medicare Part B (covers doctor services). And, you cannot be enrolled in a Medicare Advantage Plan.
People who have a Medicare Supplement plan can see any doctor who accepts Medicare patients. Additionally, on a Medigap plan, you don’t need a referral to see a specialist (like a cardiologist).
How Does a Medicare Supplement/Medigap Policy Work?
You can get Medicare Supplement Plans through a private insurance company licensed in your state to sell one.
These Medigap plans help pay for healthcare costs that Original Medicare doesn’t. Co-pays, co-insurance and deductibles are just some examples. They cover other services like medical care needed when traveling outside the United States.
When a medical bill is prepared, Medicare pays first, then the Medigap coverage pays next.
With Medigap coverage, you have two bills to pay each month. One for Medicare Part B and one for the Medigap monthly premiums.
Medicare Supplement Plans cover one person. If you and your spouse need Medigap coverage, you will have to buy them separately.
All Medicare Supplement Plans will auto renew, even if you have health problems. Your Medigap policy won’t stop as long as you make your monthly payment.
Remember, Medigap plans won’t cover all your medical costs. They don’t offer coverage for dental, vision or long-term care (like in-home nursing). If you need a plan for those types of expenses, you may need to switch from Original Medicare to Medicare Advantage (Medicare Part C).
Prescription Drug Coverage
Medicare Supplement Plans have not covered prescription drugs since January 1, 2006. If you have Original Medicare and need prescription drug coverage, you should consider Medicare Part D.
If your Medigap policy includes prescription drugs (you signed up for it before Jan. 1, 2006), let your insurance company know if you get Medicare Part D. They will take off prescription drug coverage from your Medigap policy and adjust your premium.
Instead of a Medicare Supplement plan, you might want to consider Medicare Part C (Medicare Advantage). Medicare Advantage includes Original Medicare (Parts A and B) and usually includes prescription drug coverage with some additional benefits. It’s important to research your Medigap plans vs. Medicare Part C and choose what’s best for you since you have to pick one or the other.
A Medicare Advantage Plan is not the same as a Medicare Supplement Plan/Medigap policy. You’ll have to choose between a Medigap Plan or Medicare Advantage because you can’t have both.
It is not legal for an insurance company or insurance agent to sell you a Medicare Supplement policy if you have Medicare Advantage. The only exception to this rule is if you go back to Original Medicare and drop Medicare Advantage. If you are enrolled in a Medigap plan or currently have Medicare Advantage – you are set.
You can only buy a Medicare Supplement Plan if you have Original Medicare (Parts A and B).
Some people try to sell Medigap plans illegally, so it’s important to understand when you qualify for them.
Some things insurance agents can’t do:
- Pressure you into buying a Medigap Policy
- Lie so you’ll switch plans
- Sell you a supplement policy when they know you have one
- Sell you a policy if they know you are on Medicaid or Medicare Advantage
- Claim that a Medigap plan is part of Original Medicare
Talk to a trusted insurance agent and find out if a Medicare Supplement Plan is right for you.