Medigap Explained

So, you've retired or turned 65, and have started to receive endless mailings, emails, and ads touting the benefits of various Medicare Supplement plan (Medigap) options. As you sift through all of this information, choosing which type of Medigap plan to enroll in can often feel very overwhelming.

At Time for 65, we understand the importance of truly enjoying the next chapter of your life, including spending time with your loved ones, traveling the world, or discovering new hobbies and interests. We're here to help you narrow down your options and select a Medigap plan that meets your personal lifestyle, health, and budget.

We want you to be able to spend more time living your best life in retirement rather than spending time in front of a screen reading article after article trying to future out this mess that is Medicare.

That said, how can we help you decide which plan is best for you? We'll discuss several determining factors to help you recognize what's most important to you such as each Medigap plan's cost, what each plan covers, comparing the advantages and disadvantages of each plan, and so on. Our goal is to identify the Medigap plan that will ultimately keep you happy and healthy.

What are Medicare Supplement Plans (Medigap)?

To start, Medicare is the federal government healthcare program for people 65 and over. Once you're eligible for Medicare, you'll have several options for health plans, including Original Medicare (Part A and Part B) on its own, a Medicare Supplement plan (Medigap) or a Medicare Advantage (Part C) plan.

If you're receiving Social Security benefits when you turn 65 years old, you'll be automatically enrolled in Medicare Part A, which covers hospital costs, and Part B, which covers doctor visits. However, Original Medicare only covers about 80% of your costs for doctors, hospitals, and medical procedures. Also, Original Medicare usually doesn't cover prescription drug costs or other health needs like hearing aids, dental care, or eyeglasses.

One of your options for a health plan that helps cover all other costs that aren't covered in Original Medicare is Medigap. Medigap is a Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies.

Medigap plans cover more than 10 million Medicare beneficiaries. They are available for purchase in all 50 states. Typically, Medigap plans are popular for those who want little to no-copay when they access healthcare services.

Since your Original Medicare plan doesn't pay for all of your costs for covered healthcare services and supplies, Medigap can help you pay some of your remaining healthcare costs, including:

 Copayments

 Coinsurance

 Deductibles

To become eligible for a Medigap policy, you must have Medicare Part A and Part B. If you have Original Medicare and you choose to buy a Medigap policy, Medicare will then pay its share of the Medicare-approved amount for covered healthcare costs. From there, your Medigap policy will pay its share.

It's also important to note that a Medigap policy is different from a Medicare Advantage plan. Medicare Advantage plans offer ways to get Medicare benefits. Meanwhile, a Medigap policy only supplements your Original Medicare benefits.

Also, it's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage plan unless you're switching back to Original Medicare. Medigap policies aren't allowed to include prescription drug coverage. If you need prescription drug coverage, you have the option to join a Medicare Prescription Drug Plan (Part D).

There are various types of Medigap plans for you to choose from, each providing different degrees of coverage. Although the number of plans varies from state to state, typically, the majority of the United States can offer 10 different types of Medigap coverage choices with names of the alphabet from Plan A to Plan N.

Each plan has its own mixture of deductibles, copayments, and extra costs. Additionally, every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as Medicare supplemental insurance.

When Original Medicare only pays 80% of your Part B expenses, a Medigap plan will cover the remaining 20% for you, among other things. If a serious illness arises and a pricey procedure is necessary, 20% can turn into a major financial burden on you and your family. Medigap provides peace of mind by covering out-of-pocket costs that Part A and Part B don't cover.

To learn more about Medigap plan eligibility and enrollment, costs, coverage, plan types, additional benefits, and more, contact us to be connected with Time for 65's partnered licensed agents today.

Medigap supplemental insurance plans are designed to fill Medicare Part A and Part B coverage gaps.

Medigap is a Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Medigap provides the most comprehensive options and covers almost all of the out-of-pocket costs in the Original Medicare plan. One of the top benefits of Medigap is the cost, including few to no out-of-pocket costs.
 
Other benefits include a great deal of flexibility in terms of the physician network and the lack of effort involved in filing a claim. Beneficiaries don't have any paperwork to deal with since checks are automatically made to providers and facilities after Medicare pays its portion of the bill.

What are Some of the Main Advantages of a Medigap Plan?

Medigap plans were initially created since Original Medicare plans required beneficiaries to pay out-of-pocket for services such as 20% of outpatient expenses. Medigap plans are extra insurance you purchase if you have Medicare.

Here are some more advantages of Medigap plans:

  • More flexibility with your treatment options
  • More freedom to choose your own doctors and hospitals
  • You don't need referrals to see a specialist
  • There are no surprise out-of-pocket expenses for Medicare-covered services
  • You can use your Medigap plan anywhere in the United States with nationwide coverage
  • Medigap policies can be easier to understand
  • Guaranteed renewable: A Medicare supplement company can't cancel your policy for using the policy too much or change your coverage due to a health condition. Every year, your policy will renew without having to apply.
  • No claims paperwork: You don't have any paperwork to deal with since checks are automatically made to providers and facilities after Medicare pays its portion of the bill.

What Do Medigap Plans Cover?

Now that we've discussed what Medigap plans are and their advantages, what do these plans actually cover? Medigap plans cover all or part of the coverage that an Original Medicare beneficiary would otherwise be responsible to pay out-of-pocket for expenses that are covered — but not fully covered — by Medicare.

Nearly two-thirds of the 61 million seniors and disabled Medicare beneficiaries choose Medicare Part A and Part B to cover costs for doctors, hospitals, and medical procedures. Today, more than 80% of these beneficiaries supplement their insurance with Medigap, Medicaid, employer-sponsored insurance, and/or stand-alone Medicare Part D prescription drug policies.

Many beneficiaries choose to supplement their insurance with Medigap because the plans cover you for any doctor or hospital in the United States that accepts Medicare, which the majority do. Moreover, with Medigap, there's no need for prior authorization or a referral from your primary care physician.

Moreover, Medigap coverage only includes the United States. This is an important factor for those who travel frequently or reside in a different locale part of the year. Lastly, Medigap is a great option for those who have specific physicians and hospitals they prefer to use.

Some examples of costs that Medigap covers that you're otherwise responsible for with Original Medicare include:

  • Your Medicare deductibles
  • Your coinsurance
  • Your copayments
  • Hospital costs after you run out of Medicare-covered days
  • Skilled nursing facility costs after you run out of Medicare-covered days
  • Healthcare costs when you travel internationally

A Medigap policy only covers one person. If you and your spouse/partner both want Medigap coverage, you'll each have to buy separate policies.

The following are types of coverages that aren't Medigap plans:

Find out about coverage in your specific state.

Click on your state for details.