What Is Medigap?

You might be wondering what Medigap is if you recently enrolled in Medicare and have heard about the term. The purpose of Medigap insurance is to assist in reducing some of the out-of-pocket expenses linked to your Medicare plan.

There are various Medigap policy types available, so it’s crucial to do your research and find a plan that meets both your financial and medical needs.

We’ll go into more detail about how Medigap functions, how much you’ll pay for various plans, and when you can enroll in this article.

What is Medigap?

Private companies that sell Medigap can help with the expense of original Medicare, including deductibles, copayments, and coinsurance.

In some circumstances, Medigap will also pay for emergency medical expenses incurred when traveling outside of the US. Only after you and Medicare have each covered your portion of the cost of medical treatment does a Medigap policy begin to pay benefits.

The 10 Medigap plans that are offered are A, B, C, D, F, G, K, L, M, and N.

New Medicare enrollees are no longer able to purchase certain Medigap insurance. Plans C, F, E, H, I, and J are among them. If you already have one of these plans, though, you can stick with it. It is still possible to purchase Plan C or Plan F if you were qualified for Medicare before January 1, 2020.

What do Medigap plans cover?

The majority of these Medigap plans have varying copayment, coinsurance, or other medical price policies.

Most, if not all, Medigap plans provide coverage for the following:

• Medicare Part A coinsurance and hospital fees
• Medicare Part A hospice coinsurance or copayment costs
• Medicare Part B coinsurance or copayment costs
• blood transfusion costs, up to the first 3 pints

In addition, some Medigap plans also cover:

• skilled nursing facility costs
• Medicare Part A deductible
• Medicare Part B deductible
• Medicare Part B excess charges
• emergency medical costs during foreign travel

Please be aware that Medicare Advantage is distinct from Medigap. Plans under the Medicare Advantage program provide coverage over and above that of original Medicare. The only coverage that Medigap plans help with is what you already have.

If you reside in Massachusetts, Minnesota, or Wisconsin, your Medigap policy may have a different plan name and be standardized differently.

What’s not covered?

Supplemental insurance for original Medicare, not additional coverage, is what Medigap policies are. A Medigap policy can assist in paying for some of your Medicare expenses, but it will not:

• prescription drugs
• vision, dental, or hearing care
• any other health perks, such as fitness memberships or transportation services

You must choose a Medicare Advantage (Part C) plan or add a Medicare Part D policy to your current policy in order to be covered for these kinds of medical services.

How much do Medigap plans cost?

Both original Medicare and Medigap have some costs attached to them; these costs vary from plan to plan.

Monthly premium

Your original Medicare premiums must still be paid even if you have a Medigap plan. These expenses for 2021 include:

• $259 to $471 per month for Part A, although most people qualify for premium-free Part A
• $148.50 per month for Part B, depending on your income

Deductibles

You must meet your part A and part B deductible amounts before Medicare or Medigap will cover your services. Regarding 2021, these are:

• Part A costs $1,484 for each benefit period.
• Part B for the year is $203

Some Medigap plans may pay for a portion (or all) of these deductible amounts.

Copayments and coinsurance

Once your deductible has been satisfied, Medicare covers its share of the expenses. You will nevertheless be responsible for the following copays or coinsurance charges in 2021:

Depending on how many days you’ve been admitted as an inpatient, the coinsurance for Part A services can range from $0 to $742 each day.

20% of the Medicare-approved value for Part B-covered goods and services

These copayment and coinsurance rates may be covered by your Medigap plan depending on the coverage you select.

Out-of-pocket costs

There are just two Medigap insurance, K and L, that contain caps on your out-of-pocket expenses.

However, there are no out-of-pocket maximums for Medicare Parts A or B. You will still be responsible for paying out-of-pocket for these expenses if you select Medigap coverage that doesn’t cover at least most, if not all, of your Medicare fees.

How are Medigap plans priced?

The cost of or “rating” for Medigap policies varies depending on a number of variables. Your plan premium may vary depending on how a location is ranked.

Community rated

Community-rated No matter your age, Medigap policies have the same monthly price. Although external factors like inflation may cause the monthly premium to change, your age will never be a factor in that change.

Issue age-rated

Issue-age-rated Depending on your age at the time you bought the policy, different premium amounts are charged for Medigap coverage. When you buy a Medigap policy as you get older, premiums are typically cheaper.

Attained age-rated

reached age rating Your monthly premium for a Medigap policy is based on your age, and premiums increase as you get older. These policies increase in cost as you age, in contrast to policies that are issued based on issue age.

Other factors

Only four states, according to Trusted Source, guarantee Medigap policy availability to Medicare recipients, irrespective of their health.

If you have a preexisting medical condition, you can pay a higher premium for your Medigap policy in some other states.

Does Medigap cover you when you travel?

If your Medicare plan does not already cover international travel, the following Medigap plans will pay 80% of your emergency medical expenses when you are abroad:

• Plan C
• Plan D
• Plan F
• Plan G
• Plan M
• Plan N

Additionally, even though they are no longer being marketed, plans E, H, I, and J still cover medical expenses incurred while traveling if you currently have one of these plans in place.

You must pay a $250 deductible out-of-pocket before a Medigap policy will cover emergency medical expenses incurred while traveling abroad. 80 percent of your emergency medical expenses up to a lifetime maximum of $50,000 will thereafter be covered by your Medigap policy.

It’s crucial to remember that a Medigap policy will only cover these costs if it starts within the first 60 days of your trip.

When can I enroll in Medigap?

Medicare plans have numerous enrollment windows, but you can only add a Medigap policy to your plan at specific times. The Medigap enrollment windows are as follows:

the initial period of enrolment. The three months leading up to, the three months following, and the month of your 65th birthday are the only times you are permitted to apply for a Medicare plan and add a Medigap policy.

Enrollment is open to everybody. You can apply for a policy during the Medigap open enrollment period if you forget to enroll first. If you have already reached the age of 65, this time frame starts when you sign up for Part B. This window applies to those who will turn 65 within the next six months after they enroll in Part B and reach that age.

Particularly if you’re under 65, insurance companies aren’t required to sell you a Medigap policy.

You might have a harder time locating an insurance provider who will sell you a plan after the initial enrollment period and open enrollment period has ended. If you want a Medigap policy, you should apply for one as soon as you sign up for Medicare Part B.

Also keep in mind that if you have a Medicare Advantage plan, you cannot purchase a Medigap policy. Only people with original Medicare are eligible to add Medigap to their insurance.