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What’s Medicare Supplement Insurance (Medigap)?

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What's Medicare Supplement Insurance (Medigap)?“Medigap” refers to private-sector Medicare Supplement Insurance (also known as Medicare Part D or Medigap). Some, but not all, of the costs of covered health care services and supplies are covered by Original Medicare. a Medicare Supplement Insurance (Medigap) coverage can assist pay for some of the remaining health care expenses, such as:

  • Copayments

  • Coinsurance

  • Deductibles

The Part B deductible is no longer covered by Medigap policies provided to those new to Medicare. As a result, beginning on or after January 1, 2020, no new Medicare beneficiaries will be allowed to enroll in Plans C and F. These plans that cover the Part B deductible may be available to anyone who became eligible for Medicare before January 1, 2020, but has not yet enrolled (Plan C or F). Before January 1, 2020, you can keep your current Plan C or F (or the Plan F high deductible variant).

The majority of Medigap policies also cover services that aren’t covered by Original Medicare, like medical treatment received when traveling outside the United States. The following is what occurs if you have Original Medicare and purchase a Medigap policy:

  • The Medicare-Approved Amount for approved health care expenses will be paid by the federal government.

    After that, your Medigap insurance provider covers its portion of the cost.

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medigap insurance company8 things to know about Medigap policies 

  1. Having Medicare Part A and Part B is a requirement.

  2. Medigap insurance is not the same as a Medicare Advantage plan. Medigap policies are meant to supplement your Original Medicare benefits, not to replace them.

  3. You pay a monthly premium to a private insurance company for your Medigap plan. Besides the monthly Part B fee that Medicare charges, you must also pay an additional monthly premium.

  4. Only one individual is covered by Medigap coverage. To get Medigap coverage, you and your spouse will need to acquire separate policies.

  5. A Medigap coverage can be purchased from any insurance company that is authorized to do business in your state.

  6. Even if you have a pre-existing medical condition, regular Medigap coverage is assured to be renewed. As long as you continue to pay your premiums, your Medigap policy will be unaffected.

  7. Drugs were covered by some Medigap policies that were previously sold. However, from January 1, 2006, Medigap policies can no longer include prescription medication coverage. You can enroll in a Medicare Prescription Drug Plan if you need prescription drug coverage (Part D). In some cases, you may be required to pay two premiums if you purchase Medigap and Medicare prescription coverage from the same provider. Find out how to pay your insurance premiums by contacting the company.

  8. If you’re enrolled in a Medicare Advantage Plan, no one can sell you a Medigap policy unless you’re going back to your Original Medicare.

medigap plansMedigap policies don’t cover everything

The following items are typically excluded from Medigap coverage:

  • Care for the elderly

  • As if you were receiving non-skilled care in a nursing home

  • Services such as those related to vision or oral health

  • Aids to hearing

  • Eyeglasses

  • Nursing services are provided on a contract basis

private insurance companiesInsurance plans that aren’t Medigap

Medigap plans aren’t the only sort of insurance available.

  • Health Insurance for the Elderly (like an HMO, PPO, or Private Fee-for-Service Plan)

  • The Prescription Drug Programs Offered by Medicare

  • Medicaid

  • The Federal Employees’ Health Benefits Program (FEHBP) is one example of an employer or union plan (FEHBP)

  • Tricare

  • Benefits for war veterans

  • Insurance policy for long-term care

  • There are three types of Indian health plans: Tribal, urban, and Indian Health Services.

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covered health care costsDropping your entire Medigap policy (not just the drug coverage) 

Some people choose a different Medigap policy entirely (not just your old Medigap policy without the prescription drug coverage). Medicare Advantage Plans with prescription drug coverage is an option as well.

If you decide to cancel your Medigap coverage completely, you must be very selective about when you do so.

If one of the following conditions is met, you will be subject to a late enrollment penalty:

  • It is not creditable prescription drug coverage if you cancel your full Medigap policy.

  • Your new Medicare drug coverage won’t kick in for another 63 days or more.

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