What’s Medicare Supplement Insurance (Medigap)?

As the name may imply, Medicare Supplement Insurance (Medigap) is insurance that helps to fill the “gaps” in regular Medicare.  It’s sold by private insurance companies.  While Medicare pays for many healthcare needs, supplies, and services, not everything is covered. This is where Medigap comes in.  Some of the areas that Medigap may help cover are: 

• Copays
• Coinsurance
• Deductibles
• Medicare services when travelling outside the U.S. (if they qualify).  

(It’s important to note that as of January 1, 2020, new Medicare plans will not be allowed to cover any deductibles that are part of Medicare Part B (routine and preventative care).  If you are already enrolled in a Medicare plan, you will be “grandfathered” in to this assistance, and this change will not affect you.  If you qualified for Medicare before January 1, 2020, you may still be able to buy one of these plans.)        

How Medigap Works

When using regular Medicare, Medicare will cover a pre-approved amount of certain healthcare costs.  In the event you need further assistance, Medigap will step in to help cover the rest of your out-of-pocket expenses where it applies.  This may not mean everything will be resolved with no cost to you, but it may allow you to greatly reduce the amount you owe for your coverage needs.  

What Medigap Doesn’t Cover:

• Vision
• Dental
• Hearing aids
• Long-term care
• Private nursing
• Eyeglasses

Important Things To Know

There are a few important things to know about Medigap.  Some of these things are the following: 

• You must be enrolled in Medicare Parts A and B.
• If you enrolled in Medicare before 2006, your plan may include coverage for prescription drugs.  However, plans that started after this will require separate enrollment in Medicare Part D (prescription drug coverage plan).  
• The premiums you pay are paid to the private insurance company you get your Medicare through. The premium you pay is on top of the Medicare Part B insurance premium you pay directly to Medicare.  
• You can get your Medigap policy from any licensed insurance company in your state that is qualified to sell them.  
• Medigap policies only cover one beneficiary.  They do not cover your spouse, your child, or anyone else.  
• A Medigap Policy is not a Medicare Advantage Plan.  While Medicare Advantage Plans are used to get Medicare benefits, Medigap is strictly used to fill in any holes the original Medicare may have when it comes to affording coverage.  
• It is illegal for anyone to sell you a Medigap policy if you are already enrolled in a Medicare Advantage Plan, unless you switch back to original Medicare.  
• Your standard Medigap policy is guaranteed renewable, even if you have health conditions. As long as you are paying your premium and paying it on time, it is illegal for your insurance company to cancel your Medigap policy.   

Medigap is not to be confused with: 

• Medicare Advantage Plans 
• Medicaid
• TRICARE
• Union or employer plans
• Medicare Prescription Drug Plans (Medicare Part D)
• Long-term care insurance
• Health insurance through tribal plans, including Urban Indian Health Plans and Indian Health Service
• Veteran’s Benefits (through Veterans Association)

Dropping Your Medigap Policy:

In the event you need to drop your Medigap coverage (if say, for example, you are switching to a Medicare Advantage Plan), you will need to make sure that you do not do so more that 63 days before your new plan is due to begin, or drop your entire Medigap policy when the prescription drug coverage wasn’t creditable, or you may find yourself slapped with a late enrollment fee.  You can get assistance with finding a Medigap policy by calling your State Health Insurance Assistance (SHIP) network or State Insurance Department.