Medigap, also known as Medicare Supplement Insurance, is private health insurance designed to fill the coverage gaps left by Original Medicare (Parts A and B). It helps pay some or all of the out-of-pocket costs that Medicare doesn’t fully cover, such as deductibles, coinsurance, and certain copayments, and some plans may cover additional items like foreign travel emergencies. Key points to understand
- What it covers: Most Medigap plans pay the Part A hospital coinsurance and hospital costs, the Part B coinsurance or copayments, and the Part A hospice copayment. Many plans also cover the Part A deductible and certain other charges that Original Medicare doesn’t fully pay. Some policies may offer limited coverage for things like foreign travel emergencies.
- Standardization and options: In many states, Medigap plans are standardized and identified by letters (Plan A, Plan B, Plan C, etc.). Each plan type covers a core set of benefits, but the exact benefits and costs can vary by plan and by insurer. Availability and specifics can differ by state.
- How it works with Original Medicare: Medigap is designed to complement Original Medicare. It does not replace Medicare Part A and Part B, and it generally does not include prescription drug coverage. If you want drug coverage, you typically enroll in a separate Medicare Part D plan.
- Enrollment timing: Many people enroll during their Medigap Open Enrollment Period, a six-month window that starts the first month you have Medicare Part B. During this period, you can buy any Medigap plan sold in your state without being subject to medical underwriting. Outside this window, it may be harder to qualify or you may pay higher premiums based on health.
- Costs: You pay a premium to the Medigap policy in addition to your Part B premium and any other Medicare-related costs. Premiums can vary by plan, insurer, location, and age, and they may increase over time.
Common questions
- Do I still need prescription drug coverage? Yes if you want drug coverage, you’ll typically need a separate Medicare Part D plan since Medigap policies generally do not include prescription drug coverage.
- Can I have Medigap if I’m under 65? Some individuals under 65 with certain disabilities or conditions may have access, but rules vary by state. In many cases, insurers aren’t required to sell Medigap to people under 65, and eligibility may depend on state law and medical underwriting.
- How to choose a plan: Compare what each plan covers, the monthly premium, deductibles, coinsurance, and how it fits with any existing Part D coverage. Consider your anticipated healthcare needs, preferred doctors and hospitals, and travel plans if foreign travel coverage matters.
If you’d like, I can tailor this to your location and age, and help compare specific Medigap plans available where you live, including typical premium ranges and which plans cover the costs most relevant to you.
