Who Is Eligible for Medigap and What Is Its Purpose

Who Is Eligible for Medigap and What Is Its Purpose

The term Medigap should not be new if you’ve recently signed up for Medicare. But at the same time, are you wondering what it could mean? Then this article is for you. In simple terms, Medigap policies or plans are designed to help cover some of the out-of-pocket costs associated with your Medicare plan.

Although there are various Medigap policies to choose from, it is vital to conduct in-depth research. You should even consult a general care physician or a primary care doctor to find a plan that suits your medical and financial needs better.

So, What Is Medigap, and How Does It Work?

Also known as Medicare Supplement, Medigap is a health insurance policy sold by private companies. This policy can be used along with Medicare Parts A and B to fill the gaps in their original coverage. Also, it can help you cover costs related to co-payments, deductibles, coinsurance, and lots more.

So, should you be in the original Medicare plan and have a Medigap policy? Then your Medigap policy and Medicare will each pay their share of covered health care costs.

Some Medigap policies provide coverage for medical services that are not under Original Medicare. An example is a doctor or hospital visit that takes place when traveling in another country. In this case, a Medigap policy will typically pay the difference between the total healthcare costs and the Medicare-approved amount.

To obtain a Medigap policy, you must have Medicare Part A and Part B, it will also be better to visit a primary care doctor near your area. 

If you are unfamiliar with general care physicians in your area, simply search “dr office near me” on search engines to see their locations. Furthermore, one can purchase a Medigap policy from any insurance carrier that’s licensed in your state to sell one.

Having discussed this, let’s examine the difference between Medigap and Medicare advantage, as most people often confuse both terms.

Medigap vs. Medicare Advantage

You are wrong if you think a Medigap policy or plan is the same as a Medicare Advantage Plan or Part C. Medicare Advantage plans are an alternative way of obtaining Medicare benefits immediately after you qualify. 

On the contrary, a Medigap policy is designed to bridge the gaps or additional costs in your Original Medicare Coverage. This means it is purely a supplemental plan.

What Is the Purpose of the Medigap Policy?

Medigap plans are designed majorly to cover out-of-pocket costs for services covered by Medicare, as opposed to care that it doesn’t cover, and an enrollee has to pay entirely out-of-pocket. 

For instance, Medigap plans do not cover vision and dental charges, as Original Medicare (i.e. Medicare Parts A & B) does not provide routine vision and dental coverage.

This said, let’s give a summary of the must-know things about the Medigap policy.

5 Must-Know Things about Medigap Policy

  1. Medigap plans don’t generally cover long-term care, hearing aids, vision clear, and many more.
  2. Medigap plans are usually standardized, meaning regardless of the company, they offer the same benefits and claims the same.
  3. Medigap offers plans for one person at a time.
  4. Medigap can cover international healthcare expenses, particularly Medigap plans C, D, E, F, etc.
  5. Medigap covers all increased costs associated with aging.

Insurance Plans That Aren’t Medigap

Various insurance types aren’t Medigap plans and some of them include:

  • Medicare Advantage Plans, including HMO, PPO, or Private Fee-for-Service Plan
  • Medicaid
  • Tricare
  • Medicare Prescription Drug Plans
  • Employer or Union Plans, like the Federal Employees Health Benefits Program (FEHBP)
  • Long-term care insurance policies
  • Veteran’s benefits, etc.

Who Is Eligible for Medigap Policy?

Who Is Eligible for Medigap Policy?
Source: Pixabay

People with Medicare Part A and Part B are eligible to buy a Medigap policy. Those with Medicare Part C Advantage Plan don’t stand the chance of purchasing this type of insurance.

Immediately you turn 65 and have Medicare Part B, you enter the Medigap open enrollment period. This period usually lasts for 6 months and during this time, the insurance company doesn’t use medical underwriting to determine if it will offer you a policy or not.

Typically, this means it is unable to do the following things due to your health issues:

  • Decline to sell you a Medigap policy
  • Insist that you wait for an extended period before coverage begins.
  • Overcharge you based on your health.

After the open enrollment period ends, the insurance company may refuse to sell you a policy as a result of your health or charge you more. However, this may not happen if you have a guaranteed right to buy a Medigap policy. Often, this happens in cases where you lose your existing policy through no fault of your own.

Wrapping Up

As stated above, Medigap policies are a supplemental insurance alternative for people enrolled in original Medicare and also looking for additional financial coverage. When you enroll in a Medigap policy, you are covered for certain costs, including copayments,  deductibles, and coinsurance.

However, you are expected to pay some out-of-pocket costs for the services you receive. To explore the Medigap options around you, consult a primary care doctor or a general health physician to find a policy that best works for you.

Frequently Asked Questions about Medigap Policy

  1. What Do Medigap Plans Cost?

Medigap is an optional insurance policy. If you choose to get one, you’re responsible for paying a monthly premium from the private insurance carrier. This cost is in addition to the monthly Part B premium that you pay to Medicare.

  1. Which Is the Most Common Medigap Plan?

Medical supplement plans F, G, and N are the most popular Medigap plans with the highest enrollment rates nationwide.

  1. Can I Enroll in Medigap and Medicare Advantage?

It is illegal and inadvisable to enroll in both plans. Enrolling in both plans means neither would become your primary coverage, leading to a service denial. Also, it could leave you paying out-of-pocket for all your healthcare services, regardless of having both coverages. 

  1. Must I Enroll in Medicare if I Work Past 65?

Although it is not mandatory, it is advisable to enroll in Medicare Part A coverage once you become eligible.

However, if you delay Medicare Part A, you will be able to enroll later during the general or special enrollment periods.

But, if you delay enrollment to the General Enrollment period, you will pay late enrollment penalties. 

  1. Which Medigap Is Most Comprehensive?

Studies show that Medigap F is the most comprehensive Medicare Supplement Plan. The plan covers Medicare deductibles and all copays and coinsurance, leaving you with nothing out-of-pocket.

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