Understanding How Medigap Works for Medicare Beneficiaries

Medigap plans are standardized, meaning they offer the same benefits regardless of the insurance company selling them. This standardization helps ensure that beneficiaries receive the same level of coverage.

Medigap plans are divided into 10 different lettered plans, each offering a unique combination of benefits. Plan A is the most basic, while Plan F offers the most comprehensive coverage.

To qualify for a Medigap policy, you must be enrolled in Medicare Part A and Part B. This is because Medigap supplements the gaps in Original Medicare coverage.

Medigap is Medicare supplemental insurance sold by private companies to help cover original Medicare costs, such as deductibles, copayments, and coinsurance.

There are 10 Medigap plans available: A, B, C, D, F, G, K, L, M, and N.

A Medigap policy only pays out after both you and Medicare have paid your share of the costs for medical services.

Medigap will also cover emergency medical fees when you’re traveling outside the United States in some cases.

You can keep your existing Medigap plan if you already have one, such as Plan C or Plan F, even if it's no longer for sale to new Medicare enrollees.

If you were eligible for Medicare before January 1, 2020, you can still buy Plan C or Plan F.

Medigap insurance helps fill in the expense 'gaps' that Original Medicare (Parts A & B) doesn’t cover, paying for costs like co-pays, co-insurance, and deductibles that aren't covered by Medicare.

This type of insurance is sold by private insurance companies and is also known as Medicare Supplement Insurance. It's not required to buy once you're enrolled in Medicare, but it can be a helpful tool.

The average monthly premium for a Medigap policy is around $155, according to ValuePenguin.

Medicare Supplement Insurance is a type of insurance policy sold by private insurance companies that helps fill in the expense 'gaps' that Original Medicare doesn't cover.

It's not required to buy once you're enrolled in Medicare, but it can be a helpful tool. A Medigap policy can help pay for some of the remaining costs, such as co-pays, co-insurance, and deductibles, which Original Medicare only covers about 80% of.

You pay a monthly premium, which is in addition to your Part B premium. The average monthly premium will be $155 this year, according to ValuePenguin.

A Medigap policy only covers one person, so spouses need to buy separate policies. If you're enrolled in a Medicare Advantage Plan, a Medigap policy is not available to you.

The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period, which begins the month you turn 65 and are enrolled in Medicare Part B. During this time frame, you are guaranteed to be approved for any Medigap policy sold in your state, regardless of your health.

Community-rated Medigap policies charge the same monthly premium regardless of age, although outside factors such as inflation may affect the premium.

Medigap policies can be complex, and there are a few other factors to consider when choosing a plan.

Only four states offer Medicare beneficiaries guaranteed access to Medigap policies, regardless of health status.

If you have a preexisting health condition, you may be charged a higher premium for your Medigap policy in most states.

These extra costs can add up quickly, so it's essential to factor them into your decision-making process.

Medigap plans cover at least some portion, if not all, of Medicare Part A coinsurance and hospital fees. They also cover Medicare Part A hospice coinsurance or copayment costs, Medicare Part B coinsurance or copayment costs, and blood transfusion costs, up to the first 3 pints.

Some Medigap plans also cover skilled nursing facility costs, Medicare Part A deductible, Medicare Part B deductible, Medicare Part B excess charges, and emergency medical costs during foreign travel. For example, Plan C covers skilled nursing facility costs, while Plan F covers Medicare Part B excess charges.

Here's a breakdown of what each Medigap plan covers:

You can buy a Medigap policy to supplement your Original Medicare coverage, but you can't have both a Medigap policy and a Medicare Advantage Plan.

There are specific rules to keep in mind when it comes to switching between Medigap and Medicare Advantage Plans. If you drop a Medigap policy to join a Medicare Advantage Plan for the first time, you'll have a 12-month trial right period to get your Medigap policy back if the same insurance company still sells it.

You can buy a Medigap policy from any insurance company in your state if you switch to Original Medicare within the first year of joining the Medicare Advantage Plan. This is a one-time opportunity to enroll in a Medigap policy without medical underwriting.

If you're switching back to Original Medicare from a Medicare Advantage Plan, you can contact your Medicare Advantage Plan to see if you're able to disenroll. This will allow you to buy a Medigap policy from the same insurance company that sold it to you initially.

You may also have an opportunity to enroll in a Medicare drug plan at the same time you buy a Medigap policy or switch back to Original Medicare from a Medicare Advantage Plan.

Medigap plans cover a range of medical expenses, but the specifics vary depending on the plan. Most Medigap plans cover at least some portion of Medicare Part A coinsurance and hospital fees, as well as Medicare Part B coinsurance or copayment costs.

Medicare Part A deductible is covered by some Medigap plans, including Plan B, Plan C, Plan D, Plan F, and Plan G. However, Plan A does not cover this expense.

Some Medigap plans also cover skilled nursing facility costs, blood transfusion costs, and foreign travel medical costs. Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N cover 80% of foreign travel emergency healthcare services.

Here's a breakdown of what each Medigap plan covers:

Keep in mind that some Medigap plans may cover other expenses not listed here, and not all plans are available in all states. It's essential to review the specific plan details and consult with a licensed insurance professional to determine the best coverage for your needs.

Medigap plans come with some associated costs, which can vary from plan to plan. Original Medicare and Medigap both have costs that you'll need to consider.

One thing to keep in mind is that Medigap policies are priced or "rated" according to various factors. This can influence the amount you pay for your plan premium.

The costs of Medigap plans can be influenced by how they're rated, which can impact your premium payments.

Medigap plans come with some costs associated with them, which can vary from plan to plan.

Original Medicare and Medigap plans both have costs, and these costs can differ depending on the specific plan you choose.

Your monthly premium amount for a Medigap policy will be determined based on your age, and it's a good idea to consider this when selecting a plan.

Attained age-rated Medigap policies charge higher premiums as you age, making them more expensive as you get older.

This means that if you enroll in an attained age-rated policy when you're young, you'll likely pay less for your premium than someone who enrolls at an older age.

Medigap policies can help alleviate out-of-pocket costs, but not all plans are created equal. Only two Medigap policies, K and L, have limits on how much you'll pay out of pocket.

If you choose a Medigap policy that doesn't cover most or all of your Medicare fees, you'll still have to pay out-of-pocket for these costs. This can be a significant burden, especially if you have ongoing medical expenses.

Some Medigap plans, like Plans K and L, have out-of-pocket limits. For Plan K, the limit is $7,060. For Plan L, the limit is $3,530. These limits can provide some financial protection against unexpected medical expenses.

Here's a brief rundown of the out-of-pocket limits for Plans K and L:

Keep in mind that these limits only apply to Plans K and L, and not all Medigap policies have out-of-pocket limits.