What Is A Medigap Plan And How It Supplements Medicare

A Medigap plan is a type of supplemental insurance that fills in the gaps in Medicare coverage. Medicare has four parts: A, B, C, and D, but some costs are still left uncovered.

Medigap plans are standardized, meaning they offer the same benefits regardless of the insurance company selling them. There are 10 different Medigap plans available, labeled A through N.

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.

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

You can enroll in a Medigap policy during specific times, known as the Medigap enrollment periods. There are two main periods: the initial enrollment period and the open enrollment period.

The initial enrollment period is a 7-month window that starts 3 months before, ends 3 months after, and includes the month of your 65th birthday. This is the best time to apply for a Medigap policy, as insurance companies are required to sell you a policy during this time.

If you miss the initial enrollment period, you can apply for a Medigap policy during the open enrollment period, which begins when you enroll in Part B. This period lasts for 6 months.

Insurance companies aren't required to sell you a Medigap policy, especially if you're under age 65, so it's essential to act quickly during these enrollment periods.

Medicare recipients under 65 have unique challenges when it comes to purchasing Medigap policies. Recipients of Social Security Disability Insurance (SSDI) benefits or patients with end-stage renal disease (ESRD) are entitled to Medicare coverage regardless of age.

Under federal law, insurers are not required to sell Medigap policies to people under 65, and even if they do, they may use medical screening. This can be a hurdle for those who need additional coverage.

A slight majority of states require insurers to offer at least one kind of Medigap policy to at least some Medicare recipients in that age group. Of these states, 25 require that Medigap policies be offered to all Medicare recipients.

In California, Massachusetts, and Vermont, Medigap policies are not available to ESRD patients. This means that those in these states with ESRD may face even more challenges when trying to purchase Medigap coverage.

You can enroll in Medigap during the initial enrollment period, which is 3 months before, 3 months after, and the month of your 65th birthday. This is the best time to apply for a Medigap policy.

Insurance companies aren't required to sell you a Medigap policy, especially if you're under age 65. This means you might have a harder time finding a company that will sell you a plan if you miss this enrollment period.

You can also enroll in Medigap during the open enrollment period, which begins when you enroll in Part B. If you're turning 65, this period runs until 6 months after you turn 65 and have enrolled in Part B.

Here are the key Medigap enrollment periods to keep in mind:

Medigap plans are standardized, which means they offer the same benefits, regardless of the insurance company providing the plan. This makes it easier to compare plans and choose the one that best suits your needs.

All Medigap plans cover at least some portion of Medicare Part A coinsurance and hospital fees, 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.

There are 10 different Medigap plans, labeled A through N, and each plan has its own unique benefits and costs. Plan A is the most basic plan, covering only Medicare Part A coinsurance and hospital fees, as well as blood transfusion costs. Plans B through J offer additional benefits, such as coverage for Medicare Part B coinsurance or copayment costs and Medicare Part A deductible.

Here's a breakdown of the benefits covered by each plan:

Keep in mind that these plans are not the same as Medicare Advantage plans, which offer additional coverage beyond what original Medicare provides.

Medigap plans help cover original Medicare costs, such as deductibles, copayments, and coinsurance. These costs can be significant, with Medicare Part A and Part B not having out-of-pocket limits.

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.

A Medigap plan will pay copayment and coinsurance amounts, depending on the policy you choose. For example, Medicare Part A has a daily coinsurance of $408 per day for the 61st through 90th day of hospitalization, and $816 per day for lifetime reserve days.

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

Keep in mind that some Medigap plans, like Plans C, F, E, H, I, and J, are no longer available for new Medicare enrollees, but existing policyholders can keep theirs.

Medicare Supplement insurance costs can vary significantly. The 2020 Medigap Price Index found that someone turning 65 could pay more than three times more for virtually identical coverage.

You might be surprised to learn that costs for Medigap insurance vary widely. The lowest cost for a male age 65 was $109-per-month available in Dallas.

Medigap plan costs are influenced by various factors, including where you live. The highest cost was $509-per-month in Philadelphia.

There are some costs associated with both original Medicare and Medigap, which vary from plan to plan.

Deductibles are a crucial part of understanding your Medicare costs. For 2024, the deductible amounts for parts A and B are $1,632 for Part A per benefit period and $240 for Part B for the year.

Some Medigap plans may pay for a portion or all of these deductible amounts. In fact, Plan C, Plan F, and Plan G cover the Medicare Part B deductible, while Plan C, Plan F, and Plan D cover the Medicare Part A deductible.

Here's a breakdown of the deductible coverage for each Medigap plan:

Keep in mind that not all Medigap plans cover deductibles, so be sure to review your policy carefully to understand what's covered.

Medigap policies are priced or "rated" according to various factors, which can influence the amount you pay for your plan premium.

The way a Medigap policy is rated can make a big difference in your premium costs. Attained age-rated policies charge higher premiums as you age, and your monthly premium amount is determined based on your age. This means that these types of policies become more expensive as you get older.

There are costs associated with both original Medicare and Medigap, which vary from plan to plan.

Community-rated Medigap policies charge the same monthly premium regardless of age. This means that whether you're 65 or 85, your premium will stay the same.

Inflation may affect the premium, but your age will never be a factor. This can be a relief for those who worry about their premiums increasing as they get older.

Medigap policies rated in this way can provide more predictable costs, making it easier to budget for your healthcare expenses.

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

Some states have different rules, so it's essential to check your state's specific regulations.

In other states, if you have a preexisting health condition, you may be charged a higher premium for your Medigap policy.

This means that your health status can impact the cost of your Medigap policy in certain states.