What is a Medicare Supplement Insurance Plan or Medigap?

Original Medicare pays for many major healthcare costs like hospital stays and doctor visits. But it does not cover all expenses. Medicare Supplement Insurance plans, also called Medigap Plans, are private insurance policies that help fill coverage gaps in Original Medicare.

If you are enrolled in Original Medicare and want to limit out-of-pocket costs, adding a Medicare Supplement Plan is an option to consider. Understanding what these plans cover and how they coordinate with Medicare can help you decide if supplementary coverage is right for you.

What is Medicare Supplement Insurance or Medigap?

Medicare Supplement Insurance refers to private health insurance policies that pay for some costs not covered by Original Medicare, which includes Medicare Part A (hospital insurance) and Part B (medical insurance).

These supplemental plans cover certain deductibles, copayments, and coinsurance amounts associated with Original Medicare. Adding a Medicare Supplement Plan helps pay your share of healthcare costs, providing more complete coverage.

Medicare Supplement Plans are also referred to as Medigap Plans because they help fill in the “gaps” in Original Medicare benefits.

How Do Medicare Supplement Insurance Plans Work?

Medicare Supplement Insurance plans are offered by private insurance companies. They are standardized to cover specific portions of Medicare out-of-pocket costs:

• Medicare Part A deductible for inpatient hospital care
• Medicare Part B deductible for doctor visits and outpatient services
• Medicare coinsurance amounts for hospital and skilled nursing facility care
• Emergency foreign travel medical costs up to plan limits

Plans may also cover extras like excess physician charges above Medicare’s approved amount.

When you have a Medicare Supplement Plan, you still pay your Part B premium. Your Medigap policy pays its share of Medicare costs directly to healthcare providers. Then you just pay any remaining balance not covered by Medicare or your Supplement Plan.

Medigap Plans do not include prescription drug coverage. You would need to enroll in a separate Medicare Part D prescription drug plan.

Benefits of Medicare Supplement Insurance

Reasons to consider adding a Medicare Supplement Plan include:

• Limits out-of-pocket costs associated with Original Medicare
• Provides nationwide coverage including when traveling
• Lets you choose any healthcare provider who accepts Medicare
• No need for referrals to see specialists
• Guaranteed renewable plans as long as you pay premiums
• Automatic enrollment without health screening if within Medigap open enrollment period

For retirees wanting comprehensive coverage with Original Medicare and lower financial liability, a Medicare Supplement Plan offers important protections.

What do Medicare Supplement Plans Cover?

There are 10 standardized Medicare Supplement Plans (Medigap Plans A – N). Each offers a different combination of basic and extra benefits.

Medigap Plans cover:

• Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used
• Medicare Part B coinsurance or copayment amounts
• Blood transfusions (first 3 pints)
• Part A hospice care coinsurance or copayment

Some plans may also cover:

• Skilled nursing facility care coinsurance
• Part A and Part B deductibles
• Part B excess charges above Medicare’s approved amount
• Emergency foreign travel medical care

Always confirm details as benefits can vary slightly by plan. Medigap Plan A provides only basic core benefits while Plan F offers the most comprehensive coverage.

What Do Medicare Supplement Plans Not Cover?

Important exclusions to understand about Medicare Supplement Insurance include:

• Prescription drugs – Medigap Plans do not include Medicare Part D prescription medication coverage. You would need to purchase a separate Medicare Prescription Drug Plan.
• Vision, dental, hearing care – Routine vision, dental, and hearing services are not covered. You would need to buy standalone insurance policies for these needs.
• Long-term care – Medigap only pays limited coinsurance for skilled nursing stays and does not cover extended custodial, at-home, or long-term care.
• Emergency care abroad – Only a few plans cover foreign travel emergencies. Many exclude foreign services.
• Spouses – Spouses must buy individual Medigap policies. Couples cannot be covered by one shared policy.

Always check your specific Medicare Supplement Plan details to confirm covered services since benefits can vary.

When Can You Enroll in a Medicare Supplement Plan?

The best time to enroll in a Medicare Supplement Plan is during your Medigap Open Enrollment Period which lasts for 6 months:

• Begins the month you turn 65 and enroll in Medicare Part B
• Ends 6 months after you turn 65

During this time frame, you have a right to buy any Medicare Supplement Plan in your state. Insurance companies cannot deny you coverage or charge more based on health status. This enrollment period provides important protections.

You may be able to enroll outside of the 6 month window if you qualify for certain special circumstances, such as losing other coverage. But insurers can consider your health and medical history in determining eligibility and premiums.

How Do I Choose a Medicare Supplement Plan?

Follow these steps when selecting a Medicare Supplement Insurance policy:

• Review covered services for each of the Medicare Supplement Plans (Medigap Plans A through N)
• Consider your expected healthcare needs and budget
• Compare Medicare Supplement Plan rates from multiple insurance providers
• Make sure the insurance company offering the plan is reputable
• Look for insurers who have strong financial ratings
• Check policy exclusions and restrictions carefully
• Enroll before your Medigap Open Enrollment Period ends to receive the best pricing and guarantees

Meeting with an independent insurance broker who specializes in Medicare can help you identify the optimal supplemental plan for your personal situation.

Should I Get Medicare Supplement Insurance?

Medicare Supplement Plans provide value for many Original Medicare enrollees by limiting out-of-pocket costs for covered medical services. These plans can provide financial peace of mind.

Key considerations include:

• Do you need coverage for expenses not paid by Original Medicare coverage?
• Are you concerned about unpredictable healthcare costs?
• How much can you afford to pay in premiums?
• Does your doctor accept assignment with Medicare?
• Do you want nationwide coverage and provider choice flexibility?

For retirees who travel or desire comprehensive protection from Medicare costs, a Medicare Supplement Plan can be advantageous. But they do come at an additional premium cost to factor into your Medicare Planning.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare Questions. Give Green Insurance Agency a Call at 904-717-1176. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.