What is Medigap?

Medigap, also known as Medicare Supplement Insurance, is a type of private health insurance that helps cover some of the out-of-pocket costs not covered by Original Medicare. These costs include copays, coinsurance, and deductibles.
Here are some important things to consider when looking at Medigap plans:

• Medigap can help cover out-of-pocket costs not covered by Original Medicare.
• Plans vary, and each type of plan offers a different range of coverage. 
• Not everything is covered by Medigap plans, so you will need additional coverage for things like Part D prescription drugs.

How does Medigap (Medicare Supplement) work?

Since Original Medicare doesn’t cover all costs associated with care, Medigap plans are designed to fill the gaps in coverage. After Medicare pays its share for covered services, Medigap covers certain out-of-pocket costs. 

You will have two separate payments: one for Part B coverage and one for your Medigap plan. Medigap premiums are paid directly to a private insurance company. This is separate from your Part B premium, which you pay to Medicare. These premiums vary and can change yearly. 

Types of Medicare Supplement plans

While Medicare Supplement Insurance (Medigap) plans are offered through private insurance companies, the government requires the companies to offer standardized plans. Plans may vary by state. There are 10 types of Medigap plans labeled with letters. Each plan offers different levels of coverage so you can choose one that fits your health care needs and budget. 
Medicare Advantage plans, also offered through private insurance companies, combine Medicare Parts A, B, and sometimes D into one plan. 

Medigap and Medicare Advantage plans both cover some of the same benefits, but there are some important differences.

Here is how Medigap Supplement plans compare to Medicare Advantage plans:  

What does Medigap cover?

Medigap covers some of the out-of-pocket costs not covered by Original Medicare. Each plan offers different benefits, so it is important to find the best plan to fit your health care needs. Here are some of the benefits offered by Medigap plans:

1. Medicare Part A coinsurance and hospital costs: Covers the coinsurance and hospital costs up to 365 days after Medicare benefits are used up.
   
2. Medicare Part B coinsurance or copays: Helps pay for the coinsurance or copays for Part B services, like doctor visits and outpatient care.
   
3. Blood transfusion: Covers the first three pints each year.
   
4. Part A hospice coinsurance or copays: pays for the coinsurance or copays for hospice care services.
   
5. Skilled nursing facility coinsurance: Covers the coinsurance for stays at skilled nursing facilities.
   
6. Medicare Part A deductible: Helps pay the deductible for hospital or inpatient stays under Part A.
   
7. Medicare Part B deductible: Some plans cover the deductible for outpatient services under Part B.
8.  Medicare Part B excess charges: Covers the excess charges when a doctor doesn’t accept Medicare and charges more than the approved amount.
   
9. Foreign travel emergency: Provides coverage for emergency medical care when traveling outside of the U.S.
   
   Here is what each plan covers: 

What does Medigap not cover?

Medigap plans help cover many costs not paid by Original Medicare, but they do not cover everything. Understanding these limitations can help you decide if you need additional coverage to help with these expenses. 

Here are some things a Medigap plan does not cover: 

1. Prescription drugs: You will need a separate Part D plan.
2. Long-term care: Does not cover long-term services, such as nursing home stays or custodial care.
3. Vision and dental: Routine vision and dental care, including glasses and dental checkups, are not covered.
4. Hearing aids: Does not cover hearing aids or exams for fitting them.
5. Private-duty nursing.
   
6. Out-of-network care: Care received outside of the U.S. is generally not covered, except for certain emergency situations. Some plans may offer limited coverage for foreign travel emergencies.

Medicare Advantage plans offer many important benefits not covered by Medigap. These plans often include additional benefits like prescription drug coverage, vision, dental, hearing, and wellness programs. Unlike Medigap, Medicare Advantage plans may also provide coverage for routine health care needs and sometimes offer lower out-of-pocket costs for certain services. Learn more about the differences between Medicare Advantage and Medigap plans, visit Medicare Advantage vs Medicare Supplement.