What Is Medigap Coverage and How Do I Get It?

medicine-1419753-1599x1199Navigating the complex world of Medicare is tough enough. You read up on all of your options, weigh those options and finally choose a plan. THEN you realize there is more to discover — Medigap policies. You may be thinking, “What? My Medicare has gaps in it?” And the answer is, yes it does. Medigap insurance policies kick in where Medicare leaves off. Here’s what you need to know.

What is Medigap?

Medigap is Medicare supplemental insurance. These policies are sold by private companies and are designed to cover some of the health care costs that Medicare doesn’t cover. Examples of these items include coinsurance, copayments and those pesky deductibles. Some policies also offer additional coverage for services not covered under Medicare, like health care provided outside of the country. It’s important that you realize that Medigap is not a Medicare Advantage Plan. Those plans are the avenues through which you tap into your Medicare benefits. Medigap supplements them.

How Does Medigap Work?

Here’s an example of how Medigap policies would kick in. You go to the doctor and pay your copay. Your doctor bills Medicare and receives payment for those services that are covered. Then Medigap pays its share. There are some services these plans do not cover, though, such as vision, dental, hearing aids and long-term care. Read your policy carefully for all exclusions.

What Should I Know About Medigap Plans Before I Purchase?

Here are six things you should know about these gap plans:

  1. You must have Medicare Part A and B in order to qualify for a Medigap plan.
  2. You will pay a private insurance company a monthly premium for your plan. This is in addition to your Part B Medicare premium.
  3. Medigap policies are only for single individuals. If you and your spouse both wish to have them, you will need to purchase two policies.
  4. Medigap policies are all guaranteed to be renewable. There are no limitations based upon your current health, and they cannot cancel your policy as long as you have faithfully paid your premiums.
  5. Medigap policies do not have prescription drug coverage. This is only offered through Medicare Part D.
  6. You can purchase a policy from any company in your state that is properly licensed to sell Medigap policies.

When Can I Buy a Medigap Policy?

The best time to buy a Medigap policy is during your six-month Medigap open enrollment period. When you purchase one during this time period, you can buy any plan you wish, even if you have health problems. Enrollment eligibility happens the month in which you turn 65 and enroll in Medicare part B. If you don’t buy a policy then, you may be eligible for a policy, but they will be able to take pre-existing health concerns into account and may charge you more. There is no guarantee that you will be able to obtain a policy once your enrollment period ends.

If you’re enrolling in Medicare and Medigap for the first time, it can be confusing. Errand Works can help you. We have developed an individualized Health Insurance Life Preserver to take the confusion out of choosing health insurance coverage, including Medicare. Based on your specific needs and finances, our Health Insurance Analyst will prepare 2-3 suggestions of comprehensive plans which best fit your needs.

Errand Works does not sell insurance, and we do not have any financial stake in our suggestions for coverage.  We simply provide guidance in an easy-to-understand format which will put your mind at ease when making these choices.

To get started or for more information, please contact Errand Works or call 703-881-1599.