What is Medigap, and how does it work with Medicare?

How do Medicare Supplement (Medigap) plans complement my Medicare coverage?

Medicare Supplement Insurance (also known as Medigap) is designed to work alongside Original Medicare (Parts A and B) to help cover out-of-pocket costs that Medicare does not fully pay for. Here’s how a Medigap plan can complement your Medicare coverage:

1. Covers Out-of-Pocket Costs:

   • While Original Medicare pays for a large portion of your healthcare services, it doesn’t cover everything. Medigap plans help pay for out-of-pocket costs such as:

     • Deductibles: The amount you pay before Medicare begins covering services.

     • Copayments: A fixed amount you pay for certain services (e.g., doctor visits).

     • Coinsurance: A percentage of the costs for covered services that you must pay after you meet your deductible.

2. Provides Additional Coverage:

   • Medigap plans can help cover costs for services that Original Medicare only partially covers, such as extended hospital stays or skilled nursing facility care. Some plans also provide foreign travel emergency coverage, something Original Medicare does not offer.

3. No Network Restrictions:

   • Medigap plans work with any healthcare provider who accepts Original Medicare, giving you broad access to doctors and hospitals nationwide. You won’t be restricted to a network of providers, as is often the case with Medicare Advantage plans.

4. Standardized Plans:

   • Medigap plans are standardized by the federal government, meaning each plan of the same letter (A, B, C, etc.) provides the same basic benefits, regardless of the insurance company offering it. The only difference is the premium you pay.

5. Does Not Include Prescription Drug Coverage:

   • It’s important to note that Medigap plans do not include prescription drug coverage. If you need help with medications, you will need to enroll in a separate Medicare Part D plan for prescription drug benefits.

6. Works Only with Original Medicare:

   • Medigap plans are only available to people enrolled in Original Medicare. If you have a Medicare Advantage Plan (Part C), you cannot enroll in a Medigap policy. If you decide to switch back to Original Medicare from a Medicare Advantage Plan, you can then purchase a Medigap policy.

By filling the gaps left by Original Medicare, Medigap plans can help reduce your out-of-pocket expenses and give you more predictable healthcare costs. To find out which Medigap plan is right for you or to explore your options, you can schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.