Medigap insurance is fairly self-explanatory in that it literally provides coverage for a ‘gap’ in policies. It is supplemental health insurance designed to help Medicare beneficiaries cover out-of-pocket costs not paid for by Medicare.
While Medicare provides essential health coverage for millions of Americans aged 65 and older, it does not cover all medical expenses, such as copayments, coinsurance, and deductibles. As a result, private insurance companies offer Medigap plans, or Medicare Supplement Insurance, to fill the gaps in Medicare coverage.
According to KFF, 12.5 million (roughly one in four) Americans enrolled in Medicare had a Medigap insurance policy in 2022, lifting the financial burden off of many individuals. Our team at HealthPlusLife is well-versed in the complexities of Medicare and Medigap insurance. We’re here to help you get the coverage you need and can offer peace of mind while you navigate this system.
Medigap is a type of health insurance policy sold by private companies to help individuals cover certain out-of-pocket costs that Medicare does not fully pay. While Medicare provides valuable coverage for hospital and medical services, it does not pay for everything.
What Medigap insurance covers:
Medicare Part A Coinsurance and Hospital Costs: Part A covers inpatient hospital care but requires coinsurance for hospital stays over 60 days.
Medicare Part B Coinsurance or Copayments: Part B covers outpatient care and certain preventive services, but beneficiaries are responsible for a 20% coinsurance for most services.
Blood: Original Medicare only covers the first three pints of blood for a transfusion. A Medigap policy may cover the cost of additional blood.
Part A Hospice Care: Medigap can cover coinsurance for hospice care under Part A.
Skilled Nursing Facility (SNF) Coinsurance: If a patient is admitted to a nursing facility after a hospital stay, Medicare covers most of the costs for the first 20 days but requires coinsurance for days 21 to 100.
Medicare Part A Deductible: Medigap can help pay the deductible required for Part A.
Medicare Part B Deductible: While Medicare Part B requires an annual deductible, Medigap plans may also help cover this cost.
Foreign Travel Emergencies: Medicare typically does not cover health care outside the United States, but some Medigap plans offer emergency coverage for international travel.
What Medigap does not cover:
Prescription drugs (for this, beneficiaries need Medicare Part D)
Long-term care (like nursing facilities)
Dental care, vision care, or hearing aids
Private-duty nursing
Routine foot care
Medigap insurance is an essential resource for many Medicare recipients. It helps mitigate the financial burden of out-of-pocket medical expenses. With a Medigap policy, individuals can be at ease knowing they have additional protection against high healthcare costs.
What Is Medigap and How Does It Work?
Medigap helps cover many out-of-pocket costs, such as copayments, coinsurance, and deductibles. This makes it a crucial option for many older adults looking for more predictable healthcare costs and additional financial protection. Medigap is meant to work alongside Original Medicare, not as a replacement for it.
Here’s how Medigap works:
Medicare as Primary Insurance: When you obtain Medicare insurance, it acts as your primary insurance. It covers most hospital and medical services, but you are still responsible for certain out-of-pocket costs.
Medigap as Secondary Insurance: A Medigap policy works as secondary insurance, stepping in to pay some or all of the costs that Medicare does not cover. Once Medicare processes a claim and determines what it will pay, the remaining eligible expenses are sent to your Medigap insurer to cover (depending on the plan you choose).
Standardized Plans: The federal government standardizes Medigap insurance policies, meaning that all Medigap plans of the same letter (e.g., Plan G, Plan F) offer the same core benefits. Premiums can differ based on the insurer, location, and other factors.
Premiums: To have a Medigap policy, you must pay a monthly premium directly to the private insurance company offering the policy. This premium is in addition to your premium for Medicare Part B.
Medigap is a valuable option for Medicare recipients who want additional coverage beyond what Original Medicare provides. Choosing the right Medigap plan based on individual needs and budget is essential. By evaluating your healthcare needs and comparing Medigap policies, you can ensure you have the coverage that best supports your health and finances.
What Is the Average Cost of a Medicare Supplemental Plan?
The average cost of Medigap insurance can vary depending on various factors, including the plan type, the insurance provider, your location, and your age. In general, the monthly premium for a Medigap plan ranges from $100 to $300, though it can be higher or lower depending on these factors.
Medigap plans are standardized, meaning the benefits are the same regardless of which insurer offers the plan. However, insurance companies can set their own premiums, which can differ significantly. On average, for a Plan G (one of the most popular and comprehensive Medigap plans), premiums tend to range from about $120 to $200 per month for a healthy 65-year-old. The premiums generally increase with age, so if you sign up for a Medigap plan at 65, your premium might rise as you age.
Location is also a factor in determining costs. Companies charge different rates based on your state or region. For example, premiums tend to be more expensive in urban areas or places with a high concentration of elderly individuals, while rural areas might see more affordable rates.
Other elements influencing the cost include whether you smoke or have pre-existing conditions. Some companies offer discounts for non-smokers or those who are married and apply for a joint plan.
What Is the Deadline for Choosing a Medicare Supplement Plan?
The Medigap Open Enrollment Period consists of a six-month window that starts when you are 65 or older and simultaneously enrolled in Medicare Part B. During this period, you can purchase any Medigap insurance plan without medical underwriting or denial because of pre-existing conditions.
If you don’t sign up for a Medigap plan during this period, you may face higher premiums or be denied coverage when applying later.After the Medigap Open Enrollment Period ends, you can still apply for a Medigap plan anytime, but the insurance company may require medical underwriting. This means they could assess your health history and charge you higher premiums or refuse coverage based on pre-existing conditions. Some states offer protections or other enrollment periods that can help in certain situations.
Contact HealthPlusLife About Medigap Insurance
To get more information or to inquire about Medigap insurance plans, you can contact HealthPlusLife directly at 888-828-5064. We offer a range of Medicare Supplement options and can help you select the right plan based on your healthcare needs and budget.
Whether you’re approaching 65 and are new to Medicare or looking to switch insurers, our team can assist with comparing different Medigap policies, explaining coverage details, and helping you understand the enrollment process. We are committed to ensuring you find a comprehensive coverage plan that fits your financial and healthcare needs.
Johanna Karlsson Johanna Karlsson is a veteran health and life insurance professional licensed in 50 states. She relocated from the countryside in the south of Sweden and has not looked back. After coming to the United States to attend university, she gained her degree in Public Relations. She brought her public relations skills to a local international health insurance where she discovered a new passion in insurance. After years with that company, Johanna now joins HealthPlusLife to help build a team of licensed insurance agents ready to meet your insurance needs.
