While there are no significant changes to policy governing Medigap plans in 2017, if you are a newcomer to Medicare, start here. Increasing your knowledge little by little is a smart move. One that will help you not feel overwhelmed, as well as give you a head start when enrollment season comes around, or when your 65th birthday nears.
The difference between Medicare, Medigap, and Supplemental Plans
First, the basics. Medicare is the overarching health insurance program provided by the government for those who are 65 or older. Within Medicare, there are various parts that cover different aspects. Part A helps to cover expenses accrued during hospital stays. Part B helps to cover outpatient care and other doctors’ services and medical supplies. Part C is also called Medicare Advantage, which uses private insurance companies to provide you with Part A and Part B benefits.
Part D provides coverage support for drug costs. Medigap, on the other hand, differs in that it provides further coverage for those who are already signed up to Medicare Part A and Part B.
Who is eligible for Medigap?
Medigap, as the name implies, helps to cover some of the gaps that traditional Medicare does not cover in total. But you must be enrolled in both Medicare Part A and Part B in order to qualify for buying a Medigap plan. There are other restrictions regarding application date and the terms of the policy type you wish to purchase. But the main requirement is to first have Medicare Part A and Part B.
Take note that if you are enrolled in any kind of Medicare Advantage plan, you do not need a Medigap plan.
What does Medigap cover?
Medigap consists of lettered policies from letters A through to N. With an A letter policy covering just the basics that make up what Medigap offers.
A basic Medigap Plan A policy includes…
- Coinsurance and hospital costs up to an extra 365 days after Medicare benefits are used up for Medicare Part A
- Coinsurance or copayments for Medicare Part B
- Blood (first 3 pints)
A Medigap Plan B policy is provided by the government and is available in all states. It is designed to fill gaps in Original Medicare, Parts A and B. It provides coverage for services that are medically necessary. Along with preventative care services.
A Medigap Plan C policy focuses on giving seniors more coverage in their health insurance related to senior living costs.
The lettered policies increase in coverage as you move toward N.
Medigap plans are provided by private insurance companies but all cover the same aspects, which are set by the government. Massachusetts, Minnesota, and Wisconsin and have different Medigap policies than the other 47 states. So bear that in mind if you are applying in these states.
What is not covered in a Medigap policy?
The following are not covered by any of the lettered Medigap policies…
- Long-term care (care in a nursing home)
- Routine vision or dental care
- Private-duty nursing
- Hearing aids
Some other things you should know
Open enrollment for a Medigap plan is six months beginning from your 65th birthday. But you need to be signed up to Medicare Part B. So keep an eye out for that milestone birthday! Additionally, you can also sign up within six months of enrolling in Medicare Part B.
Remember, if you try to buy a Medigap policy outside of these timeframes you will not be guaranteed coverage, and your rates may be higher. Outside of Medigap Plan A, insurance companies are not obligated to offer all Medigap policies. So you may need to shop around to find the insurance provider that sells the policy you want. These various points make it essential to do your homework in advance so that you can get the right coverage at a good price.