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What is Medigap Coverage


When approaching Medicare eligibility, you will have a myriad of questions on your mind. Specifically, you are likely to wonder: what is Medigap coverage?

A Medicare Supplement plan, also known as Medigap, is a secondary coverage option for Medicare. Available through private insurance companies, these plans pay after Original Medicare pays its portion.

Below, we explain the basics you should know about Medigap coverage.

What is Medigap and How Does it Work?

Understanding how Original Medicare (Part A and Part B) works is essential to know why Medigap plans exist. Primarily, Medigap policies cover the balance for most medically necessary services Original Medicare covers.

That balance is the 20% coinsurance after Original Medicare covers 80% of your bill. Without Medigap, you may also face additional copayments.

Medicare Supplement plans fill the holes in coverage Medicare Part A and Part B leave for you to cover out-of-pocket. Depending on the plan letter, Medigap covers most, if not all, of these out-of-pocket costs and more.

If Medicare Part A and Part B will not typically cover a service, your Medicare Supplement plan also will not cover these services. Consequently, you would need to pay out-of-pocket for such services.

However, Medicare Supplement plans typically include foreign travel benefits if you have an emergency overseas. With Original Medicare alone, you do not get this coverage.

What is a Medicare Supplement?

What is Medigap Coverage Used For?

Original Medicare is not full coverage. Thus, anyone with Original Medicare coverage can benefit from a Medigap plan. Although Medicare Part A and Part B – and even Medicare Part D – pay most of your healthcare costs, there are still leftover costs that can quickly amount to high expenses.

For example, if you visit the doctor because you feel ill, Original Medicare will cover 80% of the costs after you meet the Medicare Part B deductible. Then, you are responsible for the additional 20%.

Yet, most Medigap plans will cover the 20% coinsurance, leaving you with no additional Medicare Part B out-of-pocket costs after you meet the annual deductible. Thus, Medigap plans are essential for saving money while on Medicare.

Choosing or Changing a Medigap Plan

When initially choosing a Medigap plan, everyone receives a 30-day free-look period as a trial run for their new plan. During this time, you can make changes to your plan without penalty. However, you must still pay the monthly premium.

Surrounding your initial Medicare enrollment, you have a six-month Open Enrollment Period to sign up for a Medigap plan with no underwriting health questions. This begins on your Medicare Part B effective date and ends six months later.

After your initial Open Enrollment Period, you are generally subject to underwriting health questions when making changes or applying to a Medigap plan. If making a change, we recommend you keep your current coverage until the new Medicare Supplement carrier approves your application. This prevents an unintentional lapse in coverage if you face denial.

What is Medigap vs. Medicare Advantage?

Many people think Medigap and Medicare Advantage plans are the same. However, this is not true.

When asking, What is Medigap versus Medicare Advantage? the answer is simple. Medicare Supplement plans pay secondary to Original Medicare, while Medicare Advantage assumes your Original Medicare benefits through a private insurance company that becomes your primary insurer.

You cannot enroll in Medigap and Medicare Advantage plans simultaneously. This is due to the differences in coverage provided by both plan types. You must choose one or the other to prevent coverage denials.

When you enroll in a Medigap plan, it is crucial to enroll in a Medicare Part D plan. This way, you will avoid any late enrollment penalties in the future.

How to Apply for Medigap Coverage

Now that you’ve answered the question What is Medigap?, applying for Medigap coverage can feel like a daunting task. We are happy to say it doesn’t have to be!

Our licensed agents are Medicare experts who help guide you through the enrollment process from start to finish. Give us a call or complete our Applying for Medigap coverage can feel like a daunting task, but it doesn’t have to be. Our licensed agents are Medicare experts who help guide you through the enrollment process from start to finish. Give us a call or complete our online rate form to speak with a licensed agent today.

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Medigap Plans, CMS . Accessed May 2022.
    https://www.cms.gov/Medicare/Health-Plans/Medigap#:~:text=A%20Medigap%20policy%20is%20health,Medicare%20Plan%20doesn't%20cover
  2. Whats Medicare Supplement Insurance, Medicare . Accessed May 2022.
    https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
  3. What is Medigap and Why Should I Buy it, WDOI . Accessed May 2022.
    https://www.insurance.wa.gov/what-medigap-plan-and-why-should-i-buy-it

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

4 thoughts on “What is Medigap Coverage

  1. Are there rules and time lines for leaving a medigap plan to a Medicare advantage plan?

    These commercials confuse my benes and I like to give good advice

    1. Hi Angela! If you want to leave Medigap and enroll in a Medicare Advantage plan, you can do so during the Annual Enrollment Period in October. However, be cautious when doing so. Make sure to really understand the differences between these two supplemental coverage options. Most beneficiaries leave Advantage to go to Medigap, not the other way around. There are many reasons why some may find Advantage plans are bad for their healthcare needs. The good news is, if you want to give Advantage a try, you’ll have trial-rights to switch back to Medigap within 12-months if you’re unhappy.

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