Medigap/Medicare Supplements insurance are coverages that help offset some of the medical bills that Part A and B (Original Medicare) doesn’t cover. However, Original Medicare does pay for most of the healthcare services and Medical supplies (80%), it is still up to the client to pay the remaining bills (20%). This is where Medigap/Medicare Supplements come to play. Example:
Medigap helps pay with:
- Coinsurance
- Deductibles
- Copayments
Note: Medigap/Medicare Supplements are sold by private companies such as UHC, Aetna, etc.
There are several Medigap plans a client to choose from such as:
| Medicare Plan Benefits | Plan A | Plan B | Plan C | Plan D | Plan F* | Plan G | Plan K | Plan L | Plan M | Plan N |
| Medicare Part A Coinsurance & Hospital CostsUp to an additional 365 days after Medicare benefits are used | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B Coinsurance or Copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Blood (First 3 Pints) | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A Hospice Coinsurance or Copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility Coinsurance | X | X | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part A Deductible | X | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 50% | 100% |
| Medicare Part B Deductible | X | X | 100% | X | 100% | X | X | X | X | X |
| Medicare Part B Excess Charges | X | X | X | X | 100% | 100% | X | X | X | X |
| Foreign Travel Emergency | X | X | 80% | 80% | 80% | 80% | X | X | 80% | 80% |
*Plan F must have a Part A&B effective date prior to 01/01/2020
Now, there are a few things you need to know about Medigap.
- There’s no prescription coverage. (As of 01/01/2006)
- Must have Part A & B to purchase.
- You can purchase any Medigap policies from any licensed carriers who are within compliance with your state policies.
- You must pay a monthly premium along with your Part B premium to keep your policies active.
- Must be a U.S. Citizen or a Permanent Resident (Worked 40 quarters).
Medigap policies have many great benefits to offer such as Foreign Travel and nationwide coverage. However, there are few medical needs that they don’t cover such as:
- Vision
- Dental
- Hearing aids
- Long Term Care (Private Nurse)
Some Medigap carriers do offer discounts to help mitigate the cost. For more coverage, there are companies that sell Stand Alone Dental Insurance and other ancillaries that Original Medicare or Medigap doesn’t offer.
With that said, Medigap carriers must meet each state and federal law to protect consumers. The insurance company cannot cancel your medigap policy as long as you pay the premium. It is also illegal for anyone to sell you a medigap policy if you have a Medicare advantage plan unless you are switching back to original Medicare. Also, a medigap policy only covers one person. So, if you have a spouse and they would like medigap coverage, they will have to buy a separate medigap policy. Along with purchasing Medicare Supplement/Medigap, agents must reiterate the importance of Part D (Prescription plan). Without credible coverage, the prospect or client could be subject to a penalty.
For further information and details about Medigap requirements, Part D and penalties, it can be found at Medicare.gov or call 1-800-MEDICARE.
