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Click On Each Question To Learn the Answer
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1. What is Medigap?
Medigap, also called Medicare Supplement Insurance, pays for the services that Medicare doesn't; it compensates for the "gaps" in Medicare coverage, including copayments and deductibles.
Medigap policies are sold by approved private insurers. All Medigap plans are regulated by the government, and all should be clearly identifiable as Medicare Supplemental Insurance. In most states, Medigap plans are standardized and identified using letters A to N.
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2. What is Medicare SELECT?
Medicare SELECT plans and Medigap Insurance plans offer similar benefits. The difference is that Medicare SELECT plans operate like managed care policies. This means that Medicare SELECT plan holders must use "in network" doctors and hospitals, and that carriers will only pay full benefits if customers use "preferred" health providers.
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3. What is the difference between a Medicare Advantage Plan and Medicare Supplemental Insurance (a Medigap plan)?
Medicare Advantage plans help people get Medicare benefits, while a Medigap policy only supplements Original Medicare benefits. Note: Medicare doesn't pay any of the costs for you to get a Medigap policy.
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4. Who is eligible for Medicare Supplement Insurance?
To qualify for a Medicare Supplement Insurance policy, you must have Medicare Part A and Part B. Medicare Supplement Insurance cannot be combined with Medicare Part C. Also, each person wishing to be covered by a Medicare Supplement Insurance policy must have their own plan -- a spouse cannot be covered under one's policy.
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5. When should I buy a Medigap plan?
The best time to buy a Medigap policy is during your Medigap open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you're both 65 or older and enrolled in Medicare Part B.
Some states offer additional open enrollment periods including those for people under 65. During this period, an insurance company can't refuse to sell you any Medigap policy, make you wait for coverage to start, or charge you more for a Medigap policy.
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6. How do Insurance companies set prices for Medicare Supplement Insurance?
Every insurance company gets to decide how it will set its prices, or premiums, for Medigap policies. There are 3 ways to determine pricing:
- Community rated, also called "no-age-rated." These premiums are not related to age. Everyone in the same geographic area pays the same, regardless of age at the time of purchase. Premiums won't go up as plan holders age, though they will increase due to Medicare's inflation adjustments.
- Issue-age-rated. These premiums are based on the age of the plan holder when he or she buys (or is "issued") the Medigap policy.
- Attained age rated. These premiums tend to be lowest, particularly for people who just turned 65. They increase as plan holders age.
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7. What does Medicare Supplement Insurance cover?
Medigap plans are designed to make up for the out-of- pocket expenses that original Medicare does not cover. Typically, that means that Medigap plans cover copayments, coinsurance, and deductibles.
Thus, if a person enrolled in traditional Medicare purchases a private Medigap health insurance policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs, and the Medigap policy will pay for anything left over.
Medigap Insurance plans are standardized nationwide, with the exception of Massachusetts, Minnesota, and Wisconsin. Therefore, plans with the same letters must offer the same coverage, no matter where you live or what insurance company you use.
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8. What won't Medigap cover?
Medigap policies typically do not cover most dental care, routine eye care, eyeglasses, routine hearing tests, hearing aids, most care when traveling outside the United States, custodial care, long-term care, cosmetic surgery, most chiropractic services, routine foot care, and acupuncture.
Also, Medigap plans do not pay for prescription drugs. To get prescription drug coverage, one must buy a standalone Medicare Part D prescription drug plan.