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Understanding Medigap: What It Covers and What It Costs

By November 1, 2022Healthcare

 MedigapBasic Medicare policies pay for a significant portion of medical expenses for Americans 65 and older (and younger Americans with certain disabilities). However, much like employer-provided or individual-market private medical insurance, Medicare policies still make the policyholder responsible for their deductible, copays, and coinsurance. And there are some services basic Medicare policies don’t cover at all, such as non-emergency care outside of the United States.

This is where a Medigap policy can step in. Medigap policies are supplemental medical insurance you can purchase to help cover the costs not covered by your base Medicare policy. While you must have Medicare part A and part B plans to qualify, Medigap plans are purchased privately, and you are responsible for paying the entire premium. The government does not cover Medigap premiums.

Medigap plans are not the same as Medicare Advantage plans. They do not cover the things you see in advertisements for Medicare Advantage plans, like dental, vision, or hearing care. Medicare Advantage plans are a replacement for basic Medicare plans, while Medigap policies are a supplement. You are not allowed to purchase a Medigap policy if you also have Medicare Advantage. They also do not typically cover long-term care.

Once you enroll in Medicare part B and you are at least 65 years old, you have a six-month Medigap open enrollment period. During this time, all Medigap policies are guaranteed issue, meaning that insurers cannot deny you coverage or charge you higher rates because of your health history. However, Medigap policies do sometimes refuse to cover treatment for documented pre-existing conditions for the first six months, though your basic Medicare policy will still cover those conditions form the beginning. If you try to purchase a Medigap policy later, you will no longer have these guaranteed issue protections and will likely be charged higher premiums.

Here at Kamm Insurance Group, we understand that Medicare coverage can be complicated, with all of its different parts and supplemental coverage options. Our health insurance agents would be happy to help you wade through your options and choose the best ones for you. You can visit our eHealth site to start looking at plans now, and you can call or email us at any time for assistance.


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