Medicare Supplement Insurance

Medicare is federal insurance for seniors and people with disabilities. It’s paid for jointly by the federal and state governments and covers things like doctor’s appointments, prescriptions, and specialized care.

Just like private health insurance, Medicare also has exclusions and limits to its coverage. In situations where Medicare falls short of covering all of someone’s health expenses, they can purchase supplemental insurance, also called Medigap, to pay for whatever Medicare won’t.

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Medicare Supplement Insurance

What is Medicare Supplement Insurance?

Medicare Supplement Insurance, or Medigap, is an extra insurance policy that’s designed to be added to existing Medicare in order to cover any out-of-pocket costs that Medicare won’t cover. While Medicare is provided by the government, Medigap is a private health insurance policy.

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What is Medicare Supplement Insurance?

HOSPITALS, HOSPICES, AND TESTS

Medigap will help pay for expenses that are not covered by Medicare Part A, which primarily deals with hospital treatments (surgeries, hospice care, inpatient hospital care). The Medicare supplement will help cover copays and coinsurance.

NECESSARY AND PREVENTATIVE CARE

Medicare Part B covers medical costs associated with preventative or essential medical services. Especially since “essential” can be so widely interpreted, Medicare Part B will often reject claims for a variety of reasons. In this situation, Medigap can help cover the remainder of the costs.

COSTS AFTER LIMITS

Like any health insurance policy, Medicare places a limit on the amount it will cover in a single procedure or year. Especially in emergency or injury circumstances, it’s not uncommon for patients to exceed this limit amount. In these situations, Medigap will kick in after the Medicare funds are exhausted so that the patient can continue to receive affordable care.

NON-MEDICARE INSURANCE

Medigap is gap insurance, but it can only fill gaps in Medicare policies. Those with private health insurance need to purchase gap insurance that’s designed for private healthcare policies.

VISION AND DENTAL

Much like standard health insurance, Medigap does not cover vision care or dentistry.

GLASSES AND HEARING AIDS

Unfortunately, Medigap cannot be used to purchase particular pieces of medical equipment, like glasses and hearing aids.

SENIORS AND PEOPLE WITH DISABILITIES

Medigap is only available to people who are already on a Medicare plan. Since Medicare is designed for seniors and people with disabilities, these are the same demographics that are eligible for Medigap insurance as well.

SENIORS AND PEOPLE WITH DISABILITIES

Medigap is only available to people who are already on a Medicare plan. Since Medicare is designed for seniors and people with disabilities, these are the same demographics that are eligible for Medigap insurance as well.

HIGH-USAGE PATIENTS

Though Medicare recipients are the only patients who are eligible for Medigap insurance, not all Medicare patients need Medigap insurance. Patients who don’t have a lot of medical expenses are more likely to have all of their costs covered by Medicare, but those who use medical services frequently are more likely to need help covering costs.

HIGH-USAGE PATIENTS

Though Medicare recipients are the only patients who are eligible for Medigap insurance, not all Medicare patients need Medigap insurance. Patients who don’t have a lot of medical expenses are more likely to have all of their costs covered by Medicare, but those who use medical services frequently are more likely to need help covering costs.

You may want to consider enrolling in a Medigap policy if you:

  • Are 65 or older OR have a disability
  • Are currently or about to be enrolled in Medicare
  • Have consistent routine medical costs
  • Are prone to health incidents that require non-routine care
  • Have found that Medicare is insufficient to cover your medical costs
If you’re on Medicare but are finding that you’re still frequently left with additional out-of-pocket costs after Medicare has paid for your expenses, you may want to add supplemental insurance.

Just like regular health insurance, there are enrollment periods during which Medicare patients are allowed to enroll in a Medigap policy.
Typically, Medicare patients are eligible to enroll in Medigap up to six months after they enroll in Medicare Part B. After this point, patients can only enroll if they:

  • Lost their original Medigap coverage through no fault of their own
  • Lost their health coverage
  • Joined a PACE plan when they were first eligible for Medicare
If none of these situations apply, insurance companies are not obligated to sell you Medigap insurance. If you are offered Medigap coverage, it may come at a higher price than it would during an eligible enrollment period.

No. It is illegal to sell Medigap coverage to patients on a Medicare Advantage Plan unless they are eligible and actively planning to switch to Original Medicare in the next 60 days. Typically, Medicare Advantage Plan users become eligible to switch to Original Medicare if they:

  • Enrolled in Medicare Advantage when they first became eligible, and have been enrolled for less than a year
  • Are moving out of their Medicare Advantage Plan’s coverage area
  • Are enrolled in a Medicare Advantage Plan that is leaving Medicare
  • Are enrolled in a Medicare Advantage Plan that is ending coverage where they live
In these circumstances, Medicare Advantage Plan patients can make plans to switch to Original Medicare and, upon doing so, will become eligible to enroll in a Medigap plan.

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