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Medigap

Medicare Supplement Insurance, or Medigap, is a private health insurance policy that is designed to supplement Original Medicare (Part A and Part B). It is provided by private health insurance companies but run by Medicare. Medigap helps pay some of the health care costs that Original Medicare does not cover (such as copayments and coinsurance) as well as certain services that Medicare doesn’t cover at all.

Every Medigap policy must follow both federal and state laws. Medigap policies are standardized and identified by letters A-L. Each policy must offer the same basic benefits no matter which health insurance carrier sells it.

Policy A offers the basic and core benefits while the other eleven policies contain the basic benefits as well as a few additional benefits. Plan A offers the following benefits:

  • Part A Hospital Coinsurance for Days 61-90
  • Part A Hospital Lifetime Reserve Coinsurance for Days 91-150
  • 365 Lifetime Hospital days beyond Medicare coverage
  • Part B 20% Coinsurance
  • Part A and Part B 3 pint blood deducible

The remaining policies (B through L) offer a different combination of the following benefits:

  • Part A Skilled Nursing Facility Coinsurance for days 21-100
  • Part A hospital deductible
  • Part B deductible
  • Foreign Travel Emergency coverage
  • At Home Recovery
  • Preventive medical care

When you buy a Medigap policy, you must have Medicare Part A and Medicare Part B. You will have to pay a premium for both Medicare Part B and your Medigap policy.

Benefits that are not covered under any Medigap policy include:

  • Dental Care
  • Hearing Aids
  • Prescription drug costs that exceed $3,000 per year
  • Private duty nursing
  • Skilled Nursing care after 100 days
  • Vision Care

Open Enrollment Period

The open enrollment period begins the first month you turn 65 and are enrolled in Medicare Part B. The open enrollment period lasts for 6 months. If you submit a Medigap application during this period, a company cannot reject you because of your health or charge you more due to your health problems.

Unfortunately there is no open enrollment period for people who are over 65 and have been enrolled in Medicare Part B for more than 6 months. You may still apply for a Medigap policy, but at this time you are subject to medical underwriting and pre existing condition exclusions. Health insurance companies are no longer required to offer you coverage and may choose to not insure you.