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What is Medigap, and how does it work with Original Medicare?
Medigap, also known as Medicare Supplement Insurance, is a type of private health insurance designed to work alongside Original Medicare (Part A and Part B) to help cover some of the out-of-pocket costs that Original Medicare does not fully cover. Here's how Medigap works with Original Medicare:
1. Original Medicare (Part A and Part B): Original Medicare is the government-administered healthcare program that provides coverage for hospital services (Part A) and medical services (Part B) in the United States. While it offers broad coverage, it still involves certain out-of-pocket expenses for beneficiaries, such as deductibles, copayments, and coinsurance.
2. Medigap (Medicare Supplement Insurance): Medigap plans are private insurance policies that individuals can purchase to complement Original Medicare. These plans are standardized by the federal government, meaning that each plan type (e.g., Plan F, Plan G) offers the same coverage, regardless of the insurance company offering it.
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3. Coverage of Out-of-Pocket Costs: Medigap plans are designed to cover some or all of the out-of-pocket expenses associated with Original Medicare, such as:
4. Part A deductible: Medigap can cover this deductible, which applies to each benefit period when you're hospitalized.
5. Part B coinsurance or copayments: Medigap can help pay for the 20% coinsurance or copayments that you would typically be responsible for under Part B.
6. Skilled nursing facility care: Medigap can cover the coinsurance for skilled nursing facility stays after the 20th day.
7. Part B excess charges: Some Medigap plans cover Part B excess charges that can occur if your doctor charges more than the Medicare-approved amount.
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8. Choice of Doctors and Providers: With Original Medicare and a Medigap plan, you have the freedom to see any healthcare provider who accepts Medicare, without being restricted by networks. You don't need referrals to see specialists.
9. Premiums and Enrollment: Beneficiaries pay separate premiums for their Medigap policies in addition to the premiums for Part B of Original Medicare. In addition Beneficiaries pay for separate Part D Prescription Drug coverage.
10. Medigap policies are typically purchased from private insurance companies, not from CMS or Medicare itself. Medicare does not sell Medigap Supplemental Insurance.
11. You can enroll in a Medigap plan during your Initial Enrollment Period, but it's often recommended to do so during the six-month Medigap Open Enrollment Period, which starts the month you're 65 or older and enrolled in Part B. During this Initial Enrollment period, insurance companies must sell you any Medigap plan they offer, and they cannot charge you more based on pre-existing conditions.
12. IMPORTANT: If you purchase a Medigap Supplement after your initial Enrollment Period, your private policy can be medically underwritten based on your pre-existing conditions.
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13. In many cases, insurance companies are allowed to medically underwrite Medigap policies if you apply for coverage after your initial enrollment period. This means they can take your current health status into account when determining your eligibility for coverage and the cost of your premiums. However, whether they choose to medically underwrite and the specific rules vary by state and may change over time.
14. Guaranteed Issue Rights: In certain situations, you have guaranteed issue rights, which means insurance companies must offer you a Medigap policy without medical underwriting, even if you have pre-existing health conditions. These rights typically apply when you're leaving certain types of coverage, such as employer-sponsored coverage.
Medhelpcenter.us recommends calling the Senior Health Insurance Agency at 813-592-8568 for professional advice on these matters.
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