Health and Fitness

Everything to Know About What Medigap Covers

In 2020, there were over 62 million members of the Medicare system. About 24 million of these members were enrolled in a Medicare supplemental insurance or “Medigap” plan.

This Medigap enrollment rate in the US grows approximately by nine percent every year. This growth rate translates into over 2 million new beneficiaries entering the system every year.

Have you recently retired? If you want to learn more about the benefits of these supplemental plans or what Medigap covers, then this article is for you. This useful guide can help you make informed decisions on this hard-earned privilege.

What Is Medicare Insurance?

Medicare is health insurance managed by the federal government to provide US senior citizens, aged 65 and over, with medical care. Medicare allows a patient to cover a portion of the cost for every health care service received and then Medicare covers the rest. The US Centers for Medicare and Medicaid Services (CMS) states that there are over 55 million people enrolled in the current Medicare system.

What Are the Parts of Medicare?

Several plan options within the main Medicare system support different retirement living situations. These options include:

Original Medicare Parts A and B

Medicare has two original plans that members can still leverage today. Medicare Part A and B were the first versions of the coverage created in 1965.

What Does Medicare Part A Cover? Part A covers expenses like hospital fees, in-home health care expenses, and hospital fees.

What Does Medicare Part B Cover? Part B covers costs like doctor exam co-pays, diagnostic test expenses, and medical-equipment fees.

What’s a Medicare or “Medigap” Plan?

A Medicare supplemental insurance plan is called a “Medigap” or sometimes just “Gap” plan, for short. A Medigap plan covers the out-of-pocket expenses that Medicare Part A or B can’t cover like medical expenses you have when traveling outside the US.

There are currently ten different Medigap plans available to deliver added benefits above what’s already included in these Original Medicare parts. Medigap plans are purchased from private health insurance companies. These companies contract with the federal government to provide this extra coverage on top of Medicare Plan A and B coverage.

What Medigap Covers

Below is a summary of each Medigap plan that you can sign up for when it’s time to retire. Study these different coverage packages so that you can ask informed questions when you meet with a private health insurance company:

Medigap Plan A and B

Medigap Plan A pays for extra overnight hospital costs beyond what Original Medicare Plan A pays for. Medigap Plan B can cover 20 percent more of any outpatient expenses that aren’t paid for under the Original Medicare Part B.

Medigap Plan C

Medigap Plan C covers additional medical expenses like hearing and dental exams. Plan C can also cover costs for the first three pints of blood transfusions. Medicare members who retired before 2020, can qualify for Plan C benefits.

Medigap Plan D

Medigap Plan D is additional coverage for seniors that was introduced in 2003. Plan D pays for self-administered medication costs. You can find more information on Medicare plan D (separate from Medigap D) and how it varies from supplemental coverage you can buy.

Medigap Plan F

Medigap Plan F pays for nursing home and hospice co-pays beyond what Medicare Part A can pay for. Part F covers approximately 80 percent of any medical emergency costs you might have when traveling outside the US. Part F will also cover all original Medicare benefits for another year after they’ve been depleted.

Medigap Plan K, L, and M

Medigap Plan K can cover 50 percent of your co-pays for nursing home and hospice services. Medigap Plan L pays 70 percent of the same fees. Medigap Plan M will cover an additional 20 percent of these same costs.

Medigap Plan G

Medigap Plan G pays for hospitalization costs for another 365 days once your original benefits are exhausted. Nursing home and hospice costs and blood transfusion expenses are also covered by Medigap Plan G.

Medigap Plan N

Medigap Plan N pays for lab-work and imaging fees. Plan N can also be used to cover ambulatory service fees as well.

How Can I Sign up for a Medigap Plan?

Most states have additional protections that provide their residents additional opportunities to sign up for a Medigap plan. You can contact your State Department of Insurance or State Health Insurance Assistance Program (SHIP) to research more about any state-specific Medigap rights.

Open Enrollment Periods

The time you can sign up for a Medigap plan is during your state’s open enrollment period. Federal Medicare guidelines state that an enrollee has a six-month open enrollment window that begins the month when they turn 65 years or older.

During an open enrollment period, private insurance companies can offer you one of their policies at their best available rates regardless, of your current health status. These rates will depend on numerous factors, such as your gender, age, marital status, residence, and whether you smoke.

Guaranteed Issue Rights

Guaranteed Issue rights mean that enrollees are guaranteed coverage within a certain amount of time when their previous health care coverage ends. For Medigap plans, enrollees who are 65 years or older have a guaranteed issue right within their state’s Medigap enrollment period.

During this period, private insurance companies can’t deny you coverage and must provide you a policy at their best possible rate, regardless of your health history. Guaranteed issue rights also prohibit a company from applying waiting periods for coverage of a pre-existing condition.

What’s Your Next Step?

Check out this Medicare comparison table that charts the different benefits of each Medigap Plan. Meet with an insurance agent and learn more about how each Medigap plan can augment your retirement lifestyle circumstances.

You can find more advice on what Medigap covers from our website. Do your research today so that you will rightfully enjoy the benefit you worked your entire career to earn.

Read Also: The Different Types of Emotional Disturbance Explained

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