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Medigap: What You Should Know

June 9, 2021

Do you ever think to yourself, “Do I need Medicare Supplement Insurance? The answer: Depends on your medical needs and your financial habits!

Signature Senior Solutions can help find the Medicare plan that’s right for you, but you may want to consider extra coverage. For example, if you are not currently saving for your Medicare Part B premiums, you might find your monthly budget in hot water.  Furthermore, you need to be prepared to cover the difference of your healthcare costs–especially, if you do not have Medigap or a Medicare Advantage Plan.

Let’s not beat around the bush: The gaps in Medicare are huge. You could be in the hole for paying the expensive deductibles and up to 20% of your outpatient coverage if you do not have any supplemental coverage. Here is where Medigap can lend a hand.

What is Medigap?

Medigap can be a great option to supplement your Medicare plan.

Medigap can cover what your Medicare plan doesn’t.

Medigap is exactly what it sounds like: Medicare Supplement Insurance that fills in the “gap” of your Original Medicare. This extra insurance coverage is offered by private companies, and it can even be found in our great state of Arizona.

It’s important to note that Medigap is different from the Medicare Advantage Plan. Medigap only boosts your Original Medicare benefits. While Original Medicare covers much of your health care services, a Medicare Supplement Insurance policy helps pay for the additional health care costs including co-payments, co-insurance, deductibles, and coverage when you travel outside of the U.S.

Medigap Eligibility

When you turn 65, you have a one-time opportunity to enroll for a Medicare Supplement Insurance policy. After you sign up for Medicare Part B, you have a six-month window to enroll for supplemental insurance coverage. The best part, you cannot be turned down by any pre-existing medical conditions!

You should know that a Medigap policy only covers one person. If you are planning to register both you and your spouse, then you will each need to buy separate policies. In addition, any standardized Medicare Supplement Insurance coverage is guaranteed renewable. Even if you have health problems! Hence, the insurance company cannot cancel your Medigap policy, as long as you keep paying the premium.

Be Informed

Did you know that beginning on January 1, 2020, Medicare Plans C and F are no longer available to people new to Medicare? Also beginning on the same date, Medigap policies are no longer allowed to cover Part B of Original Medicare.

However, if you have either of these two plans prior to January 1, 2020, you’ll be able to keep your current plan. Finally, if you were eligible prior to January 1, 2020, but still have not enrolled, then you may be able to still buy one of these plans.

Previously, some Medigap policies used to cover prescription drugs. However, after January 1, 2006, Medigap is no longer allowed to cover prescription drugs. If this coverage is important to you, you may want to consider joining a Medicare Prescription Drug Plan (Part D).

How Does Medigap Work?

One man lending a hand to another is similar to Medigap

Medigap is like a helping hand.

In order to gain a Medigap policy, you must be enrolled into Medicare Parts A and B.  In addition to your Medicare Part B monthly premium, you will have a separate monthly premium for your Medigap policy. These monthly premiums vary across private companies and coverage. However, as long as you continue your premium, your coverage will still be available.

Overall, Part B of Medicare only pays for 80% of approved services. This means you could be responsible for paying the remaining 20%. This even includes some high-priced services such as emergency room visits, blood tests, X-rays, surgeries, chemotherapy, and medical equipment.

Once your Medicare plan has paid its part, your Medicare Supplement Insurance policy will pay most of what’s remaining in that 20% balance. Even so, payment will only cover Medicare-approved charges. It should be noted that you can see any doctor that participates in Medicare, which is one of the best features of Medigap coverage.

Non-Medigap Insurances

The experts of Signature Senior Solutions know it’s difficult to navigate the many paths of Medicare and supplemental coverage. We not only want to ensure that you have the BEST Medicare options, we want you to be an informed citizen of Maricopa County. For example, did you know that it’s illegal for a private company to sell you a Medigap policy if you have a Medicare Advantage Plan? The only loophole is if you plan to switch back to Original Medicare.

With this in mind, it’s important to point out the non-Medigap plans. There are many insurance policies out there that look like Medigap, but vary in coverage and benefits.

For instance, here is list of of insurance plans that are not considered as Medigap:

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or Union Plans
  • Veterans’ Benefits
  • Long-Term Care Insurance Policies
  • Indian Health Service, Tribal, and Urban Indian Health Plans

To Buy or Not to Buy?

A Cave Creek Woman Reading in Peace Because Signature Senior Solutions has her covered

Spend more time doing the things you love, and let Signature Senior Solutions take care of the rest.

In the end, only you can decide if a supplemental insurance policy is right for you. If the Medigap premium does not fit into your monthly budget, then you may want to consider a Medicare Advantage Plan. Actually, the Medicare Advantage Plan was created to provide an alternative plan for Medicare recipients!

Signature Senior Solutions are experts in Medicare and we happen to be located in Cave Creek, Arizona. Not in Arizona? No problem! Jim Schmidt is a multi-state licensed professional.

We can help you compare and contrast Original Medicare + Medigap with the Medicare Advantage Plan, for we strive to tailor your Medicare plans to fit your health and financial needs.

Contact Jim Schmidt today to discover which plan is best for you, and whether or not you need Medigap coverage.