What Is a Medicare Supplement/Medigap Insurance?

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

• Deductibles – Like Part A/Hospital Deductible.
• Copayments – Like Emergency Room and Medical Doctor Copays.
• Coinsurance – Like Part B 20% Coinsurance.
• Excess Charges – Like the Part B Excess Charges.

Medicare Supplements impose no hospital/medical network restrictions and do not replace Medicare. They pay – according to the plan contract – the cost that remains after Original Medicare has paid. If you have Original Medicare and you buy a Medigap policy, here’s what happens:

• Medicare will pay its share of the Medicare-approved amount for covered health care costs.
• Then, the beneficiary’s Medigap policy pays its share.

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Some Medigap policies do cover services that Original Medicare doesn’t cover, like medical care when you travel outside the US. Medicare Supplement policy premiums vary depending on age, gender, and – when underwritten -tobacco use and the health of the insured. During the Medigap Open Enrollment period, no underwriting stipulations are in effect; otherwise, however, underwriting is mandated.

Medicare Part C or Medicare Advantage

Medicare Part C is commonly called “Medicare Advantage.” Medicare Advantage Plans are a type of Medicare health plan offered by a private companies that contract with Medicare to provide Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage.

Helps cover:

• Medicare Part C is an alternative to Original Medicare that includes Parts A and B, and usually Part D.
• Beneficiaries may be able to find Medicare Advantage plans with lower out-of-pocket costs than Original Medicare.
• Part C plans usually require beneficiaries to see in-network providers.
• Most MA plans offer additional benefits not found in Original Medicare, like dental, hearing, and vision services.

If a Medicare beneficiary is enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. While the premium is typically less than a Medicare Supplement (in many cases as little as $0), Medicare Advantage enrollees will incur copays and coinsurances that would be paid by a Medicare Supplement.