What Is Medigap and Do I Need It?

Written by

Medicare is the federal health insurance program mainly for people over the age of 65, though younger people with certain disabilities may also qualify for the program. The basic coverage is provided by Original Medicare Part A (hospital insurance) and Part B (medical insurance). However, this coverage may not be adequate for you, in which case you may need a supplemental Medigap 2019 plan.

A Medigap policy supplements your Original Medicare Part A and Part B coverage. It may cover expenses that aren’t covered by Original Medicare, so you don’t have to pay as much when you have the right Medigap policy and you get seriously ill or injured. The Medigap plan may also offer benefits that aren’t included in Part A and Part B.

So do you need Medigap? That depends on your particular circumstances. However, here are some possible reasons as to why it may be a sound investment.

You Get Help Paying for the Deductibles and the Coinsurance

The deductible is the amount of the healthcare expense you need to cover yourself before the Medicare benefits start to pay for the costs. The coinsurance is the amount you have to pay in terms of percentage for various medical services.

So let’s say that you have a $1,000 deductible and then Medicare pays for 80% of the rest of the medical bill. You get sick and you’re faced with a $5,000 medical bill. This means that you pay $1,000 and then 20% of the remaining $4,000 which is $800. That means you have to pay a total of $1,800. This can be rather expensive for some people, and that’s especially true if it’s a recurring treatment you have to receive regularly.

But you can get a Medigap policy that pays for part of (or even the whole) the $1,800 that counts as your out-of-pocket expenses. These include the deductibles and the coinsurance found in Part A and Part B of Medicare.

If You Enroll at the Right Time, You Can’t Be Denied Medigap Coverage

The Medicare Supplement Open Enrollment Period starts on the first day of the month after you turn 65 and you have Medicare Part B coverage. This period will last for 6 months, and it’s important that you obtain your Medigap policy during this time.

This is because, during the Open Enrollment period, the insurance company cannot refuse to sell you a Medigap policy it offers for any reason (such as you’re too sick right now). The insurance company also can’t charge you a higher premium than the others who are also 65 years old or older. They also can’t delay the start of your coverage.

There may be some issues regarding a waiting period for specific preexisting conditions, but this can be shortened or avoided if you get Medigap during the open enrollment, you’re replacing creditable coverage (such as your previous workplace-sponsored health insurance), you have at least 6 months of continuous creditable coverage, and your break in coverage doesn’t exceed 63 days.

Automatic Renewal

All standard Medigap policies are guaranteed renewable, and the insurance company cannot cancel your plan simply because you make a lot of claims. This is as long as you make your premium payments on time.

Foreign Coverage

In most cases, you can keep the same Medigap policy if you relocate to another state. The Medigap policy will also usually cover your expenses if you travel abroad and you receive emergency medical services. In contrast, Original Medicare won’t cover your emergency medical expenses if you travel to another country.

If you’re at least 65 years old, you may really want to consider getting that Medigap policy to cover your Medicare expenses. A small increase in your monthly premiums may be a small price to pay for the savings you get when you’re faced with a hefty medical bill in the future.

Article Categories: