How Do I Choose a Medigap Policy?

Medicare Benefits Solutions
Aug 21, 2020

Original Medicare coverage may help lower the costs of healthcare associated with inpatient hospital care, outpatient services, and prescription drugs. Although you might find that Original Medicare is affordable in terms of your monthly premium, there are associated costs that come along with using your Medicare insurance, including co-payments, coinsurance and deductibles that you need to pay for out of your own pocket. For some, these costs are manageable, but for others, they add up quickly. A Medigap policy, also known as Medicare Supplement, may help you save on costs associated with Original Medicare.

How do I choose a Medigap policy?

Choosing the right policy for your needs comes down to evaluating costs and benefits, and comparing them against your medical needs and budget. Medigap policies are intended to supplement your Original Medicare coverage and are standardized by the federal government. Some plans will offer more benefits for a higher premium. Some include coverage for medical care outside of the United States, while others offer an out of pocket maximum limit.

They are identified by letters (Plan A-Plan N). However, different states have different regulations regarding how much leeway their insurance providers have to work with in creating policy terms. As such, you might want to speak with a licensed agent who understands your specific state’s laws and regulations regarding medical insurance to receive the most accurate information.

How is Medigap different from Medicare Advantage?

You might hear insurance providers talking about Medicare Advantage and Medigap policies in the same sentence, but the two are actually quite different. A Medicare Supplement, or Medigap, policy is meant to bridge the gap between you and your Original Medicare coverage by paying for things like co-payments, coinsurance or deductibles.  Essentially, these policies can help you pay for things that Original Medicare does not.

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare.
When you enroll in a Medicare Advantage policy, you receive the same Part A and Part B benefits of Original Medicare in addition to extra benefits offered by the insurer. These may include things like prescription drug coverage, membership at local gyms and wellness centers, or dental and vision care. You cannot be enrolled in a Medicare Advantage plan and Medigap.

Enrolling in Medigap

When you turn 65 and are enrolled in Medicare Part B, you’ll have a 6 month Medigap enrollment period. During this time, you’ll have a guaranteed issue right to buy any Medigap policy sold in your state. You won’t have to go through medical underwriting. If you don’t enroll during this time and decide later you want to buy a Medigap policy, you can be charged more or even turned down for coverage based on pre-existing conditions.