medigap is medicare supplemental insurance that helps fill in the “gaps”
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and is sold by private companies. Original Medicare pays for much, but not all, of the cost of covered health care services and supplies. A medicare supplemental insurance (medigap) policy can help pay for some of your remaining health care costs, such as:
- Medicare will pay its share of the Medicare-approved amount for covered health care costs.
- then your medigap insurance company pays their share.
Some medigap policies also cover services that original medicare doesn’t cover, like medical care when you travel outside the us. uu. If you have original medicare and you buy a medigap policy, this is what happens:
9 things to know about medigap policies
- must have medicare part a and part b.
- A medigap policy is different from a medicare advantage plan. those plans are ways to get medicare benefits, whereas a medigap policy only supplements your original medicare benefits.
- You pay the private insurance company a monthly premium for your medigap policy. You pay this monthly premium in addition to the monthly Part B premium you pay to Medicare.
- a medigap policy only covers one person. If you and your spouse both want medigap coverage, you’ll each have to buy separate policies.
- You can buy a medigap policy from any insurance company that is licensed in your state to sell one.
- It’s important to compare medigap policies because costs can vary between plans offered by different companies for exactly the same coverage and can go up as you age. some states cap the costs of medigap premiums.
- Any standardized medigap policy is guaranteed renewable even if you have health problems. this means that the insurance company cannot cancel your medigap policy as long as you pay the premium.
- Medigap policies can no longer be sold with drug coverage, but if you have an older medigap policy that was sold with drug coverage (before January 1, 2006), you can keep it. You can choose to join a separate Medicare prescription drug plan (Part D). because most medigap drug coverage is not creditable prescription drug coverage and you may pay more if you join a drug plan later. If you buy Medigap and a Medicare drug plan from the same company, you may have to make 2 separate premium payments. contact the company to find out how to pay your premiums.
- It is illegal for someone to sell you a medigap policy if you have a medicare advantage plan, unless you are going back to original medicare.
medigap policies don’t cover everything
Medigap policies generally do not cover:
- long-term care (such as non-skilled care you get in a nursing home)
- dental or vision services
- private duty nursing
- medicare advantage plans (like an hmo, ppo, or private fee-for-service plan)
- medicare prescription drug plans
- medicaid [glossary]
- employer or union plans, including the federal employee health benefits program (fehbp)
- veteran benefits
- long term care insurance policies
- Indian health service, tribal and urban Indian health plans
non-medigap insurance plans
Some types of insurance are not medigap plans, including:
cancel your entire medigap policy (not just drug coverage)
You may want a completely different medigap policy (not just your old medigap policy without the prescription drug coverage). Or, you can decide to switch to a Medicare Advantage plan that offers prescription drug coverage.
If you decide to cancel your entire medigap policy, you need to be careful about timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of the following applies: