Some Medigap insurance cover medical procedures that are not covered by Original Medicare. One example would be medical or hospital appointments when traveling in another country. A Medigap coverage will often cover the difference between the entire cost of healthcare and the Medicare-approved amount.
To receive a Medigap coverage, you must have Medicare Parts A and B. A Medigap policy can be purchased from any insurance company that is licensed to offer them in your state.
What Is Medigap Coverage Used For?
Medigap plans, for the most part, are meant to cover out-of-pocket expenses for Medicare-covered treatments, as opposed to care that Medicare does not cover and that the enrollee must pay out-of-pocket. Medigap insurance, depending on the kind of coverage, are meant to cover all or a portion of those extra expenses, although they normally do not cover long-term care, vision, dental care, hearing aids, eyeglasses, or private nursing.
Medigap Costs
You'll pay a monthly payment to a private insurance carrier for Medigap coverage. This cost is in addition to the monthly premium for Original Medicare Parts A and B that you will continue to pay. There are three types of cost structures among the states that offer a standardized pricing plan.
Community rated: Everyone, regardless of age, pays the same cost for the same Medigap coverage. Premiums may rise due to inflation, but everyone is charged the same amount.
Issue-age rated: This pricing plan bases your premium on your age when you purchase the policy. That implies that the older you are when you buy it, the higher your premium. Premiums may then rise because of inflation, but they will rise evenly for all policyholders.
Attained-age rated: As you become older, your premiums rise. These policies often begin with a cheaper cost but might gradually escalate to become more expensive than premiums in other pricing models.
What are the different types of Medigap plans?
Medicare standardizes Medigap coverage into ten lettered plans: A, B, C, D, F, G, K, L, M, and N. These standardized plans are sold by private insurers to Original Medicare users, and the particular private insurers and related fees vary according to your location and state.
Here are some of the federally approved Medigap benefits, as well as the plans that offer them.
Medigap Plan A
Plan A must be available from all Medicare insurance providers. Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up. Part B coinsurance or copayment and the first 3 pints of blood for a transfusion.
Medigap Plan B
Plan B covers everything that Plan A does, plus the Medicare Part A hospital deductible. Part B coinsurance or copayment and the first 3 pints of blood for a transfusion.
Medigap Plan C
Part C and F are two of the most popular choices. Part C covers everything besides Medicare excess charges. Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020.
Medigap Plan D
Not to be confused with Part D (drug coverage), Plan D covers everything PLan C does except your Part B deductible or the Medicare excess charges.
Medigap Plan F
Part F and C are two of the most popular choices. Part F covers everything including Medicare excess charges. Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020.
Medigap Plan G
Similar to Plan F, G offers everythingexcept Part B deductible. Depending on your state and their options Plan G could be a very good option. This is especially true to new Medicare enrollees that aren't eligible for Plan C or F.
Medigap Plan K and L
These are structured a little differently but still offer some decent coverage. Both offer Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up. Their main difference is the percentage they pay for services. You are responsible for paying the remaining percentage on both plans. Check out the chart below:
Part B deductible, Part B excess charge and Foreign travel exchange is not offered on Plan K and L. After you have met your yearly out-of-pocket maximum and your yearly Part B deductible, the Medigap plan will pay 100% of eligible treatments for the remainder of the calendar year.
Medigap Plan M
Covers the entire cost of the majority of the treatments it covers, but just half of the Medicare Part A deductible and 80% of Foreign travel exchange. It does not cover Part B deductible or Part B excess charge.
Medigap Plan N
Works similar to Plan M but covers Part A 100%, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission. (2022)
Note: Massachusetts, Minnesota, and Wisconsin have their own Medigap plan standards, which differ from the national 10-plan standardized scheme.
Can you switch from Medicare Advantage to Medigap?
Yes. During Medicare open enrollment (October 15th to December 7th) and Medicare Advantage open enrollment (Janurary 1st to March 31st). Keep in mind, if you switch when your Medigap open enrollment period is over, you may have to go through medical underwriting. As a result, insurers may charge you higher rates or refuse to offer you a policy depending on your health or medical history.
To advoid this you have a few excemptions that will allow you to switch without having to go under underwriting. You have a trial right to switch back to specific plans if you tested Medicare Advantage and want to go back to Original Medicare with a Medigap coverage within the first year. If you lose your Medicare Advantage coverage, you may be able to purchase some Medigap policies through a guaranteed issue right.