As I mentioned in my earlier Sixty and Me blogs, Original Medicare (Part A and Part B ) covers most costs for hospital and doctor fees. However, there are some “gaps.” Most importantly, under Original Medicare, there are no limits on out-of-pocket expenses from copayments and coinsurance.

Medigap Fills In

A popular way to cover the gaps is through a Medicare Supplement Insurance policy (a.k.a. “Medigap.”) Sold by private insurers, Medigap policies come in various versions specified by rigorous government requirements.

Medigap Coverage

Aside from capping out-of-pocket expenses, a Medigap policy can also cover all or part of some other costs:

• Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
• Medicare Part B coinsurance or copayment
• Blood (first 3 pints)
• Part A hospice care coinsurance or copayment
• Skilled nursing facility care coinsurance (for limited stay, not long-term care)
• Part A deductible
• Part B deductible
• Part B excess charges
• Foreign travel emergency care

However, Medigap plans typically don’t pay for things like vision or dental services, or hearing aids.

Medigap policies are categorized by letter (A-D, F, G, and K-N.) Each type offers differing coverage and levels of coverage. The table below shows coverage differences between Medigap plan C and plan G:

Plans differ from state to state in terms of price and companies offering policies. Also, Massachusetts, Minnesota and Wisconsin handle Medigap policies differently. More information can be found in the Medicare publication Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.

The Medigap Process

When a supplemental Medigap policy piggybacks on Original Medicare, Medicare will first pay its part of covered costs. After that, the Medigap policy pays all or a portion of the rest, depending on the type of policy purchased.

Medigap only supplements Original Medicare. Those with Medicare Advantage plans cannot also have Medigap coverage. (I’ll cover Medicare Advantage plans in another Sixty and Me blog.)

How to Buy a Medigap Policy

Buying a Medigap policy takes four steps and must occur during the Medigap Open Enrollment Period. This period extends six months, beginning when a person turns 65 and is enrolled in Medicare Part B. Buying Medigap coverage may not be possible outside this period and may cost more if it is.

First Step: Choose the Type of Medigap Coverage

Official Medicare publications or conducting web research will yield helpful information. Also, calling 1‑800‑MEDICARE (1-800-633-4227) will provide information on coverage options. Health insurance brokers can also offer assistance in understanding Medigap options.

Second Step: Identify Insurers Who Offer Your Chosen Type of Medigap Policy

Information sources are:

• The Medicare website
• State Health Insurance Assistance Program (SHIP)
• State Insurance Department (Ask about complaints against companies selling Medigap in the state so you can avoid those insurers.)
• Online research
• Recommendations from trusted family, friends or advisors

Third Step: Obtain Quotes and Compare Policies

It’s essential to confirm you’re comparing the same type of policies.

Fourth Step: Make Your Purchase Within the Six-Month Medigap Open Enrollment Period

Don’t forget that in addition to your Medigap policy premium, you will still need to pay your Medicare Part B premium and, if applicable, your Medicare Part D (optional drug coverage) premium.

You can learn more about Medigap by visiting the Medicare website or downloading the latest Medicare and Me handbook. Also, look for my future blog posts on Sixty and Me for more valuable Medicare information. For an even deeper dive, check out my Medicare eBook at Cantissimo Senior Living.

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Let’s Have a Conversation:

Are you insured by Medigap? Which plan have you purchased? Are you happy with it, or will you try a different plan?