How Medigap helps with out-of-pocket medical costs

Here’s one thing that every person over 60 starts to realize: growing older underscores the importance of healthcare. And for many seniors over 65, Original Medicare is a fundamental source of coverage. However, some will also recognize that Original Medicare doesn’t cover all medical expenses, leaving beneficiaries quite vulnerable to out-of-pocket costs. 

That’s when Medigap, also known as Medicare Supplemental Insurance, often gets introduced. Medigap covers some of the out-of-pocket expenses for users of Original Medicare to help them manage and mitigate financial challenges brought on by inflation and rising healthcare costs. It’s available in a range of plans, which vary in their coverage levels and costs. More on that later.

The unpredictable gaps in Original Medicare

While Original Medicare, consisting of Part A and Part B, is often a lifeline for seniors, it has its limitations. Gaps in coverage can translate to beneficiaries having to dip into their savings to cover out-of-pocket expenses, including deductibles, copayments, and coinsurance. 

As you can imagine, the unpredictability of healthcare costs can be particularly stressful for seniors on fixed incomes — which isn’t good for anyone’s physical and mental health. Medigap, a supplementary solution, can fill the voids in coverage and provide a safety net for those unexpected medical expenses. This allows beneficiaries to plan their healthcare budget more effectively, giving them peace of mind and reducing the financial strain associated with unexpected medical bills and out-of-pocket costs.

Medigap provides both consistency and flexibility

Medigap stands out for its flexibility, allowing seniors to choose a plan that aligns with their unique needs and financial situations. 

There are 10 different Medigap policies, which are only available to someone enrolled in Original Medicare. All Medigap plans are standardized using an alphabetical naming convention that refers to them as Medigap Plan A, B, C, D, F, G, K, L, M, & N. 

Regardless of your location, plans of the same letter provide the same benefits. For example, Plan N from one company in one state will offer the same coverage as Plan N from a different company, even in other states. The most popular Medigap plans are the following:

  • Medigap Plan F: Covers all the gaps of Original Medicare, leaving you with having to pay nothing out of pocket.
  • Medigap Plan G and Medigap Plan N: Same coverage as long as you agree to pay for a few things yourself or take on a higher deductible in return for a lower monthly premium. 

A wider network of healthcare providers

Medigap not only offers financial security but it also grants beneficiaries the freedom to choose their healthcare providers. Unlike some Medicare Advantage plans with restricted networks, Medigap allows individuals to see any doctor or specialist who accepts Medicare. 

This flexibility is crucial for seniors who value their relationships with their healthcare providers and want the freedom to maintain those connections.

What won’t Medigap cover? 

Medigap is designed for those enrolled in Original Medicare, explicitly addressing the out-of-pocket expenses that Medicare alone doesn’t cover. It’s important to note, however, that Medigap plans do not extend their coverage to other types of health insurance, including Medicare Advantage plans, Medicaid, and health insurance provided through employers.

Some Medigap plans offer additional coverage, like protection for international travel, but they generally do not extend their policies to cover specific expenses like vision care and eyeglasses, dental care, hearing aids, and long-term care services, such as nursing homes and private-duty nursing. These all fall outside the scope of coverage provided by Medigap.

What to know about Medigap enrollment 

Timing is crucial when it comes to enrolling in Medigap. The open enrollment period begins when an individual aged 65 or older enrolls in Medicare Part B. 

The next six months are important as they allow you to enroll in any Medigap plan — even if you have a preexisting health condition — without being required to answer any questions about your medical history. You can be refused during this one-time, six-month window. 

However, as mentioned above, this period ends 6 months after Medicare Part B starts. If a beneficiary does not enroll during their 6-month window, a Medigap provider may refuse coverage on the basis of a person’s preexisting condition, provide limited coverage, or provide full coverage but at a higher premium. 

The good news is that all Medigap plans have “renewable guarantees,” meaning that as long as the beneficiary pays their monthly premium, the insurer company cannot cancel the policy.

Remember, your one-time Medigap enrollment period begins on the first day your Medicare Part B is effective. If your Part B coverage starts on April 1st, then your personal enrollment period lasts for precisely 6 months and ends on September 30th of the same year.

The exception to this rule is for Medicare beneficiaries who haven’t yet reached the age of 65. These beneficiaries will receive a second opportunity to opt into Medigap coverage when they turn 65.

Keep in mind that coverage through a Medigap plan is for individuals only: married partners must have separate policies.

What does Medigap cost?

The costs of Medigap plans can vary significantly, ranging from less than $100 to several hundred dollars per month. The differences in costs come from things like the rules set by the Medigap plan provider, how old the person is when they sign up, the specific Medigap plan they go for, and where they live.

Want to fill the Medicare gap?

Supplemental Medigap coverage is a practical choice for Original Medicare folks. It fills the coverage gaps and offers flexibility, financial security, and choice. 

If you recently became, or are soon to be, a Medicare Part B beneficiary, Guided Solutions can assist in finding the right Medigap plan for your particular situation in your location. 

Contact our team of Medicare experts at Guided Medicare for a free consultation and stay on top of your healthcare!


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