Medicare Supplement Insurance is also known as Medigap, which is provided by private companies. It acts as a health insurance coverage for expenses not under Original Medicare. The latter covers four parts, from Part A to Part D.
The Original Medicare is also known as Traditional Medicare or Fee-for-Service (FFS) Medicare under the federal government. This means the government directly pays for whatever healthcare services you receive.
To understand what Medigap is, you should first understand Original Medicare. In this health insurance coverage:
- When you need care, you can directly go to the hospital without authorization from your primary care or Medicare doctor.
- You can pay for Part A’s premium, and you’re also eligible for Part B’s premium. Part A covers hospital or inpatient coverage, while Part B covers medical or outpatient care. Part C has alternative ways to claim your Medicare benefits, such as the Medicare Advantage Plan and Medigap. Lastly, Part D is for prescription drug coverage.
- For every service you receive, you usually pay a coinsurance. This means you pay some portion of the care expenses that the insurance pays. It usually takes about 20% of Medicare’s coverage.
- Lastly, hospitals and doctors have a limited amount to charge for your care.
Coverage Of Medigap
As the name suggests, Medigap fills ‘gaps’ in FFS Medicare. Although the latter can pay more, it doesn’t cover everything. Medigap policy providers offer various benefits to help you pay for the gaps in FFS Medicare. Mostly, Medigap policies help you pay for remaining healthcare expenses, such as the following:
- Deductibles: In FFS Medicare, deductibles refer to your payment for healthcare services coverage before Medicare pays for it when you avail such. With Medigap, it pays for such out-of-pocket expenses.
- Coinsurance: As mentioned, FFS Medicare covers a lot but not everything. That means you still have to pay for some of your medical expenses. If you have Medigap, you can use it to pay your share of the medical expenses.
- Medical care outside the US: Since your Original Medicare plan doesn’t pay for medical expenses you incur outside the US, Medigap pays for its share.
Medicare Supplement Insurance only supplements your FFS Medicare benefits. That’s why it doesn’t cover others, such as private-duty nursing, eyeglasses, hearing aids, dental or vision care, and long-term care. If you want to learn more about Medigap coverages, this link provides a comprehensive review for Aetna’s Medicare supplemental plans.
How Does It Work?
Before you can buy a Medigap policy, you should have Part A and Part B of the Original Medicare, and you must be at least 65 years old. Having a spouse doesn’t mean that your Medigap policy will cover them. Many private health insurance companies are offering Medigap so you can apply for a policy anytime.
With Medigap plans, you’re likely to pay monthly premiums in the following ways:
- Attained-age rated: As you get older, your premium gets higher because your monthly premium is tied to your current age.
- Issue-age rated: For this one, your premiums don’t go up as you age, but is tied to the age you first purchased the insurance. It means you have lower premiums.
- Community rated: With this policy, you pay the same monthly premium just like other policy buyers. This disregards the ages of the buyers.
Paying your Medigap premium is an additional expense to your other Medicare premiums.
With Medigap, you can have healthcare services from any hospital covered by your Medicare. Both policies will pay their share of medical costs. If you have premiums for Medicare’s Part A and Part B, your Medigap policy will help pay your deductibles, coinsurance, and other medical care depending on your policy.
With Medigap, you can choose various monthly premiums, from community-rated to attained-age rated or issue-age rated. However, this policy only covers only one person, so your spouse should have their own policy if they want to enjoy the benefits of Medigap.