A Medicare patient has two options -- enroll in a Medicare Advantage Plan or receive coverage through Original Medicare. If they choose to receive medical and hospital coverage through Original Medicare (Parts A and B), they must also enroll in a stand-alone Medicare Part D plan. With this route, they have the option to sign up for an additional medical insurance policy to help cover certain expenses. These policies are called Medigap policies (Medicare Supplement Insurance).

What is Medigap?

Medigap policies are supplemental insurance policies for patients with Original Medicare (NOT enrolled in a Medicare Advantage plan). These policies help pay some of the health or medical costs such as deductibles, copays, and coinsurance.
There are 10 standardized kinds of Medigap plans available in most states.

How can this benefit your patient?

On average, Original Medicare covers about half of the healthcare charges for beneficiaries. Patients who are enrolled for Original Medicare plans must cover the remaining approved charges by either paying out-of-pocket or with supplemental insurance.

If a patient is hospitalized, sees many doctors, and/or has frequent medical needs, deductibles, copays, and coinsurance can be very costly! Because of this reason, patients with Original Medicare with chronic health issues would benefit from also enrolling in a medical plan that can help cover these expenses.

Note: Patients with low income subsidies, such as dual-eligible patients, would have no reason to enroll in a Medigap plan because their deductibles and coinsurances are already covered by their subsidy.

What are some things to be aware of about Medigap?

Medigap policies are sold by private companies, so patients would have to pay the private insurance company a monthly premium for the plan in addition to the monthly Part B premium that they pay to Medicare.

Medigap cannot be used to pay the deductibles, copays, and premiums of a patient's Medicare Advantage plan.

Please keep in mind that Medigap does not cover everything!

  • Long term care

  • Vision or dental care

  • Hearing aids

  • Eyeglasses

  • Private-duty nursing

What's Next?

Check out this article to learn more about the basics of enrolling in a Medigap plan!

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