Medigap offers a unique health care insurance policy that fills in the gaps of Medicare. While Medicare covers a variety of health care expenses, there are aspects of it that you have to pay for. These aspects or gaps can be covered by a supplemental plan such as retiree insurance. However, the gaps can also be covered by Medigap.
Medigap Coverage – See What Plans Cover Before Buying
The main reason people buy Medigap is to get insurance coverage for pocket expenses not necessarily covered by their Medicare policy. These include deductibles, coinsurance and co-payments. This means that after Medicare pays for its share of the expenses, Medigap comes in to pay the rest of the cost. Keep in mind that Medigap insurance applies to government or traditional Medicare insurance. Hence, if you have a private Medicare Part C insurance, Medigap does not apply. Hence, the gaps in the policy cannot be paid by the company. Take note that if you are already covered by Medicare Part C policy, the law does not permit any agent to sell you Medigap insurance, since it will not be beneficial on your part, unless you opt to drop your private insurance and revert back to the original Medicare insurance plan.
If you have Part A and B Medicare coverage, then there are gaps in the policy. The cost of these gaps can be quite expensive, but having a supplemental coverage can take care of them. One of the most expensive costs in health care is hospitalization. Take Part A of the Medicare insurance for instance. For the first 60 days, you will have to pay a deductible of $1,156; after 60 days, $289 a day (in 2012); after 90 days, $578 a day (in 2012); after 150 days, you will have to pay for the entire hospital cost.
For Part A, Medigap covers hospital stay coinsurance. The plan covers up to 365 days of hospital stay after the original Medicare benefit runs out. It also covers hospice coinsurance or co-payment in between 50 to 100 percent of the expenses. This will depend on what plan you opt for. It will also cover 50 to 100 percent of the hospital deductible. For Part B, Medigap covers 50 to 100 percent of the coinsurance and co-payment amounts depending on the plan you choose.
Only Medigap plans C and F cover the deductibles though. This is why most people prefer these options. For extra charges, you can opt for Medigap plans F and G for coverage. Other benefits include the cost of blood purchase, skilled nursing facilities, and foreign travel. Most hospitals provide blood for no additional cost, but if the hospital needs to purchase blood, your insurance policy covers the cost of up to 3 pints. It will also cover 50 to 100 percent of skilled nursing facilities as well as the cost of foreign travel if it is required. Learn more about Medicare supplement policy costs.
What Medigap Does Not Cover
While the plan does cover a lot of gaps, it has its limits as well. These include:
- Eye care
- Dental care
- Hearing aids
- Private nursing services
- Nursing home expenses
- Prescription drugs
Nonetheless, Medigap provides a wide range of supplemental coverage that will prove beneficial in the long run.