Medigap – What is It and Do I Need It?

You already have Original Medicare, and it seems to pay a fair amount towards your medical costs. Where, then, does Medigap come in?

Many people might be surprised when learning that Medicare doesn’t always pay your full bill – only part of it. That’s where additional coverage like Medicare Supplement Insurance, also known as Medigap, can help. These plans are designed to cover the extra expenses that Medicare doesn’t fully pay for – such as copays, coinsurance, and deductibles. Keep reading to find out how these types of plans work and if they may be the right coverage option for you.

What Does a Medigap (Medicare Supplement) Plan Cover?

Medicare Supplement plans work alongside Original Medicare to help reduce your out-of-pocket costs. This means when you receive medicare-covered care, whether it’s a hospital stay, doctor visit, or other covered medical service, your Medigap plan helps pay your share of the costs (copayments, coinsurance, and deductibles).

Depending on the plan you choose, Medigap may also offer limited coverage for services like foreign travel emergencies. Each plan follows a standardized set of benefits determined by the state, so you know exactly what’s included, no matter which insurance company you select.

Medigap plans are different from Medicare Advantage Plans (like an HMO and PPO). Medigap policies don't cover most Part D prescription medications.  If you want drug coverage, you can add standalone Part D plans available in your service area.

Should I Get Medicare Advantage or Medigap?

Types of Medigap Plans

Medicare Select 

A Medicare Select policy is a Medigap plan that limits the plan to a network of doctors and hospitals.

Standardized

A Medigap policy that has no network and requires no prior authorization for Medicare-approved services. If your provider participates in the Medicare program, you are covered for standardized Medigap.

Medigap Coverage and Costs

Most Medicare Supplement plans are guaranteed renewable plans. Guaranteed Renewable plans are where the benefits stay the same every year, although the premiums may change.

Medigap premiums can be set in one of three ways:  

• Community rated (also called "no age rated")
• Issue-age rated (also called "entry age rated")
• Attained-age rated 

Do you have other questions about Medicare Supplement Plans? Join us at one of our Free Medicare workshops to get your Medicare-related questions answered!

Are Medigap Plans Available in My State?

Medigap plans are available in all 50 states; however, they are not always the same. The types of Medigap plans and what they cover can vary.

Enrollment in Medicare Advantage plans has been steadily growing in recent years, but about half of Medicare beneficiaries still have Original Medicare. Of those half, more than 40% are enrolled in a Medigap plan, though the percentage varies by state.

Here is a chart of the various Medigap plan types and what they cover: Compare Medigap Plans and Benefits

Some states, such as Minnesota, are unique and do not follow the same Medigap plan structure as much of the rest of the nation.

What You Need to Know About Medicare Supplements in Minnesota

When Should I Buy a Medigap Plan?

There is an open enrollment period that starts the month you turn 65 and enroll in Medicare Part B. During this time, you can buy any Medigap policy sold in your state, regardless of your health status. After that, you may be subject to medical health underwriting and can either be approved or denied coverage. There may be other times you are eligible to receive a guaranteed issue right to enroll in a Medigap plan.

Have Your Medicare Questions Answered

Enrolling in a Medigap plan can make Original Medicare more predictable and can give you greater peace of mind by covering expenses that might otherwise come directly from your wallet.

Choosing the right Medicare coverage isn’t always easy. With the guidance of an experienced Medicare insurance broker who represents multiple insurance companies, like our team at Twin City Underwriters, you can get answers to all your Medicare questions and make confident, informed decisions about your healthcare coverage.

Reach out today and get support you can count on from our trusted agents.

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.