Medigap, or Medicare Supplemental Insurance, helps pay some of the costs that Original Medicare (Medicare Parts A and B) doesn't, which may include:
Insurance > Medicare Basics
What Is Medigap?
Medigap policies are sold by private insurers, and may also cover things like medical coverage when you travel outside of the United States. Medigap policies pay for deductibles, coinsurance, and copays after Medicare has paid its share of approved expenses.
Medigap policies are different from a Medicare Advantage plan: Medicare Advantage plans are a way to get Medicare benefits, while Medigap policies only supplement Medicare benefits.
Some important things to know about Medigap
- Medigap policies generally don't cover long-term care, vision care, dental care, hearing aids, eyeglasses, or private-duty nursing
- You must be enrolled in Medicare Part A and Part B
- Medigap policies can’t work with Medicare Advantage plans
- The premium you pay for your Medigap policy is in addition to your monthly premium that you pay to Medicare
- A Medigap policy only covers one person, so you and your spouse will need 2 separate policies
- You can buy a Medigap policy from a licensed insurance company in your state
- Insurance companies can’t cancel your Medigap policy as long as you pay your premiums
- Medigap policies sold since early 2006 can’t include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D)
- You can’t be sold a Medigap policy if you already have a Medicare Medical Savings Account plan. (These plans are similar to Health Savings Account plans and allow you to choose your health care services and providers)
Medigap vs Medicare Advantage
|Original Medicare and Medigap||Medicare Advantage|
|Doctors and hospitals||You can select your doctors and hospitals as long as they accept Medicare patients.||You may be required to use doctors and hospitals in your plan’s network.|
|Referrals||You can see specialists without referrals, but the specialist must be enrolled in Medicare.||You may need referrals and may be required to use network specialists.|
|Network||No network restrictions. Coverage goes with you across the United States.||May have network restrictions. Emergency care is covered for travel within the United States and sometimes abroad.|
|Enrollment||You can apply to buy a Medicare supplemental insurance plan (Medigap) any time after you turn 65 and join Original Medicare (Parts A and B).||Generally, there are specific periods during the year when you can enroll or switch to another Medicare Advantage plan.|
|Costs||You pay a monthly Medigap plan premium in addition to your Part B premium. When you use a service, your out-of-pocket costs are limited.||Generally, you pay a low or $0 monthly plan premium in addition to your Part B premium. When you use services, you pay copays, coinsurance, and deductibles.|
|Prescription drug coverage||Prescription drug coverage is not included. Consider also purchasing a Medicare Part D plan.||Prescription drug coverage is included with most plans.|