Medicare is a pretty successful system as far as seniors are concerned. However, it doesn’t cover everything and the difference between what Medicare pays for and what many seniors need is a gap large enough that the Congress implemented rules to regulate the insurance plans that cover the gap. A Medigap policy is health insurance sold by private insurance companies to fill gaps in Medicare coverage. Lacking creativity, the Congress designated different medigap plans alphabetically A – L, adding plan M and N later, while retiring plan E, H, I, and J.
What Is Medicare?
Medicare is health insurance for the following:
- People 65 or older
- People under 65 with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
What is a Medigap policy?
A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that is designed to supplement Medicare. This means it helps pay some of the health care costs (“gaps”) that Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have Medicare and a Medigap policy, Medicare will pay its share of the Medicare approved amounts for covered health care costs. Then your Medigap policy pays its share.
The following is a Medigap Plans chart from medicare.gov that illustrate the differences between different plans.
The difference between the plans, in theory, comes down to what variety of “extras” you want and how much you want to pay for them. Plan A is the most basic one, B is a plan offered by the government, and the rest elaborate on a particular care. For example, K is designed to cater towards those anticipating or undergoing hospice care. F and G are some of the most popular plans because they cover all additional Medicare charges for an increased premium.
Complexities and Confusion
Confusion sets in at the state and local level, because many of the lettered plans have dozens of private versions offered by different insurance companies. For example, Medigap policies arestandardized in a different way in Massachusetts, Minnesota, and Wisconsin. Not only that, there’s glaring contradictions between what the official Medicare website says is the typical premium in your area and what the cost actually ends up being.
For retirees, the navigating is often a marathon of clicking, writing, and phone calling that can leave even the most stoic of seniors disgruntled against the whole process. It’s imperative you know the potential for aggravation before setting off on your mission to fill your Medigap.
There are also many websites that offer detailed assistance with choosing the right Medicap plan. In fact, you may live in an area where there exists a public service that can help you coordinate your Medicare with your health and budget to pick the right plan. If not, there’s likely an “agent” service in the area that will tell you about the plans that are available, though be careful with these people because they might have an incentive to offer plans that aren’t the best for your particular situation.
Medicare is an incredibly popular program that performs an important function in our modern society, and individual seniors should have the ability to choose the coverage that is best for them. The process could be confusing, but it doesn’t have to be if you assign yourself enough time and afford yourself enough patience to make the right decision. This article only touches on the basics of Medicare and Medigap plans. If you are eligible for Medicare and are looking for additional coverage to reduce the gaps, it is a worthwhile excercise to learn more about these programs. One of the best place to start is with the official guide from medicare.gov and the medicare.gov site itself.
Pinyo is the owner of Moolanomy Personal Finance and a Realtor® licensed in Virginia and Maryland. Over the past 20 years, Pinyo has enjoyed a diverse career as an investor, entrepreneur, business executive, educator, financial literacy author, and Realtor®.