You should also consider additional coverage for the coinsurance, copayments, and deductibles that aren’t covered by Original Medicare. This coverage is known as Medicare Supplement Insurance and is often referred to as Medigap coverage.
Medicare Has Gaps
Medicare coverage gaps are a problem due to an underlying issue. You’ve paid taxes that were fed into the Medicare program through your entire working life. You paid 1.45% of your earnings to Medicare, and your employer threw in another 1.45% for a total of 2.9%, at 2022 rates. These taxes cover Medicare benefits, including Original Medicare, which is Part A and Part B. Here’s an example of a gap in Medicare coverage. Imagine that you had a heart attack. Medical science has come a long way, and a heart attack isn’t as catastrophic as it once was, but it can still cost a lot of money. Your Part A coverage picked up a portion of the bill when you went to the hospital and were admitted. You pay the first $1,600 as of 2023 ($1,566 in 2022), and Medicare picks up the rest for up to 60 days. You then begin paying a portion of the daily bill. You pay a larger portion after 90 days. You may pay another $1,600 if you go back to the hospital later that year. It could be another $1,600 each time you’re admitted. But what about all of the tests and procedures? That’s where Part B comes in. You pay a monthly premium for Part B, then you pay your deductible, and then you pay 20% of the bill after that. Your portion is $6,000 if your total bill was $30,000, not counting the cost of staying in the hospital or your deductible). You’ll pay 20% of all of it for the year if you have other procedures, tests, surgeries, and most other care. That could translate to a huge bill that you may not be able to afford. To pour further fuel on the financial fire, you have no out-of-pocket maximum with Original Medicare. There’s no upper limit to reach after which you can stop paying. You could go bankrupt trying to afford it if you require a great deal of care.
What Is Medigap Insurance?
Gaps in Original Medicare coverage can represent a huge financial burden to retirees, so it’s a good idea to consider additional insurance coverage that fills those gaps. You have two choices: a Medicare Advantage plan, known as Part C, or Medigap Insurance. Medicare Advantage plans typically include Original Medicare Parts A and B and often include prescription drug coverage typical of Part D. Medicare Advantage plans are not compatible with Medigap. Medigap insurance, also called Medicare Supplement Insurance, helps fill the gaps created by out-of-pocket expenses. As with any supplemental insurance plan, you can expect to pay an additional premium on top of the premiums you pay related to Original Medicare coverage. Medigap insurance is labeled much like Original Medicare, using A, B, C, D, F, G, K, L, M, and N for the plan names. Depending on the additional coverages you desire and how much you’re willing to pay in additional premiums, these plans offer various options. Similarly, Medicare standardizes these plans across insurers. For example, Plan G has the same benefits regardless of the provider. Unless you live in Massachusetts, Minnesota, or Wisconsin where plans are slightly different, all you have to compare is the price and the quality of the company.
How To Get Medigap
The best time to get a Medigap policy is during your Medigap initial enrollment period. This timeframe begins the first month that you’re at least age 65 and enrolled in Part B and it lasts for six months. During this time, insurance companies can’t charge you more for Medigap or deny Medigap coverage based on your gender, age, health, or any preexisting conditions. But they can do so once this period expires. You have to be enrolled in both Parts A and B to get a Medigap policy. The Medicare Plan Finder can help you compare Medigap plans from different providers in your state.
Quick Facts About Medigap Insurance
Medigap isn’t a replacement for Original Medicare. You’ll pay a private insurance company a separate premium for your Medigap Insurance. There’s no family plan. A Medigap policy covers just a single person, so you’ll need a separate policy for your spouse. Medigap policies don’t cover prescription drugs. You’ll need Medicare Part D to help pay for prescriptions, which comes with a separate premium. You’re likely to be paying premiums for Original Medicare, Medigap, and Part D coverage, but it’s essential to do so if you want all aspects of your care to be covered and the gaps filled. Finally, Medigap insurance doesn’t cover long-term care, vision and dental care, eyeglasses, hearing aids, or some types of nursing.
Ask for Help
Identifying the coverage gaps in Original Medicare and knowing which plans offer the best value for your medical needs can get complicated. It can become very expensive if you don’t make the right choices, so it’s always a good idea to discuss your medical needs with an insurance agent who specializes in Medicare.
