Medigap: 4 important facts you need to know now

Like peanut butter and jelly, shoes and socks, toothbrushes and toothpaste—Medicare and Medigap are designed to work together. Medigap is supplemental healthcare insurance that can help cover “the gaps” in your existing Medicare plan.

Depending on the type of Medigap policy you buy, there are a couple ways it can benefit you:

• Medigap can provide you with full coverage. If you purchase a Medigap Plan F, your coverage will pay for your Medicare deductible and the remaining 20% of costs. Working seamlessly with Medicare, Medigap Plan F can allow you to enjoy 100% healthcare coverage.
  
  
• Medigap can extend your Medicare coverage. Medigap Plan G, which is the next level down from Plan F, costs a little less, but also offers less coverage. For example, it will cover most of your gaps in Medicare coverage, with the exception of your deductible. This means you’re responsible for paying for your care until you meet the amount of your deductible.At this point, your Medicare and Medigap plans will begin to work together so you have less to pay out of pocket.

A realistic example of Medigap in action

We know healthcare can be a little confusing. To help, here’s an example of how the two plans can work together.

Let’s say David needs knee replacement surgery this year. He’s concerned about the costs, but he also knows his Medicare policy will help pay for most of the expenses—but not everything. The good news is he has a Medicare Plan F policy, which can supplement his costs this year. He even has two separate insurance cards for the two, different policies.

When David meets with his surgeon to discuss the upcoming procedure, he gives both insurance cards to the receptionist. Fortunately, David doesn’t have to do anything else in order for his Medicare and Medigap insurance to work together. Instead, here’s what happens behind the scenes:

• The doctor’s office files a claim to David’s Medicare policy.
• The company receives the claim and begins processing it.
• Someone from David’s Medicare insurance company reaches out to Medigap to coordinate payment for his deductible and any other expenses that aren’t covered by Medicare.
• After the visit (and David’s knee surgery), the Medicare and Medicap insurance companies send an Explanation of Benefits, showing the amount and dates they paid for David’s care.

Along the way, David doesn’t have to worry about knowing what part of his care is covered by Medicare and what part is paid for by Medigap. Instead, he can focus on recovering from his knee surgery, and feel peace of mind knowing that the expenses are taken care of. If he wants to know the details, he can call his insurance company with questions or refer to his Explanation of Benefits, which outlines what costs were paid and when.

4 important facts about using Medigap insurance

Now we’ve covered the basics (what Medigap is and how it works), we’ll discuss 4 important aspects of the insurance you should understand.

#1 – Medigap isn’t the same as a Medicare Advantage Plan.
Here’s the difference. Medigap is designed to be supplemental insurance for Medicare policies, which is federal insurance that’s offered to people age 65 and older. On the other hand, Medicare Advantage Plans (also known as Part C or MA Plans) are offered through private health insurance companies. This means that a Medigap policy won’t work with a Medicare Advantage Plan.

#2 – Medigap policies only cover one person at a time.
If you buy Medigap insurance, keep in mind that your policy will only cover your supplemental expenses. If you’re married and want your spouse to enjoy coverage, then you’ll need to purchase a second, separate Medigap policy.

#3 – There isn’t a specific provider network for Medigap.
Many doctors and hospital systems across the country accept Medicare insurance. But, keep in mind, there isn’t a specific provider network for Medicare. You just need to make sure you visit a provider who accepts Medicare insurance (and most do). Your Medigap policy will work at the same locations that accept Medicare. But, if you visit a provider who doesn’t take Medicare, they won’t take a Medigap policy either.

#4 – Medigap doesn’t offer coverage for prescription drugs.

In the past, some Medigap policies offered prescription drug coverage. But, since 2006, Medigap is no longer allowed to help cover the costs of prescriptions. Instead, you can add a Medicare Prescription Drug Plan (Part D) to your Medicare policy. If you have questions about this process, talk to a Lumico customer service professional today.