Medigap Covers the Medicare Gaps by Mary Jane Stern

You know about Medicare Parts A, B, C and D, but do you know what a Medigap plan is all about? 

Medigap is a standalone plan that covers what original Medicare doesn't cover.  A Medigap plan covers the "gaps."  You can only have a Medigap plan if you are enrolled in Parts A and B.  You cannot enroll in a Medigap plan if you elect to be covered in an Advantage Plan.

You also must be 65 years of age to enroll, if you decide on a Medigap plan, sign up when you are 65 as it gets more expensive as you get older.  Some States do have Medigap policies for people who are disabled and on Medicare.  Unfortunately, the State I live in, Florida, doesn't offer anything like this for people who are disabled.  If your State doesn't have a plan for the disabled to cover the gaps, you either self-insure or enroll in an Advantage plan.

All Plans Are Standardized

What's great about the Medigap plans they are all standardized supplemental policies and the only difference is the cost.  You need to contact the private insurance companies to receive a quote and they all vary from provider-to-provider and State-to-State.  You can find a list for your State at http://medicare.gov.

Enrolling in Medicare A and B, along with a Medigap plan allows you to choose the Doctors you want to use.  There are no restrictions, unless someone doesn't participate in Medicare.  If they don't, Medicare provides that they can only charge you 15% over the allowed charge and some of the Medigap plans pick up this excess.

We contacted every provider in Florida and the prices ranged from $190 - $350 per month.  Florida is either the first or second most expensive State for Medigap plans.


What They Cover

There are 12 Medigap plans and each offer something different, but Medicare requires that all plans provide for:

1. Coinsurance for days 61-90 ($267 per day) and days 91-150 ($534 per day) in hospital
2. Payment in full for 365 additional hospital days
3. 20% coinsurance for physician and other Medicare Part B services

Some of the extra benefits provided for in the various plans are:

• Medicare Part A Hospital Deductible
• Skilled Nursing Facility (SNF) Coinsurance\
• Part B Yearly Deductible
•  Part B Excess Charges
• Foreign Travel Emergency
• At-Home Recovery
• Preventive Care

Everyone's situation is different and you really need to evaluate all of the Medigap plans and I can't stress that enough.  Unfortunately, there are the unscrupulous that will say and do anything just to make a sale.  Know what you need and make sure you call all the plans in your State to get the best price to make an informed decision.

It's also a good idea to ask you doctor's office staff if they have run into any problems with the Medigap provider you are selecting.  Since we enrolled, we have only found one doctor's office who will not accept our provider.

REMEMBER - Medigap plans are all the same - the only difference is in price:

Shop for the best price and for the best plan that meets your needs.