Medicare Supplement “Medigap” Insurance Policies

Are you new to Medicare? Do you think that Medicare will cover all your medical expenses? If so, think again. Medicare does not cover all treatments or procedures. It also requires you to pay premiums, deductibles, and copays. This can be a huge financial burden, especially for those with lower incomes. There are Medicare Savings Plans (MSPs) for those with extremely low incomes. But not everyone qualifies for MSPs. What do those folks do to cover their out-of-pocket expenses? The answer is that these folks often purchase Medigap Insurance policies. Here is some information about Medigap policies.

Medigap policies are private health insurance policies that are regulated by the federal government and sold to fill “gaps” in Original Medicare, also known as Medicare Parts A and B. These gaps include most copays, coinsurance costs, and deductibles. However, as of January 1, 2020, Medigap policies are not allowed to cover the Medicare Part B deductible. Medigap policies also offer coverage for treatments and services not approved by Medicare. This includes services such as medical care when you travel outside of the United States. 

So how do Medigap policies work? The answer is simple. Medigap policies are a supplement to your existing Medicare coverage. This means that, if you have medical costs, Medicare will pay its share of the costs (in other words, the Medicare approved amount for covered health care costs), then your Medigap policy will kick in and pay its share. For example, if you had a $100,000 medical procedure and Medicare only covered $80,000 of the costs, Medicare would pay that portion, then your Medigap policy would pay its share, which would hopefully be the remaining $20,000.

There are some restrictions as to when policies can be purchased. To purchase a Medigap policy, you must already have Original Medicare. You have a guaranteed issue to buy a policy in the first 6 months you are eligible for Medicare, meaning you cannot be refused due to existing conditions. After your initial period you may be subject to medical underwriting. This means that you should strongly consider applying for a Medigap policy during the first 6 months you become eligible for Medicare, especially if you have a preexisting condition. 

Finally, please be advised that your Medigap policy only covers you. If you have a spouse or other family member that wants Medigap coverage, he or she will have to purchase it separately. Additionally, Medigap policies do not cover prescription drugs.

So, there you have it. A few quick facts about Medigap policies. If you want to learn more about Medigap policies, other Medicare topics, or about health benefits in general, reach out to Benefits in Action by calling 720-221-8354 or emailing Their counselors can answer all your questions about any health benefits for which you may be eligible.

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