What Is Medigap Insurance & Where Do I Get It?

Medicare has gaps. It does not pay for all the health care service needs of people who are enrolled in Medicare. If you are enrolled in the Original Medicare Plan, for example, you may be able to buy Medigap insurance or a Medicare Advantage Plan. Not everyone who has attained age 65 can or needs to enroll in a Medigap plan.

Medigap as Supplemental Insurance

• Medigap is supplemental insurance to Medicare. A Medigap policy is intended to fill the gaps left uncovered in the Original Medicare Plan by helping to pay for some of the health care costs that Medicare does not cover. When Original Medicare Plan benefits and Medigap policy benefits are combined, each pays a share of covered health care costs. Medigap policies are standardized to make comparisons easier for consumers. The plans are identified by an initial. Each plan labeled "A" must have certain basic benefits and can have extra benefits. The same is true for plans labeled "B" through "L." To the consumer, this means that benefits of any insurance companies' Medigap Plans A through L can be easily compared to another company's A Plan.

Basic Benefits Provided by Medigap

• About two dozen standard Medigap insurance plans are available. Each standard plan offers a different set of benefits and fills varying gaps in Medicare coverage. The plans also vary in price. All these Medigap plans are required to cover certain basic gap-filling benefits. The gaps they address include extensions of hospital benefits, some coverage for preventive services and blood, skilled nursing, doctor's services and some limited foreign travel emergency benefits. Some of the plans are offshoots of others, changing either in their amounts of co-pay or deductible. Some plans will be phased out in 2011, so interested persons should check with insurance companies to determine plan availability.

Sources of Medigap Insurance

• Private insurance companies sell Medigap insurance. Each individual insurance company can decide which of the Medigap policies to sell.

States Regulate Insurance Including Medigap

• In the United States, insurance regulation is handled by each individual state. Medicare is a federal program. Medigap policies must conform to both federal and state laws. It is important for Medicare enrollees to learn about supplemental insurance plans available in their areas. As an example, Medicare enrollees in Wisconsin, Massachusetts or Minnesota are offered different standardized Medigap plans than other states.

Choose Either a Medicare Advantage Plan or Medigap

• If you are a subscriber in a Medicare Advantage Plan, you already have supplemental Medicare insurance. These plans, usually designated as a Medicare Health Maintenance Organization, also known as an HMO, provide an extensive package of supplemental Medicare insurance. With a Medicare HMO, you may pay a monthly premium or have no out of pocket cost. You usually have a primary physician and/or primary medical group, and receive maximum benefits when you utilize preferred providers. When you have supplemental Medicare insurance through an HMO, you do not need Medigap insurance.