What Is Medicare
What is Medicare and what is Medigap? These are two of the most commons questions we are asked on a daily basis, so we decided to dedicate an entire page to the what is Medicare, what is Medigap trivia question. While both Medicare and Medigap are very in-depth, this page should give you a broad understanding of how to discern one from the other and how to see if either of them apply to you. As always, you can call us with questions at 866-260-9829 if need be. We’re here to help!
Medicare Part A and B are provided by the government. Your Part A is paid for through 40 quarters of Medicare taxes while working and Part B is paid monthly once you enroll in Medicare. For most people, as of 2019, the Part B premium is $135.50, however, it is based on your income. Medicare Part A and B by themselves leave you with many gaps in coverage, so using them alone isn’t a great idea.
So, what is Medigap? A Medigap plan fills the gaps in Part A and B. For most people, the best Medigap plan (Plan F) runs between $100 to $150 at age 65, depending on where in the country you live. Plan F fills all of the gaps in coverage (Prescriptions aside, that’s Part D, below), however, around here, we are big fans of Plan G, the second best plan. More on that later.
What Is Medigap
A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits. Note: Medicare doesn’t pay any of your costs for a Medigap policy.
All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest.
*Plan F is also offered as a high-deductible plan. With a high-deductible Plan F, you must pay for Medicare-covered expenses such as copays and deductibles up Plan deductible of $2,300 for 2019 before the policy pays anything.
*Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.
**Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% for Plan K, and 75% for Plan L. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The annual out-of-pocket limit does NOT include costs from your provider that exceed Medicare-approved amounts (excess charges). For 2019, the out of pocket will be $5,560 for Plan K and $2,780 for Plan L.