What Does Medigap Cover?
So what exactly will your Medigap insurance policy cover and not cover? Again the purpose of a Medigap plan is to make up for the out-of- pocket expenses that original Medicare does not cover.
Typically that means copayments, coinsurance, and deductibles. In other words, if you are enrolled in traditional Medicare and you purchase a private Medigap health insurance policy, Medicare pays its share of the Medicare-approved amounts for covered health care costs, and then your Medigap policy will pay for anything left over.
Medigap Insurance plans are standardized nationwide, with the exception of Massachusetts, Minnesota, and Wisconsin. The same letter designated Plan, must have the same coverage no matter where you live, or what insurance company your purchase it from.
Typically Medigap Insurance plans will not cover:
- Long-term care such as nursing homes
- Vision Care and Eyeglasses
- Dental care
- Hearing aids
- Private-duty nursing
- Prescription Drugs - Medigap Plans sold after January 2006, cannot include a prescription drug benefit. If you need prescription drug coverage you need to enroll in Medicare Part D.
The Chart on the Following page, reprinted form an official Government Pamphlet entitled, A Guide to Health Insurance for People with Medicare offers a snapshot of the benefit provided by the various plans available as of June 2010.
A Note About Medicare Advantage
Understand that Medigap Insurance only applies to traditional (Government provided) Medicare Benefits. If you have opted in to a Private Medicare Advantage Plan, such as an HMO or PPO, (sometimes referred to as Medicare Part C), you cannot, nor do you need to, purchase Medigap insurance.
If you already have a Medigap policy and you are changing from traditional Medicare to a Medicare Advantage Plan, deductibles, copayments, coinsurance, or premiums will not be paid by your Medigap policy. You may elect to cancel your Supplemental policy, but you should contact the State Health Insurance Assistance Program in your area, and your current Medigap insurance company first because you may not be able to reinstate that Medigap policy if you choose to in the future. If Medicare Advantage currently insures you, it is against the law for anyone to offer you a Medigap policy unless you are dropping Medicare Advantage to go back to original Government Medicare.