It is necessary to have an understanding of the difference between Medicare and Medigap in order to know when you do need to get Medigap insurance. The terminology refers to the “gaps” in Medicare services that are covered under this private insurance and are not part of the Medicare program. Medigap is an insurance policy sold by private health insurance providers to supplement the government sponsored program.
There are different policies you can choose with Medigap. In order to purchase the right policy for you, it is important to do an annual review of what your current Medicare program provides and where you can benefit from taking out a Medigap policy. The federal government has 12 such policies lettered A through L. An A policy is the most basic whereas the newest plans, K and L, have payments included of 50% to 75% on certain medical expenses, such as payments, coinsurance policies and deductibles. There are also plans that will cover the cost of medical care if you are in a foreign country.
Each person must have his/her own Medigap plan. You cannot assume that you spouse or your children are covered under your plan, because they are not. If you do not have much sickness or have the monies available to pay the additional costs not covered by Medicare, you may not need to have a plan in place. If you or one of your dependants does have a medical condition, however, it would be in your best interests to start looking for a plan that meets your needs.
Plans K and L of Medigap will pay for costs such as:
blood tests the first three pints
coinsurance or copayment of hospice care when it is needed
coinsurance for the services of a skilled nursing facility
the deductibles for Parts A and B of the Medicare plan
Plan K of a Medigap insurance policy will pay 50% of the costs and Plan L will pay 75% of the costs.
A Medigap insurance policy is of particular interest to senior citizens. There is a free enrolment period during which you cannot be turned down because of pre-existing medical conditions. This free period starts in the month after you turn 65 years of age and continues for the next six months.
Medigap insurance is not the same in all states. You do need to find the requirements and coverages included in such an insurance policy for your state. There are also additional options in some states, such as Medigap Select, which will require you to use specific doctors and hospitals. If you are wondering if Medigap is for you, this requirement may not be to your liking. It is cheaper than the option that allows you to choose whatever doctor or hospital you want.