Which gaps in Medicare can a Medigap plan cover?
Medicare Supplemental insurance, also referred to as Medigap or Supplement insurance, was created to help beneficiaries fill the gaps that are not covered by original Medicare.
Medigap plans are standardized by the Center for Medicare Services (CMS), which makes them easily comparable, as every insurance company that offers one of the plans must give you the exact same plan benefits. The different plans available are labeled with letters A, B, D, G, K, L, M and N, with each plan having a different set of benefits.
This diversity is one of the many reasons that Medicare Supplement plans have become an increasingly popular way to supplement the basic original Medicare coverage.
So which gaps in original Medicare need to be filled? The answer it, it depends on each beneficiary’s individual health care needs and financial budget. A plan that is best for one person is not necessarily right for someone else. A starting point to find the plan that is best for your individual needs, is to evaluate your medical needs, and compare them to the gaps in the original Medicare plans.
While it is impossible to list everything that is not covered by original Medicare, here are some of the services and items that Medicare does not include:
- Long-term care
- Routine dental care and dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting hearing aids
On top of the services or items that are not covered by Medicare, there are gaps for co-payments, coinsurance or deductibles you are responsible for if you don’t have other insurance to cover those expenses. In case you have to stay in a hospital, for example, Medicare Part A only covers the first 60 days in full – after your deductible has been met. After that period of time, a hefty daily coinsurance will be charged. Also, when it comes to Medicare approved doctor’s services, there is always a coverage gap of 20% of the costs in case you solely rely on original Medicare.
Important: don’t overlook that you won’t be covered for prescription drugs – no matter which Medigap policy you choose! Medicare Supplement Plans do not include prescription drug benefits, therefore Medicare beneficiaries with supplemental insurance plans have to add a stand-alone prescription drug plan in order to also be covered for prescription medications.
