Medigap is an extra level of insurance you can buy from a private company. It covers Medicare’s co-payments and deductibles, as well as health insurance if you travel outside the country. Medigap plans do not cover any service that Medicare itself doesn’t cover, so it wouldn’t cover your long-term care nursing, for example.
There are a range supplementary plans offered by each private insurer. Plans in New Jersey are standardized and named by letter, so the coverage for each plan is the same across the board. However, each insurer chooses which premium to charge for their plan.
If you’re new to Medicare, you might be wondering about these Medicare supplement plans, and which one—if any—is right for you. Here are some common questions about Medigap, answered:
Are there any limitations on signing up for a Medigap plan?
The policies are only available for those who have both Medicare Part A and Part B. The best time to purchase a policy is during the open enrollment period. It runs for six months from the first day of the month of your 65th birthday, if you signed up for Part B. If you join Part B later, your open enrollment period is three months before and after signing up. In this six-month window, your premiums will be the same as the general population’s, regardless of how poor your health may be. Once the period ends, you may not be able to get coverage if you have a preexisting condition.
Can I get a Medigap plan to supplement my Medicare Advantage plan?
No. Medigap plans are only available to original Medicare beneficiaries.
What do the plans cost?
As mentioned above, the premiums vary from provider to provider. The cost also depends on what the plan offers and if there’s a separate deductible. The average plans that have good coverage and low-to-no deductible cost around $100 to $150 a month in New Jersey.
Are Medigap plans worth their cost?
The short answer is yes. Medicare has substantial gaps in coverage (hence the term “Medigap”), and you’ll be on the hook to pay for them if you don’t have supplementary insurance. For example, Medicare only pays 80% of approved Part B services. And there’s no cap on the 20% co-payment like private plans offer. Your Medigap plan will kick in and cover that 20% fully. In the case of an ER visit, hip replacement surgery, or medical equipment needed for sub-acute rehab, you save significantly more than the annual cost of the premiums.