Does My Medigap Plan Cover What Medicare Doesn’t?

Basics of Medigap Plan

There is a great deal of misunderstanding about Medigap policies and Medicare in general. People assume that all the expenses left out by the medicare is filled by Medigap plan. The truth is, no policy on the market covers the entire expenses. The more you know about the subject, the better you will be able to deal with any future circumstances.

Benefit Gaps and Coverage Gaps

It is important to learn that there are two different areas where Medicare policy fails to pay the entire expenses- coverage gaps and benefit gaps. Coverage gaps are those areas of health care where Medicare does not pay a single dime such as routine annual checkup, certain prescription drugs and so on. Benefit gaps are where medicare pays the payable amount, but not fully to cover the expenses incurred. For example, for a major surgery under Part B, the patient is required to pay at least 20 percent of the overall cost(deductible), before any benefit is payable by the Medicare.

More About Medigap Plan

Medigap plan is designed to cover benefit gaps only and not the coverage gaps. These policies differ depending on the company, hence it is necessary to ask the agents question like “Is the Part A deductible covered?”, “Does the policy cover nursing home co-payments, long hospitalization?”, “What other coverages does the policy offer?” etc. Many unscrupulous operators try to pose as being affiliated to sell the best Medigap plans. If such salesperson tells you that the Medigap policy he/she is selling covers all the expenses not paid by the Medicare, that is a sign of deception. Another area of confusion that exists among plan holders is, who actually sells these Medigap policies. No government offices or government affiliated parties sell Medigap policies, as this can only be purchased from a private insurance company.

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