Medicare Expert

Linda Bergthold

When it’s time to enroll in Medicare, you will have several choices. Since Original Medicare covers only about 80% of your medical costs, you may want to consider buying a Medicare Supplement insurance or Medigap policy, which will cover most of the remaining 20% of services <a href="https://www.openmedicare.com/guide/medicare-101/what-is-medicare-supplement">that Medicare approves</a>. You can also choose a Part C or Medicare Advantage plan, which includes Parts A, B, and usually D in one package which <a href="https://www.openmedicare.com/guide/picking-a-plan/is-a-medicare-advantage-plan-right-for-me">we describe here</a>.

How do you decide if a Medigap policy is right for you? If you are not comfortable taking the risk of paying that extra 20%, you can purchase a Medigap policy. 
There are ten Medigap policies (labelled alphabetically, Plan A through Plan N) that are standardized in terms of the benefits they can offer, but they differ in what is covered in each of the plans and the costs for that coverage1. The more the plan covers, the more you will pay. All plans cover your hospital coinsurance, but most plans do not cover Part B excess charges or the Part B deductible. You will pay a monthly premium for Medigap coverage that ranges in terms of your gender, age, and whether or not you smoke.

If you join when you are first eligible for Medicare and/or your Part B coverage begins, the insurance company cannot deny your coverage or charge you more because of any pre-existing conditions.

What if you cannot afford a Medicare supplement plan? Since the premiums for these plans can vary tremendously, what do you do if you cannot afford the monthly premium? You may be eligible for Medicaid, which is assistance for <a href="https://www.openmedicare.com/guide/medicare-101/medicare-vs-medicaid">people with low income</a>. Check with your state Medicaid program about your eligibility.

The main advantage of a Medigap policy is the freedom it offers you to seek medical care from any provider who takes Medicare patients, no matter what the county or state. There are no referrals required and no preauthorization for treatments. A Medigap policy may be best for you if you can afford the monthly premium and you want to be able to go to any medical provider.

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1<a href="https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?lang=en&amp;year=2021">https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?lang=en&amp;year=2021</a>

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