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As the name suggests, Medigap policies are designed to fill the gaps in health care expenses that Original Medicare either doesn't cover or doesn't cover completely. Medigap policies (also called Medicare supplemental insurance) typically pay for incidentals like copayments and coinsurance, which can add up quickly if you visit doctors regularly or require an extended hospital stay.
There are a number of reasons to consider purchasing a Medigap policy if you have Original Medicare (Part A and Part B). But keep in mind that while a Medigap policy is appropriate for many beneficiaries, it may not be right for you.
Do I Need a Medigap Policy?
If you are considering getting a Medigap policy, here are five questions to ask yourself first:
- What are my current health care needs?
- How might my needs change over the next few years?
- How much of my health care does Original Medicare cover?
- Do I travel often outside the United States?
- Do I already have enough coverage?
What are my current health care needs?
Think about what kind of medical services and supplies you need now or will likely need in the future. For example, do you see your doctor or a specialist on a regular basis? If so, it may be wise to get a Medigap plan, especially if your copayments are more than the premium you will pay for a Medigap policy. On the other hand, if you visit your doctor only for annual check-ups or have very low medical bills, a monthly Medigap premium would be an unnecessary expense.
How might my needs change over the next few years?
You may be healthy now, but what about a few years from now? If you've recently started seeing your doctor more often, do you think you will need even more medical care next year? What about your current health: Has your doctor recently diagnosed you with any condition that may require ongoing treatment over the coming years? Do you participate in any activities that could result in an injury? For example, an injury to the knee from playing tennis may heal with a few weeks of physical therapy, but if the injury leads to complications, you might want help paying for skilled nursing care.
How much of my health care does Original Medicare cover?
Many people think Medicare will have them covered once they turn 65, but in fact, Part A and Part B don't cover everything. That means if you need certain health care services that Medicare doesn't pay for, you'll have to pay the full cost out of pocket.
Although Medigap policies will cover a few expenses not covered by Medicare, many services and supplies such as hearing aids, eyeglasses, and routine dental care are not covered by Medicare or Medigap plans. For the most part, Medigap policies are designed to help you with your Medicare deductibles, copayments, and coinsurance. That's why it is important to know how much you expect to spend on these items before deciding to purchase a policy.
If your Part A and Part B copayments and coinsurance amounts are low, a Medigap policy may not be right for you. You also may not need this type of policy if a majority of your medical bills are for services and supplies that are not covered by Medigap plans.
Do I travel often outside the United States?
In general, Original Medicare doesn't cover health care costs outside the United States and its territories. However, foreign travel emergencies are covered by six Medigap plans: C, D, F, G, M and N. If you travel abroad or have a vacation home outside the U.S., you may definitely want to consider getting a Medigap policy, if only to give you peace of mind for unexpected medical emergencies in a foreign country.
Do I already have enough coverage?
In general, you will not need a Medigap policy if:
- You have a Medicare Advantage Plan (Medicare Part C)
- You qualify for Medicaid
- You have group health insurance through an employer or union (or group coverage through your spouse)
It is also important to know that it is illegal for an insurance company to sell you a Medigap policy that significantly duplicates any existing coverage you have.
Even if you do not have immediate needs to supplement your Medicare coverage, it's still a good idea to carefully consider all of these questions before making any quick decisions. As healthcare costs continue to rise and life expectancy increases, you may want to consider getting a Medigap policy now to prepare for the future and ensure peace of mind.