Original Medicare—Parts A and B—provides broad coverage for hospital and medical services, but it does not cover everything. Deductibles, copays, and coinsurance can add up, leaving beneficiaries responsible for a portion of their healthcare costs. For many people, that financial exposure is a concern.
Medicare Supplement insurance, commonly known as Medigap, is designed to help fill some of those gaps. Offered by private insurance companies, Medigap policies work alongside Original Medicare to help cover certain out-of-pocket costs.
What Medigap Covers
Medigap plans are standardized at the federal level, meaning the benefits included in a particular plan letter (such as Plan G or Plan N) are the same regardless of which insurer offers it. This makes it easier to compare policies based on premium cost and insurer reputation rather than trying to decode different benefit structures.
Common Medigap benefits include coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance or copayments, the first three pints of blood used in a medical procedure, and Part A hospice care coinsurance. Some plans also cover skilled nursing facility care coinsurance and the Part A deductible.
It is worth noting that Medigap plans generally do not include prescription drug coverage—for that, you would need a separate Medicare Part D plan.
When to Buy a Medigap Policy
The best time to purchase a Medigap policy is during your Medigap Open Enrollment Period, which is a six-month window that begins the month you are both 65 or older and enrolled in Medicare Part B. During this window, insurers are required to sell you any Medigap policy they offer in your state at the same price they offer it to anyone else, regardless of your health status.
Outside of this window, insurers may be able to use medical underwriting, which can affect your eligibility or premium cost depending on your health history.
Medigap vs. Medicare Advantage
It is important to understand that Medigap is designed to work with Original Medicare (Parts A and B) and cannot be used alongside a Medicare Advantage plan. If you are enrolled in Medicare Advantage, Medigap coverage does not apply to your benefits.
Getting the Right Guidance
Navigating Medicare options—Original Medicare, Medigap, Part D, and Medicare Advantage—can feel overwhelming. Working with a licensed insurance professional who focuses on Medicare coverage can help you understand the options available in Pennsylvania and make decisions that reflect your healthcare needs and budget.
Reach out to Wm. R Karschner & Sons at (570) 724-4852 or visit our website to request a consultation. We are here to help you explore your Medicare options.