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General Medigap Information

In the United States, older people’s health services are primarily funded by older people’s health insurance (Medicare), the federal poor health care system (Medicaid), Veterans Health Administration, private insurance and cash payment. In addition, many states offer health-related benefits and programs, such as transportation subsidies, housing, utilities, telephone charges, food expenses, and home care and nutrition services. Health workers should help older patients learn about the health benefits and programs that they are entitled to.

About 87% of Medicare service fee beneficiaries have additional insurance policies (most of which are Medigap forms of insurance) that cover some or all of Medicare deductibles and bonuses, usually in Parts A and B. People must be enrolled in Part A and B programs to be eligible to purchase Medigap insurance. People with Pre-Coverage Medicare (Part C) cannot purchase a Medigap until they quit Pre-Medicare and return to their original Medicare program. Most Medigap insurance is purchased individually from private insurers, although employers can provide retirees with this insurance.

There are 14 different types of insurance available from Medigap, labeled A to L. Payments are the same for all plans with the same letter, regardless of the selected insurer. No plan can duplicate the benefits of Medicare. The main plan (plan A) covers:

Other plans that have higher insurance premiums than Plan A may provide additional coverage at skilled nursing facilities and may cover Part A and B deductibles, preventative health services, and short-term home care for daily activities (ADLs) in the period of recovery after illness, injury or surgery. Some of these plans, if paid by Medicare before Part D takes effect, cover a fraction of the cost of prescription outpatient drugs.

The open enrollment period for a Medigap policy begins with the month when people turn 65 and lasts 6 months. During this period, people who have pre-existing conditions cannot be denied cover or charge more, but they can be forced to wait up to 6 months until the pre-existing conditions are closed.