Medicare "Gaps"

& How To Fill Them

 

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Medigap Insurance

Medigap Insurance (Medicare Supplement)

As a person insured with Original Medicare (Medicare A & B), you have the right and opportunity to be covered by Medigap Insurance. Medigap, also known as Medicare Supplements, are insurance policies that help you cover the deductibles and co-insurance with Parts A & B. These costs are some of the "gaps" we refer to in this guide.

 

By helping you cover some of the most expensive Gaps, Medigap Insurance can give you the peace of mind of not having to worry about large medical bills.

Medigap Facts

Medigap insurance is provided by private insurance companies.

Medigap it is secondary to Medicare A & B. Medicare determines what is covered and pays first then forwards the claim to the Medigap insurer.

Each Medigap Plan is represented by a letter, which means certain standard coverage. The coverage for each letter is the same at any insurance company that offers it. The rates each insurer charges can differ.

Standard Medigap plans cover you at any doctor or medical provider in the country that accepts Medicare A & B. There are no networks.

Medigap - A Picture

Medigap Insurance pairs with Original Medicare A & B and covers 3 of the most expensive Gaps (more explanation down the page). But, Medigap does not include pharmacy benefits or dental & vision. When you have Medicare A & B and Medigap, you will need a single plan to cover both medications and dental & vision benefits. Here's what it looks like.

Includes Hospitalization under Part A and Outpatient care under Part B.

Medigap helps you cover the medical deductibles & copays with Medicare A & B.

"Stand Alone" Part D plan to cover medications at the pharmacy.

Single plan to cover dental & vision.

With Medicare & Medigap it is "un-bundled." You choose your benefits "A La Carte."

Filling The Gaps

Now that you have an understanding and picture of how this set up looks. Let's take a closer look at the Gaps mentioned in this guide and how the plans mentioned above cover them.

We will start with Medigap Insurance and how it covers the first 3 most expensive Gaps. Then, we'll examine Part D & Dental Vision coverage and how they cover the remaining.

As we mentioned earlier, each Medigap Plan is represented by a letter. That letter means a certain amount of Gap coverage.

 

Out of the 6 main plans available, Plans G and N are the most popular.

Medigap Plans G AND N

Gap # 1

Part A Deductible 

& Copays

Both Medigap plans G and N cover all Part A Deductibles & Copays. You have $0 out of pocket for Part A covered Hospitalization, Rehab Facility, or other costs.

Gap # 2

Part B Deductible 

& Coinsurance

Plan G covers the 20% coinsurance after you pay the Part B deductible.

Plan N also covers the 20% coinsurance after you pay the deductible. Plan N has a $20 copay for doctors and $50 for emergency room. Plan N also does not cover balance bills if a doctor bills over Medicare's fees, Plan G does.

Gap # 3

Annual Out Of Pocket Maximum

With Plan G your annual out of pocket maximum for Medicare covered services is simply the Part B deductible. The deductible is $198 per year in 2020. With Plan N your out of pocket maximum is the Part B deductible, copays each time you see a doctor or emergency room, and Medicare balance bills if they occur.

Gap # 4

Prescription Pharmacy Benefits

Gap # 5

Dental & Vision Coverage

Stand Alone Part D plans are provided by private insurance companies and help pay for medications you fill at the pharmacy. Part D plans have a monthly cost and may have deductibles & copays when you fill your medications. The various plans available may cover different medications and have different costs.

Single Dental & Vision plans help you cover routine and restorative dental & vision services. These are things like semi annual cleanings, fillings, crowns, eye exams, glasses, and contact lenses. You have a monthly premium and may have deductibles & co-insurance when services are received.

Stand Alone Part D Plan

Stand Alone Dental & Vision Plan

Medigap premiums in Texas can range from $73 to $150 per month in 2020, depending on several factors. The monthly premium is in addition to what you pay for Medicare. The standard Medicare premium is $144.60 per month in 2020.

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Since beginning his career as a Licensed Insurance Agent, Ben Rodriguez has personally helped nearly 700 Medicare recipients. He has a degree in Business Finance from Kent State University and has acquired nearly 15 years of experience in financial services & insurance. Having a close relationship with his parents and grandparents has made him in tune to the needs of boomers and seniors.  Ben is known for his professionalism with a personal touch that he brings to each of his clients.

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