Medigap plans bridge the gaps

How to Choose the Right Medigap Plan in NC

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What is A medigap Plan?

Medicare Supplement insurance plans, better known as Medigap Plans, help fill the gaps left behind by Original Medicare. If you have Original Medicare, you’re likely aware that it doesn’t cover all of your healthcare costs. Things like deductibles, copayments, and coinsurance are still your responsibility.

Medigap policies are sold by private insurance companies and are designed to help ‘fill the gaps’ by paying for some of those remaining costs. A Medigap plan can give you more predictable healthcare expenses and greater peace of mind. Let’s explore how they work.

Filling the Gaps: Understanding Medigap Plans

Partners with Original Medicare

It’s important to know that Medigap policies only work with Original Medicare (Part A and Part B). They cannot be used with a Medicare Advantage plan. When you have a covered service, Medicare pays its share first, and then your Medigap policy pays its share, simplifying your out-of-pocket costs.

Standardized Plans (A through N)

Medigap plans are standardized, and in most states are identified by letters like A, B, C, D, F, G, K, L, M, and N. This means that a Plan G from one company offers the exact same basic benefits as a Plan G from another company; the only difference is usually the price. This makes it easier to compare plans.

What Typically Is Covered

Depending on the plan letter you choose, Medigap policies are designed to help pay for your share of costs for services covered by Original Medicare.

Benefits can include:

  • Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are used up.
  • Part B coinsurance or copayments.
  • The first three pints of blood each year.
  • Part A hospice care coinsurance or copayments.
  • Skilled nursing facility care coinsurance.
  • The Part A deductible.
  • Foreign travel emergency care (up to plan limits).

What Typically Isn’t Covered

It’s just as important to understand what Medigap plans are not designed for.

Medigap policies sold today generally do not cover:

  • Prescription Drugs – You will need to enroll in a separate Medicare Part D plan for prescription drug coverage.
  • Long-term care (like ongoing care in a nursing home).
  • Routine dental or vision care.
  • Hearing aids.
  • Eyeglasses or contacts.
  • Private-duty nursing.
  • Non-emergency medical travel (trips to appointments).

Is a Medigap Plan a Good Choice for You?

A Medigap policy can be a fantastic tool for managing your healthcare costs. It might be a great fit for your needs if you:

Prefer to pay a monthly premium to a private insurance company in exchange for this cost-sharing coverage.

Value the freedom to see any doctor or hospital in the U.S. that accepts Medicare, typically without needing a referral to see a specialist.

Value the security of knowing your policy is guaranteed renewable for life; it can’t be cancelled by the insurance company as long as you pay your premium.

Want help paying for some of the out-of-pocket costs that Original Medicare doesn’t cover, giving you more predictable expenses.

Understand that you will need a separate Part D plan for your prescription drug coverage, as Medigap policies do not include it.

Plan to travel and want coverage for medical emergencies that happen outside the U.S., as some Medigap plans offer this benefit. ($50k lifetime limit).

YOUR ENROLLMENT WINDOW

When is the Best Time to Buy a Medigap Plan?

Timing is incredibly important when it comes to Medigap. The absolute best time to buy a policy is during your Medigap Open Enrollment Period. This is a 6-month period that automatically starts on the first day of the month in which you are both 65 or older AND enrolled in Medicare Part B. It is a one-time, non-repeatable window for most people.

Why This Period is Critical: Guaranteed Issue Rights

During your 6-month Open Enrollment Period, insurance companies are legally required to sell you any Medigap policy they offer, regardless of any health problems you may have. They cannot use medical underwriting to charge you more or deny you coverage. Outside of this special period, your application may be denied or your premium could be significantly higher based on your health history.

Medigap plans

Questions About Medigap Plans?
We Can Help.

Sometimes a personal conversation is the best way to get clarity. If you’d like to talk through your specific situation or compare Medigap plans with a friendly local expert, we’re ready to help.

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For a complete and official list of all Medigap policies available in your area, you can always visit the official U.S. government site for Medicare.