Fact vs. Fiction: What to Know about Medigap Plans

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If you've ever had to deal with a surprise medical expense, you're probably willing to do all you can to avoid going through that again. So when it comes time to enroll in Medicare, you may be interested in buying a Medicare Supplement, or "Medigap", plan to help pay for some of the health care costs Original Medicare (Parts A and B) doesn't cover.

While Medigap plans do help fill the gaps in Original Medicare, these plans are often misunderstood. To help you make the best decision for your total health and well-being, make sure you know fact from fiction.


Fiction: Medicare Advantage plans are a type of Medigap plan

Fact: Like Medigap plans, Medicare Advantage plans are offered by private insurance companies, but they're not a type of Medicare Supplement plan.

Medicare Advantage plans (also called "Part C" or "MA plans") are an alternate option to enrolling in Original Medicare. Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. They may also offer extra coverage like vision, hearing, dental, and prescription drug coverage.

Put simply, Medicare Advantage plans replace Medicare benefits, while Medigap plans help fill gaps in coverage that Medicare Parts A and B don't cover.

Which is right for you? It all depends on what you're looking for in a plan. The costs, benefits, rules, and restrictions vary across all Medicare Advantage plans. The costs, benefits, and restrictions also vary across the 10 different Medigap plans: A, B, C, D, F, G, K, L, M, and N. So it's important to learn about these plans to make sure you're making the right decision for both your health and financial well-being.

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Fiction: You have to enroll in a Medigap plan during the Medicare Annual Enrollment Period (AEP)

Fact: Every year from October 15 to December 7, the Medicare Annual Enrollment Period (AEP) allows Medicare beneficiaries to change their Medicare coverage. You may be able to enroll in a Medigap plan during this time, but it's certainly not the only — or best — time to do so.

Instead of waiting for the Medicare AEP, it's best to enroll in a Medigap policy during your six-month Medigap open enrollment period. This period automatically starts the month you're 65 and enrolled in Medicare Part B. During this time, you can buy any Medigap policy sold in your state, no matter your health condition.

If you wait until after your six-month Medigap open enrollment period to enroll in a Medigap plan, you may not be able to buy a Medigap policy. This is because after this period, Medigap insurance companies can decide to reject your application based on your health. So, if you're interested in enrolling in a Medigap plan, be sure to do so during your six-month Medigap open enrollment period to avoid any rejections.

Fiction: Medigap plans cover prescriptions

Fact: Medigap plans can help cover costs like your deductibles, coinsurance, and copayments under Original Medicare, but prescription drug coverage isn't part of that coverage. If you need prescription drug coverage, you can enroll in a Medicare prescription drug plan (PDP) once you enroll in Original Medicare. Or, you can choose to enroll in a Medicare Advantage plan that includes prescription drug coverage. It's important to know that if you enroll in a Medicare Advantage plan, you can't enroll in a Medigap plan.

Fiction: You must get care in network with your Medigap plan

Fact: Most Medigap plans don't have provider networks. This means you can see any doctor you'd like as long as they accept Medicare. To avoid unexpected costs, be sure to check that your doctor accepts Medicare before scheduling an appointment. If they don't accept Medicare, you may be responsible for the costs of your visit.

If you have a Medigap plan called Medigap Select, you may have to get care that's in network with your plan. So it's best to check with your plan for specific details before receiving care.

Knowing fact from fiction when it comes to your Medicare options can help make sure you choose the best plan for your physical, mental, and financial health. So remember to do your research before making a final decision on what plan is right for you.

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