Coverage Gaps: Identifying the Coverage Gaps in Original Medicare and How Medigap Can Help

As you approach your eligibility for Medicare, it’s important to understand that Original Medicare, consisting of Part A (hospital insurance) and Part B (medical insurance), may not cover all of your healthcare expenses. These coverage gaps can lead to unexpected out-of-pocket costs, leaving you financially vulnerable. Fortunately, there is a solution: Medigap plans, also known as Medicare Supplement Insurance. In this blog post, we’ll explore the coverage gaps in Original Medicare and how Medigap can help fill those gaps.

Coverage Gap 1: Medicare Part A Deductible and Coinsurance

Original Medicare Part A covers hospital stays, but it requires beneficiaries to pay a deductible amount before the coverage kicks in. In addition to the deductible, there are coinsurance costs for hospital stays that can quickly add up. Medigap plans can help by covering some or all of these costs, depending on the plan you choose. Plans such as Plan A and Plan B provide coverage for Part A coinsurance and hospital costs, giving you peace of mind and reducing your financial burden.

Coverage Gap 2: Medicare Part B Coinsurance and Deductible

Original Medicare Part B covers outpatient services, but it requires beneficiaries to pay coinsurance and an annual deductible. The coinsurance is typically 20% of the Medicare-approved amount for services, which can become significant if you require frequent medical care. Medigap plans can help by covering some or all of the Part B coinsurance and deductible. Plans such as Plan C, Plan F, and Plan G provide comprehensive coverage for Part B costs, ensuring that you’re not left with hefty bills for doctor visits and medical services.

Coverage Gap 3: Skilled Nursing Facility Coinsurance

Original Medicare provides coverage for skilled nursing facility (SNF) care, but only for a limited time and under specific conditions. After the first 20 days, beneficiaries are responsible for a daily coinsurance amount. Medigap plans can help by covering some or all of the SNF coinsurance costs. Plans such as Plan C, Plan D, and Plan G provide coverage for SNF coinsurance, providing you with extended coverage and financial protection.

Coverage Gap 4: Foreign Travel Emergency Care

Original Medicare generally does not cover medical expenses incurred outside of the United States. If you travel internationally, you may be at risk of significant medical costs in case of an emergency. Medigap plans can help by providing coverage for emergency medical care while traveling abroad. Plans such as Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N offer coverage for foreign travel emergency care, ensuring that you’re protected no matter where you are in the world.

Coverage Gap 5: Excess Charges

Original Medicare allows healthcare providers to charge up to 15% more than the Medicare-approved amount for certain services. These excess charges can catch beneficiaries off guard and result in additional out-of-pocket expenses. Medigap plans can help by providing coverage for excess charges. Plans such as Plan F and Plan G cover excess charges, giving you the confidence to seek medical care without worrying about unexpected costs.

Choosing the Right Medigap Plan for You

With several Medigap plans available, it’s important to choose the one that best suits your needs. Consider factors such as your health condition, budget, and anticipated healthcare expenses. Compare the coverage and costs of different plans to find the one that fills the coverage gaps in Original Medicare while aligning with your financial capabilities.

In conclusion, Original Medicare leaves coverage gaps that can lead to significant out-of-pocket costs.