Is Medicare Supplement Insurance (Medigap) Really Worth the Cost?


The goal is to stay healthy and live longer, right? What does that mean in terms of a lifetime of medical costs? The better we are at living longer, the more we end up spending on health care.

If you are serious about designing your best possible retirement, planning for preventive care and preparing for major medical expenses are crucial. It’s not too different from buying auto or homeowner’s insurance. We all hope that we never need to use insurance, but we’re protected from crushing debt to be on the safe side.

What Can You Expect from Medicare?

First, be aware that Medicare does not cover every medical service, and it does not pay for 100 percent of many services that it does cover. Part A deals with home health care, hospice, hospital and skilled nursing care. You have to meet a $1,100 deductible per illness before your Part A coverage will begin. After that, Part A pays will cover your hospitalization charges for the first 60 days, but it only pays for a portion of the daily cost starting on the 61st day.

Part B handles doctor services, and other services that are not covered under Part A. After you have met the $155 annual deductible, Part B will pay 80 percent of Medicare’s pre-approved amount. You’re responsible for the other 20 percent, and for any amount your doctor charges that exceeds the pre-approved amount.

What Can You Expect from Medicare Supplement Insurance?

Medicare Supplement Insurance, also known as Medigap, offers you 10 different plans to cover the gaps in Medicare in ways that best fit your situation. That’s important so you can get the coverage you need without paying for benefits you don’t need.

Nine Medigap plans will pay for that $1,100 Part A deductible and many also pay for the $155 Part B deductible. All Medigap plans will pay your coinsurance amount for hospital charges after the 60th day, and they also pay for the total Medicare reimbursement amount for an additional 365 days per lifetime.

Immediately following hospitalization, Part A will also pay for 20 days in a skilled nursing facility to help with rehab and getting your strength back so you can care for yourself when you return home. If you need more than 20 days, you have to pay for part of the daily costs, which is called a coinsurance amount. Eight of the Medigap plans pay for that coinsurance amount that you’re charged after 20 days.

Two Medigap plans cover your annual Part B deductible of $155 for doctor services. This deductible has been increasing each year so Medigap pays for 100 percent of Medicare deductibles for any given year.

Even after you meet the Part B deductible, you’re only covered for 80 percent of Medicare’s pre-approved amount. When doctors don’t accept that Medicare-approved amount, they bill you for the difference between what Medicare will pay and what they can legally charge. As we all know, doctors charge vastly different amounts for the exact same procedure. Medigap Plan F pays for 100 percent of all these excess charges. That can really cut your out-of-pocket fees! For a slightly lower premium, Plan G pays for 80 percent of the doctor’s excess charges.

If you had hoped to travel during retirement, be aware that Medicare won’t pay a dime for any emergency medical care you might need while traveling abroad. Seven Medigap plans will cover 80 percent of your emergency medical care even though you’re traveling through a foreign country. These plans cover you for up to 60-day trips with only a $250 deductible. Check each plan for a lifetime maximum, though, to be sure you get what you expect.

If you’ve kept your insurance premiums low with high-deductible policies before you turned 65, you’ll be happy to hear that certain insurers also offer high-deductible versions of Medigap Plans F and J. These plans pay the same benefits as the standard versions of Plan F and J after you meet a $2,000 annual deductible.

Keeping Your Health Care Costs under Control

With a choice of 10 Medigap plans, you can pick and choose the benefits you need. As long as you’re relatively healthy, you’ll be able to change plans whenever your situation requires a different set of benefits. Without a Medigap supplement, you may find out far too quickly how the gaps in Medicare’s coverage really pile up and threaten you with out-of-control health care charges.

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