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Medigap: Covering the Gaps in Medicare


Learn about the policies designed to fill the gaps in Medicare coverage -- called medigap insurance.

Even for those who have Medicare coverage, a serious illness or injury can cause financial havoc because of the bills Medicare does not cover. Responding to this risk, about two-thirds of all Medicare recipients aged 65 or over buy some kind of private health coverage -- called medigap insurance.

The term medigap comes from the notion that these insurance policies will cover the gaps in Medicare payments. Unfortunately, most medigap coverage is not nearly as complete as its advertising would lead you to believe.

 
Medicare Managed Care Plans

HMOs and other managed care plans, an alternative way to cover these gaps, typically provide broader coverage at slightly lower cost than most medigap policies -- and many people opt for these forms of coverage instead of medigap. However, HMOs and other managed care plans restrict the doctors and facilities available to you in ways that most medigap policies do not. And in recent years, Medicare managed care plans have been dropping seniors in large numbers, adding an element of risk to the managed care option.

Before you buy a medigap insurance policy, consider not only the services covered, but the amount of benefits and the monthly cost of the policy. Also pay attention to two other factors: how much premiums may rise in the years to come and, assuming you are willing to pay those premiums, whether you will be allowed to keep the policy.

Premium Increases

It is one thing to find insurance coverage you can afford today. It may be quite another to find a policy that you can still afford in later years when your income and assets have decreased and the policy premium has increased -- as it is sure to do. In choosing a medigap policy, consider the terms on which the policy premiums will rise over time. If the current premium will be a significant strain on your financial resources, you may want to consider a less expensive policy.

Copyright 2007 Nolo

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