Medigap, or Medicare Supplement, policies can help lower your out-of-pocket costs incurred with Original Medicare. Your Medigap 6-month initial enrollment policy begins when you turn 65 and are enrolled in Part B. During this period, you have a guaranteed issue right to purchase any Medigap policy sold in your state. You cannot be turned down or charged more and there is no medical underwriting during that time. After your initial enrollment period has ended, you may be turned down or charged more for a policy based on pre-existing conditions.
Medigap plans can help cover the costs that Original Medicare does not, including coinsurance, copayments, deductibles, and medical care outside of the United States. Prior to January 1, 2006, some Medigap plans included prescription drug coverage. Medigap plans purchased after that date do not cover any prescription drugs. Medigap can only help offset out-of-pocket expenses that may include costs related to medications in certain circumstances.
Prescription Medication Administered in the Hospital
Medicare Part A coverage is also called hospital insurance. Part A helps cover the costs incurred by inpatient services at hospitals, skilled nursing facilities, hospice and some home health care needs. In many situations, the coverage includes any medications administered by healthcare professionals in these settings. There can be exceptions to that general rule, so it’s important to talk to your providers in order to understand any additional costs you may need to pay.
Medigap, which is also known as Medicare Supplement insurance, can help reduce your cost-sharing obligations with deductibles, copayments and coinsurance amounts for services you incur as an inpatient in the hospital. There are a variety of Medigap policies available, and the exact package of benefits depends on the plan you choose.
Prescription Medication Administered in Outpatient Facilities
Medicare Part B may offer coverage for some prescription medications when they are administered in an outpatient setting by a healthcare professional. Medigap plans can reduce copayment and coinsurance amounts for the services you receive at an outpatient facility. Medigap plans have their own monthly premium, which is separate from Part B’s monthly premium.
Prescription Medication Taken at Home
Medicare Part D prescription drug coverage became effective on January 1, 2006. After that date, Medigap plans were no longer able to offer prescription drug coverage as part of their benefits.
If you purchased a Medigap plan that included prescription drug coverage before this date and continue to pay the premium without interruption, you may be able to keep that plan. If you choose to cancel a Medigap plan that includes prescription drug coverage, you will not be able to renew it in the future since plans like these are no longer available to new or returning recipients.
If you have Original Medicare, you have the option of signing up for a stand-alone Prescription Drug Plan (PDP). You also have the option of receiving your Part A and Part B coverage through a Medicare Advantage plan that includes prescription drug coverage. However, enrolling in a Medicare Advantage plan will make you ineligible to purchase a Medigap plan at the same time.