The original Medicare plan does not cover some physician and hospital services. The Medigap program is a supplemental insurance policy that assists beneficiaries in paying for non-covered physician and hospital expenses. The policy is sold by private insurers to help with these services that Medicare does not cover. An individual must be a member of Medicare plans A or B to meet the eligibility requirement for Medigap.
The core benefits for the Medigap program are Part A daily coinsurance for days 61 to 90 of hospitalization, Part A daily coinsurance for each of Medicare’s 60 lifetime inpatient hospital days, 100 percent of covered hospital charges for 365 additional days after all Medicare hospital benefits have been used, Part B coinsurance amount (usually 20 percent of approved charges) after the deductible, and first three pints of blood per calendar year. I believe the coverage needs of consumers are sufficiently met by this program.
This program works well for individuals who cannot afford to pay the extra out-of-pocket expense such as copayments, coinsurance, and the sometimes costly prices of prescription drugs. Considering the benefits and limits offered by each plan, it is my opinion the cost is fair. The out-of-pocket expense would be greater than the Medigap premium if one had to pay a hospital co pay without the coverage. If one does not require frequent doctor visits and is in reasonably good health, it would probably be less expensive to pay a co- pay as opposed to paying a premium each month.
The types of services that are covered as well as the ones that are not are the implications of a private insurance company associated with a government insurance program. The individuals who are covered under a private insurance are typically offered more services. Individuals who are covered under a government insurance program are required to obtain prior authorization for most services unless these services are deemed medically necessary.