What About Traditional Medicare?
For those folks who are still on the Original Medicare Plan that existed prior to the
changes that created Parts A, B, C, and D, gap insurance needs work a bit differently.
Overall, Medicare pays a share of costs and a Medigap policy tailored to the Original plan
pays the remaining share.
Not to be outdone by the
Medicare Parts approach, gap
insurance for Original Medicare
Plan clients comes in ten
different models of coverage.
Again, these models are
regulated by the federal
government, so insurers cannot
tweak them very much with
marketing or odd details.
Additionally, many of the same
labeling requirements occur on
Original Medicare Plan gap
insurance policies as well,
including the title of "Medicare
Supplemental Insurance" on
the top of the policy document
Points to Note About Gap Insurance
Just because you purchase a gap insurance plan does not mean that you can use the
coverage at just any medical provider. Many times, to control costs that do occur and
must be covered, insurance providers will want the services and care to be provided by a
predetermined network of providers.
This network has already been pre-negotiated with the particular insurer on the rates that
will be charged to a policy. As a result, clients very often are required to use specific
hospitals, pharmacies, and pre-approved drug brands to stay "in network."
Going outside of this network creates unexpected cost ranges, which defeats the whole
purpose of the insurance provider setting up the network in the first place. For this reason
many gap insurance plans include a penalty for not staying within the rules and terms,
usually requiring the client to take on a larger out-of-pocket share of costs incurred out of
Medical Gap Insurance
Are you in the Doughnut Hole? Gap Insurance may be your best solution.