Expert's View

The older you are the more ads you get offering to sell you a Medigap plan. The big question is this: If you are covered by the FEHB and Medicare, do you need one?

To answer that question, we’ll first need to find out what a Medigap plan is. Simply stated, it’s a plan that fills in benefit gaps in Medicare coverage. By law, every state has a standardized Medigap plan, which must cover certain basic benefits, for example, Medicare coinsurance and copayments. While Medigap plans do fill a number of gaps in Medicare, they don’t cover such things as long-term care, vision and dental care, hearing aids, private-duty nursing or unlimited prescription drugs.

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Because states have the freedom to vary the level of benefits provided, the cost of these plans varies by state and sometimes by locality. However, if you are willing to use specific hospitals and, in some cases, doctors, the cost may be much lower. Plans that offer this more restricted access to medical care are called Medicare Select. While a Medicare Select plan will not pay for care that you receive from non-plan providers, Medicare will still pay its share of any regularly covered expenses, and you will pay any deductibles or coinsurances.

Now it’s time to answer the question, “If you are covered by FEHB and Medicare, do you need to buy a Medigap plan?” The Department of Health and Human Services says that you don’t if you are enrolled in a Medicare managed care plan or a fee-for-service plan, such as Blue Cross-Blue Shield or GEHA. The reason is that a Medigap plan won’t provide you with any coverage that you don’t already have.

Further, FEHB plans often are superior to Medigap policies, so buying Medigap insurance could be a waste of money.