Reg Jones Expert's View

A Medigap plan is designed to fill gaps in Medicare coverage. While every state has standardized Medigap plans, each has a different set of benefits. Each standardized Medigap plan has to cover certain basic benefits, for example, Medicare coinsurance and copayments. However, none of them cover such things as long-term care, vision and dental care, hearing aids, private-duty nursing or unlimited prescription drugs.

Although the cost of these plans varies by state and locality, the cost of a particular plan may be much lower if you are willing to use specific hospitals and, in some cases, doctors. Plans that offer more restricted access to medical care are called Medicare Select plans. While a Medicare Select plan will not pay for care that you receive from non-plan providers, Medicare will pay its share of any regularly covered expenses. You are responsible for paying any deductibles or coinsurances.

If you are a federal retiree who is covered by Medicare and enrolled in a Medicare managed care plan or a fee-for-service plan, do you need to enroll in a Medigap plan? The answer is “No.” That’s the conclusion the Department of Health and Human Services reached years ago because it determined that a Medigap policy won’t provide you with any coverage that you don’t already have.

And the National Active and Retired Federal Employees Association has said that because FEHB plans “are far superior to most Medigap policies, annuitants who have Medicare and FEHB coverage have little need for any type of extra health plan. In most cases, those who do purchase additional policies are wasting money on duplicate coverage.”

Generally you don’t need to purchase a Medigap policy since FEHB and Medicare will coordinate benefits to provide comprehensive coverage for a wide range of medical expenses.
More on FEHB and Medicare Coverage at ask.FEDweek.com