Exactly What is a MediGap Plan in Washington State?

MediGap insurance policies in Washington State are exactly the same as a Medicare Supplement plans. They are a product of private health insurance carriers that have the right to sponsor plans in WA State. These health insurance plans in WA State are designed to fill in the gaps or supplement the coverage of Original Medicare Parts A & B. Part A covers roughly 80% of hospitalization and Part B covers roughly 80% of everything outside the hospital.

So if you have Medicare Parts A & B, you have out of pocket amounts in the form of deductibles, co-pays and co-insurance. MediGap plans pay for part or for all these areas. MediGap plans may also provide coverage for expenses that Original Medicare doesn’t pay at all.

If you are on a Medicare Parts A and B, Medicare will pay for its share of the Medicare approved reimbursement rates. Then the optional private MediGap policy will pay its share. MediGap policies are plans in addition to standard Medicare. You have to buy these policies separately from insurance agents or directly from the health insurance company doing business in Washington State.

MediGap policies are distinct from Medicare Advantage plans. MediGap policies cover the gaps that Medicare parts A & B alone don’t. Medicare Advantage plans on the other hand actually must cover everything that Medicare Parts A and B do s and then typically a lot of what Medicare supplement plans do with the Part D benefits all together in one policy.

MediGap policies must follow Federal and Washington state laws and these policies must clearly state that they are “Medicare Supplement Insurance.” Medicare supplement and gap insurance companies must sell only standardized plans labeled Letters A through N with the Plan F plan being the strongest MediGap plans available. So an “A” plan from one insurance carrier would be identical to an “A” plan from another carrier. The cost of the plan is usually the only difference between one carrier and another although the pre-exisitng waiting period may vary if prior coverage was not obtained.

Costs that Supplement or MediGap Policies do not Cover
MediGap policies in Washington do not cover long-term care costs (nursing home care), vision, dental, hearing aids, eyeglasses and private-duty nursing.

The following are Health Insurance Policies in Washington that are not MediGap policies:
Employer plans
Indian or Tribal Health benefits
Long-term care policies
Medicaid
Medicare Part D Prescription Drug Plans (PDP)
Medicare Advantage Plans
TRICARE
Union Plans
Veteran’s Benefits

What MediGap policies can Medical Insurance companies in Washington sell?
As mentioned earlier, MediGap policies come only in standard formats from Plans A-N. Each health insurance company in Washington decides which policies they want to sell, although state law may affect which policies are available.