How Medigap Plans Cover Preventive Care

When it comes to preventive care, the rules are straightforward: if Original Medicare covers it, your Medicare Supplement (Medigap) plan will help pay the remaining costs. Preventive care is designed to keep you healthy and catch potential issues early, and Medicare Part B covers a wide range of these services.

For most preventive services - like your annual wellness visit, flu shots, and certain screenings - Medicare Part B covers 100% of the approved amount if you go to a doctor who accepts assignment. In these cases, you pay nothing out of pocket, and your Medigap plan doesn't need to step in because there is no remaining balance.

However, if a preventive service requires you to pay a coinsurance or copayment, that is where your Medigap plan goes to work. By law, Medigap policies are designed to fill the gaps left by Traditional Medicare. If Medicare approves the service but only pays 80%, your Medigap plan will cover the remaining 20% (depending on the specific letter plan you have).

We believe in straight answers, no surprises. The insurance industry loves to make things complicated, but the reality is simple: Medigap vs Medicare Advantage is a rigged comparison. The real choice is Traditional Medicare (Parts A and B) versus Medicare Advantage. The supplement decision comes AFTER you choose the Traditional path. It is a component of that path, not an alternative to Advantage. If you choose Traditional Medicare, a supplement fills the gaps by law.

It is important to note that benefits are standardized by federal law. A Plan G from one company offers the exact same coverage for preventive care as a Plan G from another company. The only difference is the price you pay and the company's reputation for customer service.

Common preventive services covered by Medicare Part B include:

• Bone mass measurements
• Cardiovascular disease screenings
• Colorectal cancer screenings
• Diabetes screenings
• Mammograms
• Prostate cancer screenings

If your doctor orders additional tests during a preventive visit that are considered diagnostic rather than preventive, Medicare may apply your Part B deductible and coinsurance. In that scenario, your Medigap plan will cover the coinsurance, and depending on your plan, it may also cover the Part B deductible (though plans covering the Part B deductible are no longer available to new enrollees).

You have worked hard for your money, and you deserve to protect what you've earned. Don't let confusing Medicare rules leave you exposed to unexpected medical bills. We are on your side of the table, ready to help you navigate your options.