What is the role of 'Medigap' in the U.S. Medicare system, and is there an equivalent in Jordan?

"Medigap" (Medicare Supplement Insurance) is a product associated with the Original Medicare program in the United States. It helps pay for certain out-of-pocket costs remaining for the beneficiary after the program provides coverage, such as deductibles and coinsurance. One should not interpret the name as a description of any health insurance in Jordan, nor should one assume its rules apply to a local policy [1]. To compare two policies, one must examine the specific terms of each policy and the services they actually cover, rather than relying solely on the similarity of their names.

How is Medigap related to Medicare?

Medicare is a U.S. health insurance program that covers people aged 65 and older and some younger people under specific conditions, such as certain disabilities or End-Stage Renal Disease. Therefore, reaching a certain age outside the United States is not sufficient to qualify for enrollment. The program includes different parts: Part A relates primarily to hospital care, and Part B relates to medical services such as doctor visits and outpatient care [2].

Under Original Medicare, the beneficiary may still have out-of-pocket expenses. This is where a Medigap policy—sold by a private insurance company—comes in to work alongside Parts A and B. This is distinct from Medicare Advantage, which offers another way to receive Medicare coverage; one should not confuse purchasing a supplemental policy with choosing an Advantage plan. Always examine the details of what the plan covers and the amount you will pay before making a decision, as the name of the insurance alone does not clarify the final cost [1].

How to understand the comparison with health insurance in Jordan?

The 2024 Central Bank of Jordan report outlines local medical insurance, which covers expenses resulting from illness or injury in exchange for premiums, whether paid by the individual or provided by an employer. It covers inpatient policies and policies that include both inpatient and outpatient care. These are examples of the varying scope of local coverage; they do not prove that every Jordanian policy is an alternative to or a supplement to another insurance in the same manner [4].

Therefore, the comparison cannot be settled by phrases like "there is an identical alternative" or "there is no supplemental coverage." Ask the insurer for a written explanation of how your proposed policy interacts with the insurance you already have, and ask specifically about the medical service you require. You can start with practical questions: What medications and tests are covered? What is the amount I must pay (co-pay/deductible) upon visiting or being admitted to the hospital? Is pre-authorization required before a procedure?

What is the practical step before selecting a policy?

Collect the names of the coverage plans you have and a list of your routine health needs, then discuss them with the insurer before purchasing an additional policy. Ask for clarification on exclusions, coverage limits, and the providers available under the policy, and retain this information to compare options. The goal is to understand the actual coverage for your specific situation, not to select a product simply because its name resembles a foreign system. You can read the comparison between elderly care in Jordan and the U.S. Medicare program (Arabic) to understand the general context, while always referring to the terms of your specific policy when making a financial or medical decision.

Medical references

• Understanding Medicare
• Medicare
• Health Insurance: MedlinePlus
• البنك المركزي الأردني: إحصاءات التأمين الطبي لعام 2024