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What's Medicare Supplement
(Medigap) Insurance?








Medicare Supplemental Plans


A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that original medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the United States. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.




What you should know about Medigap

The Medigap policy you purchase must be clearly identified as "Medicare Supplement Insurance." There are 10 different Medigap coverage options to choose from. Plans are labeled A, B, C, D, F, G, K, L, M, and N (Plans E, H, I, and J are no longer available).

You can get a Medicare Supplement Plan only if you already have Original Medicare. Medigap covers Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), but it does not cover Medicare Part C (Medicare Advantage plans),Medicare Part D (prescription drug plans), or any other private health insurance, Medicaid, Veterans' Administration benefits, or TRICARE.

Because Medigap policies are regulated by state and Federal laws, the benefits for all the coverage options are the same regardless of insurer. The differences will be in the price, who administers the plan, and which of the 10 options the insurer chooses to offer. Choose a health insurer you trust, and shop around for the best prices.




8 things to know about Medigap (Medicare Supplement) policies 

  1. You must have Medicare Part A and Part B.
  2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
  3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D)
  8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.


Open enrollment for Medicare Supplement Plans


Your open enrollment for Medigap supplemental insurance begins the first day of the month in which you turn 65 and are covered under Medicare Part B. You have six months to enroll. If you are under 65, check with your state's Social Security Administration to see if it offers additional open enrollment periods.

As long as you enroll during this six-month open enrollment period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for coverage to begin. However, you may have to wait up to six months for coverage of a pre-existing condition. Original Medicare will still cover that health problem even if your Medicare Supplement Plan doesn't cover your out-of-pocket costs.


If you enroll in a Medicare Supplement Plan outside of your open enrollment period, the private insurance company may "underwrite" the plan. That means you may be subject to a physical, and the insurance company can refuse to sell you the plan or they can adjust your premium based on your health status.

If you enroll in a Medicare Advantage plan, you are not allowed to use and can't be sold a Medigap policy. However, if you later return to Original Medicare, Parts A and B, you have a 12-month special enrollment period to sign up for a Medigap Supplement Plan.



     





 


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