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What Is Medigap?

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What Is Medigap?

Thursday, July 13, 2017 10:39 AM

Medigap: Medicare Supplement Plans A-N

Medicare Supplemental plans, or Medigap, cover the costs you’re responsible for with Original Medicare. There are 10 Medicare Supplement plan options available; A, B, C, D, F, G, K, L, M, and N. Each plan has different, yet standardized, benefits and coverage that must follow federal and state laws, and must be clearly identified as "Medicare Supplement Insurance." This means that no matter which insurer you buy from, the basic benefits of each plan type of the same letter will be the same. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

Who Can Enroll in Medigap?

You can apply for a Medicare Supplement plan insurance policy if you are:

  • A resident of a state where the policy is offered.
  • Enrolled in Medicare Parts A and B.
  • Age 65 or over or, in some states, under age 65 with a disability and/or end stage renal disease (plan offerings and eligibility vary by state).

Note: Medigap Plans are different from Medicare Advantage Plans. In fact, Medigap policies can't work with Medicare Advantage Plans. You must have Original Medicare Parts A and B to get a Medigap policy.

What Medigap Plans Can and Cannot Cover:

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, may help pay some of the health care costs that Original Medicare doesn't cover:

  • Your Medicare deductibles.
  • Your coinsurance.
  • Hospital costs after you run out of Medicare-covered days.
  • Skilled nursing facility costs after you run out of Medicare-covered days.
  • Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.

A Medigap policy can only cover one person. Medigap policies sold after January 1, 2006 do not include prescription drug coverage. You can join a Medicare Prescription Drug Plan (Part D) separately. Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Why Choose a Medigap plan?

Medigap can help pay out-of-pocket expenses that Original Medicare doesn’t cover. An Original Medicare plan paired with a Medigap policy can offer comprehensive coverage, which will likely result in lower out-of-pocket expenses. Medigap policies can vary, but the most comprehensive coverage is offered through Medigap Plan F. Compared to Medicare Advantage, you will keep the same larger network of doctors under Original Medicare. Many Medicare Advantage plans require you to go through their network of doctors and other health providers, while Original Medicare paired with Medigap Plan F will often have a larger network of doctors.

If you are eligible to switch Medigap policies because you're within your six-month Medigap open enrollment period or eligible due to a specific circumstance or guaranteed issue rights, then Medigap offers a "free look period." This means you have 30 days to decide if you want to keep the new Medigap policy. You won’t cancel your first Medigap policy until you’ve decided to keep the second Medigap policy, and you will need to pay both premiums for one month.

How Much do Medigap Plans Cost?

Medigap policy costs can vary widely and each insurance company sets its own price, or premium. Prices vary based on where you live and your age. All Medigap plans of the same letter - A, B, C, D, F, G, K, L, M, and N - cover the same basic benefits no matter which insurance company sells them. You will continue to pay your Part B premiums each month in addition to the Medigap premium. You will need to speak with a licensed Medicare agent for pricing and availability.

How to Enroll in Medigap Plans

It is highly recommended that you buy a Medigap policy during your six-month Medigap open enrollment period which starts the month you turn 65 and are enrolled in Medicare Part B (Medical Insurance). During that time, you can buy any Medigap policy sold in your state, even if you have pre-existing conditions. When this enrollment period ends, you may be subject to medical underwriting. You might have to buy a more expensive policy later, or you might not be able to buy a Medigap policy at all. There is no guarantee an insurance company will sell you Medigap if you apply for coverage outside your open enrollment period.

Once you have decided which Medigap plan meets your needs, it’s time to find out which insurance companies sell Medigap policies in your state. Once you’ve done your research and compared costs, you will buy the Medigap policy through a licensed Medicare agent.

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Last Revised 11/15/2017