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Medicare Supplements (Medigap)

Medicare Supplement Plans (Medigap)

 

Medicare Supplement Plans, sometimes called  Medigap, are sold by private companies.  These plans can cover some of the health-care costs not covered by Original Medicare. These might include copayments, coinsurance, and deductibles often referred to a Gaps.

 

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. 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.

 

There are 11 standardized Medigap plans in  and in most other states.  The plans are named with letter designations, such as Medigap Plan F or Plan G.  Because they're standardized, plans of the same letter include the same benefits no matter where you buy the policy.  For example, Medigap Plan F from an insurance company in Denver has the same coverage as a Medigap Plan F in Durango or even a Medigap Plan F in another state.  Because Medicare Supplement policies are sold by private insurance companies, rates and availability may vary.

 

Unlike Medicare Advantage, a Medicare Supplement plan in  will generally not include coverage for services like vision and dental care.  These plans also do not provide prescription drug coverage.  Instead, beneficiaries wanting prescription drug coverage should consider either select a Medicare Advantage Prescription Drug Plan or enroll in a stand-alone Prescription Drug Plan in addition to Original Medicare and Medigap.

 

8 things to know about Medicare Supplement Plans (Medigap)

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  1. You must have Medicare Part A and Medicare 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 Bpremium 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.
    You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  5. 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.

  6. 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).

  7. It's illegal for anyone to sell someone a Medigap policy if they have a Medicare Medical Savings Account (MSA) Plan.

 

Medicare Supplement Plans (Medigap) don't cover everything.

 

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

 

Insurance plans that aren't Medicare Supplement Plans (Medigap)

 

Some types of insurance aren't Medigap plans, they include:

  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)

  • Medicare Prescription Drug Plans

  • Medicaid

  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)

  • TRICARE

  • Veterans' benefits

  • Long-term care insurance policies

  • Indian Health Service, Tribal, and Urban Indian Health plans

 

Dropping your entire Medicare Supplement Plans (not just the drug coverage)

 

If you decide to drop the entire Medigap policy, you need to be careful about the timing.  For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

If you drop your entire Medigap policy and the drug coverage wasn't credible or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.

 

Available Medicare Supplement Plans

 

Federal and State laws regulate Medigap policies.  These laws are put in place to protect you as a beneficiary. Medigap policies have to be clearly labeled as Medicare Supplement Insurance. In most states, you may be able to choose from up to eleven different standardized policies (Medigap Plans A, B, C, D, F, G, K, L, M, N).

 

Each Medigap plan offers a different set of basic and additional benefits and is standardized for every insurance carrier.  Because benefits are the same for every insurance company, you do not want to overpay.  Insurance companies set their own prices and decide which policies they want to sell. 

 

A Couple Additional Items about  Medicare Supplement Plans

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  • In 2017 many  Medicare Supplement Plans added Plan G.  In 2020 there will be changes in how Plan F can be accessed.  To learn more about Plan F and Plan G click here.

  • Federal regulations allow insurance companies to deny, or avoid, paying claims associated with pre-existing conditions not to exceed the first six months that their Medicare Supplement plans are in-force. This is called the “waiting period for pre-existing conditions” and is also a part of the underwriting process

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