Medicare Supplements aka Medigap
Medicare supplement plans (also called Medigap) are private health insurance specifically designed to supplement and work only with Original Medicare (Part A and Part B).
By Tony Gossard
Original Medicare pays for many, but not all, health care services and supplies. A Medigap policy, sold by private insurance companies, can help pay some of the health care costs (“gaps”) 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 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. Medicare doesn’t pay any of the premiums for a Medigap policy.
“INSURANCE COMPANIES MAY CHARGE DIFFERENT PREMIUMS FOR EXACTLY THE SAME MEDIGAP COVERAGE.”
Every Medigap policy must follow Federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies can sell you only a “standardized” Medigap policy identified in most states by letters. All plans offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.
MORE ABOUT MEDIGAP POLICIES
- You must have Part A and Part B.
- You pay a monthly premium for your Medigap policy in addition to your monthly Part B premium.
- A Medigap policy only covers one person. Spouses must buy separate policies.
- The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional open enrollment periods.) After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
- It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap costs.
- If you’re under 65, you won’t have this open enrollment period until you turn 65, but state law might give you a right to buy a policy before then.
- If you have a Medigap policy and join a Medicare Advantage Plan (like an HMO or PPO), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums. If you want to cancel your Medigap policy, contact your insurance company. If you drop your policy to join a Medicare Advantage Plan, in most cases you won’t be able to get it back.
- If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare. Contact your State Insurance Department if this happens to you.
Information provided by: Medicare and You Handbook 2021