All About Medigap

Medicare Supplement plans — also known as Medigap — live up to their name by supplementing Original Medicare (Part A and Part B). These insurance policies are provided and administered by private companies. Original Medicare offers coverage for hospital and medical services, but there are limits to what is covered. The resulting “coverage gaps” may leave you responsible for paying costs not covered by Original Medicare out of your own pocket.

A Medigap plan can be a smart way to help pay for these out-of-pocket costs. There are a variety of different types of Medigap plans available, and the benefits available with each plan type are standardized. Depending on which type you choose, your Medigap plan may cover some of the following expenses:

1. International medical care
2. Excess medical charges
3. Copayments
4. Coinsurance
5. Deductibles

Though Medigap plans fill in some of the coverage gaps of Original Medicare, it is important to remember they typically don’t include any coverage for services that are not Medicare-approved, like dental, vision or hearing services.

How do I qualify?

Here are a few things to remember about Medigap eligibility:

• To qualify for Medicare Supplement, you must be a recipient of Medicare Part A and Part B.
• You cannot have a Medigap plan if you have a Medicare Advantage plan.
• If you have a Medicare Medical Savings Account, an agent cannot sell you a Medigap plan.

Once you get to the actual Medigap application, you may have to pass medical underwriting. Medical underwriting is usually a series of health questions that determine whether or not the insurance provider will accept your application and how much they will charge you for coverage. That’s why you may want to consider getting Medigap during your Open Enrollment period. (See “When can I enroll?” for more details.)

If you’re out of your Open Enrollment window and have medical issues that require a lot of covered care, the insurance company may not accept your application. Or they may decide to offer you coverage with a higher premium. However, Medigap insurers typically base coverage decisions on a wide variety of underwriting questions. So, don’t automatically assume you won’t qualify for Medigap — you may be surprised to find that coverage is available.

When can I enroll?

Medigap Open Enrollment is a one-time-only, six month period when you can buy any Medigap policy that’s sold in your state. Your Open Enrollment period begins the first month that you’re covered under Part B, while age 65 and older. Under Federal Law, you can’t be denied Medigap coverage or charged more based on your health. Depending on the state you live in, you may have additional rights that protect your ability to get coverage during Open Enrollment.

After enrolling in a Medicare Supplement plan, you don’t have to re-enroll every year. Every plan is federally required to be guaranteed renewable, as long as you pay your premiums — even if you develop health issues that would have initially prevented you from passing underwriting.

How much does it cost?

Because Medigap plan benefits are standardized by plan type, the coverage you receive will always be the same, regardless of which company you purchase your plan from. However, because private companies provide Medicare Supplement plans, costs can vary widely depending on the company and the plan.

In addition to services your Medicare Supplement plan doesn’t cover, you may have to pay a monthly premium in addition to your monthly Part B premium from Original Medicare. These premiums may vary based on personal factors like location, tobacco use, age and health status. For example, your premium could be higher if you are a smoker but lower if you are younger. It may be worth exploring a variety of different plans to find one with the right mix of cost and coverage.

Before you go

Medicare Supplement plans have many moving parts. With our unbiased guidance and support, you can feel empowered to make the right decisions related to your coverage. Reach out for more information and price comparisons on plans available in your area, or shop for a plan. Our licensed insurance agents are ready to help take the mystery out of Medigap.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.