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What is Medicare Supplement Insurance (Medigap)?
A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like:
Medigap policies are sold by private companies.
Some Medigap policies also cover 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, here’s what happens:
- Medicare will pay its share of the Medicare-approved amount for covered health care costs.
- Then, your Medigap policy pays its share.
8 things to know about Medigap policies
- You must have Medicare Part A and Part B.
- 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.
- You pay the private insurance company a monthly Premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
- 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.
- 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.
- 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).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you’re switching back to Original Medicare.
Medigap policies 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 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
- Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
- Veterans’ benefits
- Long-term care insurance policies
- Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap policy (not just the drug coverage)
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 decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:
- You drop your entire Medigap policy and the drug coverage wasn’t Creditable prescription drug coverage
- You go 63 days or more in a row before your new Medicare drug coverage begins
Q: What are Medicare Supplement (Medigap) plans?
Q: Who can buy a Medicare Supplement (Medigap) plan?
Q: When can I buy a Medicare Supplement (Medigap) plan?
A: Unlike other private insurance that works with Medicare, there is no yearly open enrollment to join a Medigap plan. You can apply to the insurance company directly to buy a Medigap plan at any time, but the insurer could also require you to pass a health screening before it will sell to you. There are certain times when you may be exempt from taking the health screening, including if:
Q: What do Medicare Supplement (Medigap) policies cost?
Also, some Medigap plans have a waiting period to cover pre-existing conditions. This waiting period may last up to six months, even if you are in your Medigap Open Enrollment. You might be able to have the plan waive this waiting period if you are replacing other creditable coverage within 63 days.
Q: Can I have both a Medicare Supplement (Medigap) plan and a Medicare Advantage plan?
Q: What questions should I consider when choosing between a Medicare Supplement and Medicare Advantage program?
Q: Why would I stay in Original Medicare with a Medigap instead of joining Medicare Advantage?
Q: Are you leaving a Medigap plan?
If you paid a yearly premium for your Medigap plan, the law does not require the plan to refund you any portion of that premium. Do not cancel your old plan until you verify you are active in your new coverage.
Q: What is a Medicare Select Policy?
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© 2022 UpgradeMyMedicare. All rights reserved. UpgradeMyMedicare is a trademark of Allboc Insurance Solutions, LLC
Allboc Insurance Solutions, LLC is a licensed and certified representative of a Medicare Advantage (HMO, PPO, and PFFS) organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal. By completing the contact form above or calling the number listed above, you will be directed to a licensed sales agent who can answer your questions and provide information about Medicare Advantage, Part D or Medicare supplement insurance plans. Availability of carriers and products are dependent on your resident zip code.
The purpose of this communication is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and in some states to those under age 65 eligible for Medicare due to disability or End Stage Renal disease. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
*Allboc Insurance Solutions and UpgradeMyMedicare are not affiliated with any governmental program or agency. Plans can only be changed during certain times of the year.
The UpgradeMyMedicare.com website is operated by Allboc Insurance Solutions, LLC., a Wisconsin corporation.
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