What Is Medigap?

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Do you have questions regarding Medigap coverage and what it offers that is different from Medicare? Well, we have the answers you need. But first, we should establish some basics.

Below, we will briefly ask and answer the “very important” questions you want the answers to. You really need the answers to these are critical questions before an error in timing becomes a costly mistake.

We will outline and answer the following questions:

  • What is Medigap Coverage?
  • What is required to buy a Medigap Policy?
  • Why might I need a Medigap Policy?
  • How does a Medigap Policy work?
  • What isn’t covered in a Medigap Policy?
  • Are all Medigap Policies alike?
  • What does the Medigap law require?
  • What are the different Medigap plans being offered?
  • When can or should I buy a Medigap Policy?
  • Why is it so important to choose during my open enrollment period?
  • What happens if I miss my open enrollment period?
  • What can I do if I’ve already missed my open enrollment period?

What is Medigap coverage?

Medigap coverage is a Medicare supplemental insurance policy. It is offered by private companies to assist in paying for healthcare expenses that are not covered by Original Medicare (Part A and Part B).

What is required to buy a Medigap policy?

You must have Medicare Part A and Part B if you want to purchase a supplemental Medigap policy. Medigap policies are available from any insurance company licensed in your state. You may purchase a Medigap policy for a monthly premium. This is in addition to, and not to be confused with the monthly Medicare Part B premium paid to Medicare.

Why might I need a Medigap policy?

Medigap policies are designed to help pay for healthcare costs that original Medicare does not cover. Without a Medigap policy, you can incur costly medical bills, particularly from a catastrophic injury or illness.

These uncovered original Medicare expenses also assist in deferring expenses for things such as: coinsurance, copayments and deductibles. It also helps you pay for medical care that may be necessary while you are traveling outside the United States. Medical expenses accrued while traveling outside of the United States is not covered under an original Medicare plan.

How does a Medigap policy work?

Your original Medicare plan will automatically cover a certain amount or percentage of your total medical bill. After the original Medicare plan pays its part to your medical provider, the supplemental Medigap plan will pay its portion. If there’s anything left on the bill, the financial responsibility is transferred to the insured.

What isn’t covered under a Medigap Policy?

While Medigap does cover many of those costly healthcare expenses mentioned above, it does not cover everything. Typically, most Medigap policies do not cover: hearing aids, eyeglasses, vision or dental care, private duty nursing or long-term care. Additionally, since Jan. 1, 2006, Medigap policies are no longer allowed to cover prescription drugs. However, prescription drug coverage may be obtained by joining a Medicare Prescription Drug Plan (Part D).

Are all Medigap policies alike?

In short, the answer is “no.” There are different types of coverage offered, but there are federal and state laws that were enacted to standardize Medigap policies. The standardized Medigap policy laws begin by requiring all policies to contain the same basic benefits; they may offer plans with additional benefits, though.

These laws were designed to protect you and ensure that every Medigap Policy (insurer) contains the required basic benefits. With the exception of Massachusetts, Minnesota and Wisconsin, every state in which a Medigap policy is sold requires that all Medigap policies must be clearly identified as a “Medicare Supplement Insurance” policy. And, the issuer must sell standardized policies, which include at least the basic benefits required by law. The insurance company may offer additional coverage options and plan alternatives. These are identifiable by letters, much like Medicare does with its Part A and Part B. For example, you can purchase Medigap Plan A or Medigap Plan C.

Important note: If you live in Massachusetts, Minnesota or Wisconsin, Medigap policies have different standardized policy requirements. You should contact your State Insurance Department for more information. You can also see our own information about Medigap plans in each of those states.

What does the Medigap law require?

While there are laws the insurance companies must follow, each insurance company is not required to sell every Medigap plan. Each state’s laws may affect which plans they sell, as well.

There are, however, some basic tenets for every insurance company that offers Medigap supplemental insurance policies:

  1. Every insurance company must offer Medigap Plan A in order to sell any Medigap policy or plan.
  2. Every insurance company must offer Plan C or Plan F if they sell any Medigap plan or policy.
  3. Insurers are NOT required to offer all Medigap plans.

What are the different Medigap plans?

There are 10 Medigap policy plans, identified by the letters following your Medigap policy; i.e., Medigap A or B, C, D, F, G, K, L, M and N. These various plans carry varying degrees of additional coverage, in addition to your Original Medicare Part A and Part B coverage. Which Medigap plan suits your specific medical needs and budget is a personal choice. It should be carefully weighed before choosing which Medigap policy is right for you.

Below is a brief summary of the additional benefits Medigap policies provide. These are in conjunction with your Medicare coverage and any and all standardized Medigap policies. The policy information shown is meant to give a general understanding of what the available Medigap policies may cover. Policies with varying degrees of coverage (which do exist) are not shown.

Medigap Supplemental Plans A, B, C, D, F, G, K, L, M and N cover:

Part A coinsurance and hospital costs, up to an additional 365 days after Medicare benefits are used up

Medigap Supplemental Plans A, B, C, D, F, G, M, N also cover:

Part B coinsurance or copayment

Blood (first three pints)

Part A hospice care coinsurance or copayments

Medigap Supplemental Plans C, D, F, G, M and N all contain coverage for:

Skilled nursing facility care coinsurance

Medigap Supplemental Plans B, C, D, F, G and N all contain coverage for:

Part A deductibles

Medigap Supplemental Plans C and F contain coverage for:

Part B deductibles

Medigap Supplemental Plans F and G contain coverage for:

Part B excess charges

Medigap Supplemental Plans C, D, F, G, M and N contain coverage for:

Foreign travel exchange (up to plan limits)

When can I buy a Medigap policy?

This is a very important question. Knowing the answer can save you a lot of time and even money, in some instances. The answer is, as soon as you are eligible.

“Eligibility” means it occurs during your six-month Open Enrollment Period. The OEP automatically begins the month you turn 65 and are enrolled in Medicare Part B. During the six-month OEP, it is guaranteed that you may purchase any Medigap policy sold in your state, even if you have health issues or pre-existing conditions. But once the six-month enrollment period is over, it’s over. The exception would be if you have approved special circumstances to qualify for an exception.

Why is it so important to choose during my open enrollment period?

It’s a fact that by the time many seniors enroll in Medicare, you may have or have had some sort of medical issue arise. Or, you may have a pre-existing condition that you are being treated for. But this is the benefit of applying for a Medigap policy from a licensed insurance company in your state during your OEP. You are able to buy any Medigap insurance plan that the insurance company offers, at the same price as people who are categorized as having “good health.” Applying during your OEP can save you a lot of time spent applying to insurers, as well as money.

What happens if I miss my open enrollment period?

Typically, insurance companies that sell Medigap insurance policies utilize medical underwriting standards. These determine if companies want to accept your application for a policy. Plus, they determine how much they can charge you for a Medigap policy. After the OEP is over, you are no longer guaranteed coverage from all insurers. So, if you do not meet their underwriting requirements, they are not required to sell you a policy. If they do offer you a policy, you may find the cost to be prohibitive. However, you may be able to save money if qualify for any of the requirements listed below:

  1. You are under age 65 and are eligible for Medicare because of a disability or ESRD.
  2. You have health issues.
  3. You have a pre-existing condition.
  4. You have a pre-existing condition and are replacing “creditable coverage.”
  5. You have other insurance.
  6. You have a guaranteed issue right.

What can I do if I’ve already missed my open enrollment period?

Some states do offer another type of Medigap coverage called Medicare SELECT. Under the Medicare SELECT policy, you will have the option to change your decision on purchasing a policy during the first 12 months of coverage. It also allows you to change policies to a standard Medigap policy during those first 12 months. In essence, you are sort of penalized for not enrolling during open enrollment. But this policy does offer a way back in to the standard Medigap policy group.

NOTE: There is no longer a guarantee you can get Medigap coverage after open enrollment. However, you may qualify if you meet one of the standard requirements mentioned above.

Do you still have questions? Do not hesitate to contact us by phone directly, to speak with a licensed Medicare insurance specialist about any questions or concerns that you may have.

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