What is Medicare Supplement Insurance (Medigap)?
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs 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.
A Medigap policy is different from a Medicare Advantage Plan.
9 things to know about Medicare Supplement / Medigap policies
1. You must have Medicare Part A and Part B to enroll.
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 B premium 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.
5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
6. 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.
7. 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).
8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan or Medicare Advantage Plan in place at the same time the Medigap goes into effect.
9. When you first enroll into Part B, turn 65, and when you involuntarily lose employer coverage after turning 65 you have an opportunity to get onto a Medigap plan. Other times your application will be underwritten before a policy is issued.
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.
DO NOT CONFUSE MEDIGAP PLANS FOR THE PLANS BELOW
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) – Although occasionally employers do pay for Medigap Plans.
TRICARE
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)
If you decide to drop your entire Medigap policy, you need to be careful about the timing. For example, you may want to switch to a Medicare Advantage Plan. For many, the only time of year to do this is the AEP. So, you don’t want to drop your current plan until you’re new coverage is able to begin. For AEP enrollments from October 15th through December 7th, all plans begin January 1st.