Medigap Frequently Asked Questions
What is Medigap? By definition, Medigap is private insurance that fill in the gaps between your Medicare benefits and what you must pay out of pocket. You purchase them from private insurance companies to help pay for things that Medicare does not pay for. This includes deductibles and copays that otherwise you would be responsible for.
Sometimes called a Medicare supplement, Medigap policies give you freedom to choose your own doctor. Once insured, you can never be dropped due to health reasons.
Medigap carriers offer 10 standardized insurance plans. They are each labeled with a letter of the alphabet. Each insurance plan has a different combination of benefits. (There is also one high deductible insurance plan.)
Some of the gaps that Medigap plans can cover for you are:
- Hospital deductibles, copays and an extra 365 days in the hospital
- The first 3 pints of blood as necessary in a transfusion
- Outpatient deductibles, coinsurance and excess charges
- Skilled Nursing coinsurance
- Foreign travel emergency care
The best time to apply for a Medicare supplement is during your open enrollment window. This window runs for six months from the effective date of your Medicare Part B, or when you turn 65, whichever is later. During this window, the insurance company cannot deny you coverage for any health reason, nor can they can raise their rates just on you due to any health conditions.
Some people choose to delay their enrollment into Medicare because they have other creditable coverage such as employer group health insurance. For these individuals, their 6-month Medigap open enrollment window will begin later one whenever they enroll in Part B, which is usually when they retire.
The cost of a Medigap policy depends on which plan letter you choose, and then varies by zip code, age, gender and tobacco use. Some carriers also offer household discounts if your spouse also has the same policy. We can provide quotes to find the least expensive Medigap Plan F in your area.
We also like to see which company has the lowest rate and has a history of low annual rate increases as well.
It depends. If you are applying for a Medigap policy during your initial Medicare enrollment period, then regardless of your past or current health problems, you are guaranteed the right to purchase any Medigap policy at the same premium the offering company charges other people your age. Some policies may make you wait up to six months before covering a pre-existing condition, and some may offer “discounts” for non-smokers.
If you are applying for a Medigap policy after your initial enrollment period, then in most circumstances, insurance companies are allowed to apply medical underwriting to your application, which means they may reject your application on the basis of a health condition or may charge you higher premiums even if they agree to sell you a policy. There are certain circumstances in which companies may not underwrite applications for Medigap outside of the initial open enrollment period, and some states limit or prohibit underwriting. Check with your state’s insurance department about your Medigap rights and protections.
Yes. Medigap plans and Medicare supplements are the same thing. Just two different terms.
There are two primary ways that you can shore up your Original Medicare benefits. You can enroll in a Medigap plan which will pay after Medicare. This covers some or all of the gaps depending on the plan you choose. Your other option is a Part C Medicare Advantage plan. These plans are private insurance policies which pay instead of Medicare. When you enroll, you agree to use their network and pay copays for services as you go along.
Some Medigap plans help to pay for copays and coinsurance but leave the deductible for you to pay. For example, in 2019 Plan G has a deductible of $185.
Most Medigap plans cover your inpatient and outpatient copays under Medicare. However, on Medigap Plans like, N, the plan requires you to pay a copay of up to $20 for doctor visits and $50 for E.R. visits. These are copays that you will experience on that plan.
Medicare supplements are private health insurance policies, just like life insurance. When you first turn 65 or enroll in Part B, whichever comes later, you get a ONE-TIME window during which you can buy any supplement. During this window, the insurance company cannot turn you down for health reasons. After that six-month open enrollment window passes, you can still apply to change your Medicare supplement. However, you now have to answer the health questions on the application. You must be able to pass the carrier’s underwriting to be accepted.
It’s important for you to know certain health condition may result in you being unable to change. You will want to try to use your one-time open enrollment window wisely. Be sure to choose a carrier with a proven track record of low rate increases.
You can change Medicare supplement plans at any time of year – but in most states you will have to pass medical underwriting to do so.
This is a very common misconception because people get confused about the Annual Election Period that Medicare holds each fall. During this time, you can freely change your Medicare Part D drug plan and/or your Medicare Advantage plan.
This period DOES NOT, however, apply to Medicare supplements, also known as Medigap plans.
If you are past your one-time open enrollment window, you can apply to change plans at any time of year, but it may require underwriting.
Medicare Advantage plans and Part D plans can only be changed at certain times of year, but Medicare supplements are different.
No. You and your spouse must each enroll in a Medigap plan in order to obtain Medigap coverage.
Medical underwriting involves a review of your medical history. Some health insurers use underwriting to determine whether they will provide coverage to a prospective beneficiary, what premium to charge, and whether to impose a waiting period before coverage starts.
If you’re enrolled in Medicare, and you decide to add a Medicare Supplement (also known as Medigap or MedSup) insurance plan to your Original Medicare coverage, the private insurance company might require underwriting before selling you a Medigap policy.
You can avoid underwriting, and enroll in any Medigap plan that’s available where you live, if you sign up for the Medigap plan during your six-month Medigap Open Enrollment Period. This period begins on the first day of the month that you’re both 65 years old and enrolled in Medicare Part B. For example, if you turn 65 on July 14, and are enrolled in Medicare Part B, you have until December 31 to enroll in a Medigap plan. If you apply for a Medigap plan during your Medigap Open Enrollment Period, your acceptance into the plan is guaranteed, and the plan can’t charge more if you have a health condition. As a prerequisite, you must be enrolled in Original Medicare, Part A and Part B.
If you apply for Medigap coverage after your open enrollment period has passed, you may have to go through medical underwriting. The insurer may review your medical history and refuse to sell you a policy, or sell you one at a higher cost, if you do not meet its underwriting requirements.
Sometimes you can join a Medigap plan after the Medigap Open Enrollment Period without undergoing a medical underwriting review. For example, if you’re enrolled in a Medicare Advantage plan and the plan leaves the Medicare program, you might have a “guaranteed-issue right” to a Medigap plan.
No. Modern Medigap — Medicare supplement — plans do not include prescription drug benefits. Instead, Medicare offers separate prescription drug coverage plans. Medicare enrollees can get prescription coverage either by switching to a Medicare Advantage plan (most of them include prescription coverage) or by purchasing Medicare Part D (prescription drug plan, or PPD) to go along with Original Medicare.
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You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. To find out if you qualify, you can contact the State Medical Assistance Office or the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.
If you do not qualify for Medicaid and you want to stay in traditional Medicare, you could try to switch to a less expensive Medigap policy. However, if you are applying for a Medigap policy outside your initial open enrollment period, then in most circumstances, insurance companies are allowed to deny your application based on medical underwriting or can charge you higher premiums. You can find more information about the Medigap plans available in your state by contacting your state’s health insurance department or your SHIP.
Another option could be to enroll in a Medicare Advantage plan. Medicare Advantage plans provide all benefits covered under Medicare Part A and Part B, but often have lower cost-sharing requirements than traditional Medicare. They also have limits on out-of-pocket spending, but include physician networks, which means that you will pay more if you see a provider out-of-network. Medicare Advantage plans may charge a premium in addition to the Part B monthly premium. For free assistance with understanding your options for supplemental coverage, contact your local SHIP.
No. There are different Medicare Supplements to choose from which are all standardized by Medicare. So Plan G with one company is the same as Plan G with a different company. All Medigap companies offer the same basic benefits. The only difference is in the price.
A Medigap policy only covers one person, spouses have to buy a separate policy. However, some carriers will give a household discount.
Yes! If you do not have a Medigap plan (Medicare Supplement) or a Medicare Advantage Plan, you are responsible for everything that is not covered by Medicare! A Supplement is very important because it will help pay your Medicare deductibles and coinsurance.