Medigap | Medicare Supplement Insurance

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

• Copayments
• Coinsurance
• Deductibles

Note: Medigap plans sold to people new to Medicare can no longer cover the Part B deductible. Because of this, Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans that cover the Part B deductible (Plan C or F). If you already have or were covered by Plan C or F (or the Plan F high deductible version) before January 1, 2020, you can keep your plan.

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 insurance company pays its share.

1. You must have Medicare Part A and Part B.
2. 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.
3. You pay the private insurance company a monthly premiumfor your Medigap policy. You pay this monthly premium 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. It’s important to compare Medigap policies since the costs can vary between plans offered by different companies for exactly the same coverage, and may go up as you get older. Some states limit Medigap premium costs.
7. 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.
8. Medigap policies can no longer be sold with drug coverage, but if you have an older Medigap policy that was sold with drug coverage (before January 1, 2006), you can keep it. You may choose to join a separate Medicare Prescription Drug Plan (Part D).  because most Medigap drug coverage isn’t creditable prescription drug coverage, and you may pay more if you join a drug plan later. If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.
9. 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 generally don’t cover: 

• Long-term care (like non-skilled care you get in a nursing home)
• Vision or dental services
• Hearing aids
• Eyeglasses
• Private-duty nursing

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
• Medicaid
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• Tricare
• Veterans’ benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans

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