Medigap overview

What Is Medigap?

This is supplemental health insurance that provides coverage that is not paid for by original Medicare. It is important to understand that Medigap does not apply to Medicare Advantage plans. Medigap pays for any leftover costs after Medicare is applied. This usually covers deductibles and co-payments.

Medigap coverage can be purchased through most private medical insurers. And once you are Medicare eligible — and depending upon the state — there are 10 types of Medigap policies to choose from. Each state has its own standard benefits with varying premiums. Anyone who is interested in purchasing Medigap should refer to the state-specific rules and regulations because the cost of the premiums can vary.

What To Do Before Purchasing A Medigap Policy

  • Make sure you meet the eligibility requirements. Remember, if you are enrolled in Medicare Advantage, you cannot purchase Medigap.
  • Learn and understand the restrictions regarding Medigap. Again, situations vary depending upon the state in which you live. There are federal protections for people over 65. Find out what pertains to you.
  • Once you are eligible for Medigap, find out about the existing policies. The current Medigap policies are A, B, C, D, F, G, K, L, M, and N.
  • Find out how prior medical conditions are treated with Medigap. There may be several exclusions based on your situation
  • The price of Medigap is very important. Be sure to make comparisons and explore all of your options.
  • Always ask questions before making the purchase. Have a list when shopping for a policy. While choosing a Medigap policy to fit your situation can be a bit stressful, it is important to ask pertinent questions.

Important Things To Know About Medigap

  • You must have Medicare Parts A and B before making a purchase.
  • Medigap is different from Medicare Advantage
  • The monthly premium for Medigap is paid for through your private insurer
  • Only one person is covered by Medigap. If you have a spouse, they must purchase their own separate policy
  • Any licensed insurer in your state can sell you a Medigap policy
  • Since Medigap policies have renewable guarantees, the policy cannot be canceled even for health reasons
  • Medigap policies sold after Jan 1 2020 no longer cover prescription drugs
  • Selling a Medigap plan to someone enrolled in Medicare Advantage is against the law. You may be able to get your prescriptions filled if you purchase a Medicare Part D prescription drug plan.
  • Medigap policies do not cover hearing aids, dental plans, eyeglasses, long-term care like nursing homes or care centers, or vision and dental services.

When Can Medigap Be Purchased?

A Medigap insurance policy should be purchased during the open enrollment period. During this period, you can find many policies to choose from and more affordable pricing. It is important to purchase a Medigap policy during the first month after you turn 65 years old. If you miss this window, you may not get another chance to purchase an affordable Medigap policy.

  • 65 Years Or Older – Once you sign up during the open enrollment it is important to understand that Part B cannot be changed. It is best to enroll when the period begins to avoid any extra fees.
  • Turning 65 Years Of Age – This is the best time to enroll because you have a six-month period from June to November.
  • Under The Age Of 65 – Federal laws regarding Medigap may nor may not allow you to make a purchase. It all depends on the state. If you are under the age of 65, some states may allow you to make a purchase. Keep in mind the policy may be more expensive.

Important Note Regarding Medigap

As of Jan. 1, 2020, Medigap plans with a part B, C, and F deductible will no longer be covered. However, if you were not currently enrolled but eligible, you may still qualify for the deductible. Call Medicare and speak with a representative about this issue. They will inform you of your standing.

What Happens If You Travel Abroad?

The Medigap policy will cover the remainder of what Medicare does not pay. This includes any type of medical emergency. Before you leave the U.S. it is important to speak with a Medigap professional regarding the limitations and the deductible. Your state insurance company has a wealth of information at your disposal.

Remember, there are laws that govern the purchase of Medigap insurance. Be sure you thoroughly investigate which ones pertain to your state. If you need more information regarding the Medigap plans, you may reach out to the State Health Insurance Assistance Program (SHIP) or the State Insurance Department.

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