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Medicare - A Detailed Guide
Medicare Supplements

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

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.

9 Things To Know About Medigap Policies

  • 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.

  • You pay the private insurance company a monthly premium for your Medigap policy.  You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

  • A Medigap policy only covers one person.  If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

  • You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

  • 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.

  • 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.

  • 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.

  • 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 Don't Cover Everything

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

Insurance Plans That Aren't Medigap

  • Medicare Prescription Drug Plans

  • Medicaid

  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)

  • Tricare

  • Veteran's 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)

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

Medigap & Medicare Advantage Plans

Medigap policies can't work with Medicare Advantage Plans.  If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy.  Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.

If you want to cancel your Medigap policy, contact your insurance company.  If you drop the Medicare Advantage Plan, you might not be able to get the same, or in some cases, any Medigap policy back unless you have a "trial right."

If you have a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.  Contact your State Insurance Department if this happens to you.

If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you're able to disenroll.

If you join a Medicare Advantage Plan for the first time and you aren't happy with the plan, you have a "trial right" under federal law to buy a Medigap policy and a separate Medicare drug plan if you return to Original Medicare within 12 months of joining the Medicare Advantage Plan.

  • If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it.  If it isn't available, you can buy another Medigap policy.

  • The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Drug Plan (Part D).

  • If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.

  • Some states provide additional special rights to buy a Medigap policy.

Medigap Costs

Medicare doesn't pay any of the costs for you to get a Medigap policy.  You have to pay the premiums for a Medigap policy.

Medigap Helps Pay Your Part B Bills

In most Medicap policies, the Medigap insurance company will get your Part B claim information directly from Medicare.  Then, they pay the doctor directly.  Some Medigap insurance companies also provide this service for Part A claims.

If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare.  This means that they "accept assignment" for all Medicare patients.  If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request it.

Compare The Costs Of Medigap Plans

Insurance companies may charge different premiums for the same exact policy.  As you shop for a policy, be sure you're comparing the same policy.  For example, compare Plan A from one company with Plan A from another company.

In some states, you may be able to buy another type of Medigap policy called Medicare Select.  If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.

10 Illegal Medigap Practices To Watch For

Call the Inspector General's hotline if you believe a federal law has been broken, like if someone tries to:

  • Pressure you to buy a Medigap policy or lie to get you to switch to a new company or policy.

  • Sell you a second Medigap policy when they know you already have one.  (They can sell you a policy if you state, in writing, that you plan to cancel your existing policy.)

  • Sell you a Medigap policy if they know you have Medicaid, except in certain situations.

  • Sell you a Medigap policy if they know you're in a Medicare Advantage Plan.  (They can sell you a policy if your MA plan coverage will end before the Medigap policy's effective date.)

  • Claim that a Medigap policy is part of the Medicare program or any other federal program.  Medigap is private health insurance.

  • Sell you a Medigap policy that can't legally be sold in your state.  Check with your State Insurance Department to make sure the policy you're interest in can be sold in your state.

  • Misuse the names, letters, or symbols of these:

  • U.S. Department of Health & Human Services (HHS)​

  • Social Security

  • Centers for Medicare & Medicaid Services (CMS)

  • Any of their programs, like Medicare.  For example, they can't suggest the Medigap policy has been approved or recommended by the federal government

  • Claim to be a Medicare representative if they work for a Medigap insurance company.​

  • Sell you a Medicare Advantage Plan when you say you want to keep Original Medicare and buy a Medigap policy.  A Medicare Advantage Plan isn't the same as Original Medicare.  If you enroll in a Medicare Advantage Plan, you'll be disenrolled from Original Medicare and can't use a Medigap policy.

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