What's Medicare Supplement Insurance - Medigap

The Basics
All Medigap policies are standardized. This means, policies with the same letter offer the same basic benefits no matter where you live or which insurance company you buy the policy from. There are 10 different types of Medigap plans offered in most states, which are named by letters: A-D, F, G, and K-N. Price is the only difference between plans with the same letter that are sold by different insurance companies.

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.

Every Medigap policy must follow federal and state laws designed to protect you. It’s important to watch out for illegal practices by insurance companies, and protect yourself when you’re shopping for a Medigap policy.

Medigap policies help cover Out-Of-Pocket Costs associated in Original Medicare, like: Copayments, Coinsurance, and Deductibles.

Some Medigap policies cover services that Original Medicare doesn't cover, like Emergency Medical Care when you travel outside the U.S. (Foreign Travel Emergency Care).

What's not covered?
Medigap doesn’t cover everything. Medigap plans generally don’t cover: Long-Term Care (like Non-Skilled Care you get in a Nursing Home), Vision or Dental Care, Hearing Aids, Eyeglasses, and Private-Duty Nursing.

Generally, you must have Original Medicare — Part A and Part B — to buy a Medigap policy. A Medigap policy only covers one person, so if you and your spouse both want Medigap coverage, you each have to buy your own policy.

If you have a Medigap policy and get care, Medicare will pay its share of the Medicare-approved amount for covered health care costs. In most Medigap policies, you agree to have the Medigap insurance company get your Part B claim information directly from Medicare. Then, your Medigap policy will pay your doctor whatever amount you owe under your policy and you’re responsible for any costs that are left. Some Medigap insurance companies also provide this service for Part A claims.

If your Medigap insurance company doesn't get your claims information directly from Medicare, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, your Medigap insurance company is required to pay your doctor directly, if you ask them to.

Once you buy a policy, you'll keep it as long as you pay your Medigap premiums. All standardized Medigap policies are automatically renewed every year, even if you have health problems. Your Medigap insurance company can only drop you if: You stop paying your premiums, You weren't truthful on the Medigap policy application and the insurance company goes bankrupt or goes out of business.

Medigap & Medicare Advantage Plans

A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage. When you’re getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can’t have both.

If you have a Medicare Advantage Plan, you can’t buy a Medigap policy. It's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. 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 have a Medigap policy and join a Medicare Advantage Plan for the first time, you may want to drop your Medigap policy because you’ll be paying for coverage you can’t use. If after you join a Medicare Advantage Plan for the first time and you’re not happy with your plan, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. After that period, you might have to wait to drop your Medicare Advantage Plan, and you might not be able to buy a Medigap policy, or it may cost more.

Medigap & Prescription Drug Coverage

Medigap plans sold after 2005 don’t include Prescription Drug Coverage. So, if you enroll in Medigap for the first time, it won’t include Drug Coverage. If you want Prescription Drug Coverage, you can join a separate Medicare Drug Plan (Part D).

Medigap Costs
Medigap premiums vary widely depending on the insurance company, the plan, and where you live. Each insurance company decides how it will set the price, or premium for its Medigap policies, which can affect how much you pay now and in the future.

The benefits in each lettered plan are the same, no matter which insurance company sells it. The premium amount is the only difference between policies with the same plan letter sold by different companies. There can be big differences in the premiums that different insurance companies charge for the same coverage, so be sure you compare Medigap plans with the same letter (for example, compare Plan G from one company with Plan G from another company).

When you compare Medigap plans, you’ll see their estimated costs so make sure you contact the insurance company for a more accurate price.

The cost of your Medigap policy may also depend on whether the insurance company:

• Offers discounts (like discounts for women, non-smokers, or married people; discounts for paying yearly; discounts for paying your premiums using electronic funds transfer (automatic payment from checking account or credit card); or discounts for multiple policies).

• Uses medical underwriting or applies a different premium when you don't have a guaranteed issue right or aren't in your Medigap Open Enrollment Period.

• Sells Medicare SELECT policies that may require you to use certain providers. If you buy this type of Medigap policy, your premium may be lower.

• Offers a "high-deductible option."

When you buy a Medigap policy, you’ll pay the private insurance company a monthly premium. Your insurance company will let you know how to pay for your monthly premium. You also have to pay your monthly Medicare Part B premium. Medicare doesn't pay the premiums for your Medigap policy. Premium amounts typically increase each year.

To compare the costs of Medigap plans in your area visit: https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?year=2024&lang=en