Leah Sugar Kari, Licensed Insurance Agent and Broker Specializing in Medicare Health Insurance Plans

What is Medicare Supplement (Medigap) Insurance?

A Medicare Supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like co-payments, coinsurance, and deductibles.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Your Medigap policy pays its share.

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.

What you need to know about Medicare Supplement policies:

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can switch to a Medicare Supplement insurance policy, but make sure you can leave the Medicare Advantage Plan before your Medicare Supplement insurance policy begins.
3. You pay the private insurance company a monthly premium for your Medicare Supplement insurance policy in addition to the monthly Part B premium that you pay to Medicare.
4. You can buy a Medicare Supplement insurance policy from any insurance company that's licensed in your state to sell one.
5. Any standardized Medicare Supplement insurance policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medicare Supplement insurance policy as long as you pay the premium.
6. Medicare Supplement insurance policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
7. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

When can I buy a Medigap or Medicare Supplement Insurance Plan?

Buy a policy when you're first eligible: 

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.

During open enrollment: 

Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

Find your situation below:

  • I'm 65 or older.

Your Medigap open enrollment period begins when you enroll in Part B and can't be changed or repeated. In most cases, it makes sense to enroll in Part B when you're first eligible, because you might otherwise have to pay a Part B late enrollment penalty.

  • I'm turning 65.

The best time to buy a Medigap policy is the 6-month period that starts the first day of the month you're 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.

After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. Some states have additional open enrollment periods.

  • I'm under 65.

Federal law doesn't require insurance companies to sell Medigap policies to people under 65. If you're under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you're under 65. If you're able to buy one, it may cost you more.

  • I have group health coverage through an employer or union.

If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don't need a Medigap policy.

When your employer coverage ends, you'll get a chance to enroll in Part B without a late enrollment penalty. That means your Medigap open enrollment period will start when you're ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start. Unless you bought a Medigap policy before you needed it, you’d miss your open enrollment period entirely.

Outside open enrollment:

If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below.

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

Find your situation below:

I have health problems.  

  • During the Medigap open enrollment period, an insurance company can't use medical underwriting. This means the company can't do any of these things because of your health problems:
  • Refuse to sell you any Medigap policy it sells
  • Make you wait for coverage to start (except as explained below)
  • Charge you more for a Medigap policy
  • In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. You're guaranteed the right to buy a Medigap policy:
  • When you're in your Medigap open enrollment period
  • If you have a guaranteed issue right
  • You may also buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health.

I have a pre-existing condition.

  • The insurance company can't make you wait for your coverage to start, but it may be able to make you wait for coverage if you have a pre-existing condition.In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months (called the "pre-existing condition waiting period"). After these 6 months, the Medigap policy will cover your pre-existing condition.
  • Coverage for the pre-existing condition can be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. After this 6-month period, the Medigap policy will cover the condition that was excluded.
  • When you get Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs, but you're responsible for the coinsurance or copayment.
  • Get more information on the Pre-Existing Condition Insurance Plan.

I have a pre-existing condition and am replacing "creditable coverage."

I have other insurance.

  • If you have group health insurance through an employer or union, your Medigap open enrollment period will start when you sign up for Part B.

 By contacting the phone number on this website you will be directed to a licensed agent.

Source: www.medicare.gov