Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, pays for some of the expenses not covered by the original Medicare program (Parts A and B). Medicare supplements are not designed to replace Medicare. Instead, they supplement Original Medicare by paying for things such as co-payments, coinsurance, deductibles and more. Medigap or Medicare Supplemental Insurance plans are standardized by the same agency that oversees Medicare, but these plans are sold and administered by private companies.
This chart describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issue rights.
Those who become eligible for Medicare after January 1, 2020, will not be able to enroll in a Medicare Plan C or F due to legislation changes.
You're in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.
Medigap Plan A, B, C, F, K, or L that's sold in your state by any insurance company.
You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.
As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can't start until your Medicare Advantage Plan coverage ends.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
Note: In this situation, you may have additional rights under state law.
Medigap Plan A, B, C, F, K, or L that's sold in your state by any insurance company.
If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.
No later than 63 calendar days after the latest of these 3 dates:
- Date the coverage ends
- Date on the notice you get telling you that coverage is ending (if you get one)
- Date on a claim denial, if this is the only way you know that your coverage ended
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.
Call the Medicare SELECT insurer for more information about your options.
Medigap Plan A, B, C, F, K, or L that's sold by any insurance company in your state or the state you're moving to.
As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.
(Trial right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.
Any Medigap policy that's sold in your state by any insurance company.
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.
Note: Your rights may last for an extra 12 months under certain circumstances.
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or switch to a Medicare SELECT policy) for the first time, you've been in the plan less than a year, and you want to switch back.
The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it.
If your former Medigap policy isn't available, you can buy Medigap Plan A, B, C, F, K, or L that's sold in your state by any insurance company.
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.
Note: Your rights may last for an extra 12 months under certain circumstances.
Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
Medigap Plan A, B, C, F, K, or L that's sold in your state by any insurance company.
No later than 63 calendar days from the date your coverage ends.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn't followed the rules, or it misled you.
Medigap Plan A, B, C, F, K, or L that's sold in your state by any insurance company.
No later than 63 calendar days from the date your coverage ends.
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.
9 things to know about Medicare Supplement Insurance
- You must have Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you have a valid disenrollment period from the Medicare Advantage Plan before your Medigap policy begins.
- You pay the private insurance company a monthly premium for your Medigap policy 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.
- 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.
- Some Medigap policies sold in the past cover prescription drugs, but Medigap 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).
- It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
- If you enrolled in Medicare prior to January 1, 2020, you will remain eligible to apply for Medicare Supplement Plan C and F at anytime in the future. If you were already enrolled in a Plan C or Plan F supplement before January 1,2020, you may keep your plan. On the other hand, those who became eligible after January 1, 2020, will not be able to enroll in a Medicare Supplement Plan C or Plan F due to legislation changes.
What's covered?
The chart below shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit and you're responsible to pay the rest.
Standardized Medigap policies aren't required to cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing.
* Plan F is also offered as a high-deductible plan by some issuers in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,200 in 2017 before your policy pays anything.
** Plan N pays 100% of the part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
*** For Plans K and L, after you meet your out-of-pocket yearly limits and your yearly Part B deductible ($183 for 2017), the Medigap plan pays 100% of covered services for the rest of the calendar year.
Questions to ask when you choose a Supplement
When you are shopping for a Medigap policy, here are some questions to keep in mind when speaking with a Copeland Insurance sales agent:
- How much does the policy cost per month? (Premium cost)
- How does the premium increase as I grow older?
- Is it no-age-rated or community-rated so everyone in my area pays the same premium regardless of their age?
- Is it issue-age-rated so the premium is based on how old I was when I bought the policy?
- Is it attained-age-rated so the premium increases based on my age?
- Do I have to wait before my Medigap will cover pre-existing conditions? If so, how long is the wait for me? (If you have guaranteed issue rights, pre-existing condition exclusions can’t apply. If you are in your open enrollment period, make sure you tell your Copeland licensed agent what kind of coverage you have now or have had recently. Depending on the coverage, you may have a reduced wait period or may not have to wait for coverage of pre-existing conditions at all.)
- When will my coverage under the Medigap begin?
Medicare Supplement Insurance doesn't cover everything
Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
With a wide range of companies to choose from, Copeland Insurance Group can help you find the Medicare Supplement that best meets your needs, providing the peace of mind to enjoy your retirement without unnecessary financial worry. Call a Copeland Insurance Group agent today to find the perfect Medicare supplement for you!
Watch Now
Copeland Insurance Group's informative Medicare video series.
Note: Those who become eligible for Medicare after January 1, 2020, will not be able to enroll in a Medicare Plan C or F due to legislation changes.
