What is medigap?
A Medicare Supplement Insurance (Medigap) policy, is sold by
private insurance companies and help pay many of the health care
costs that Original Medicare doesn't cover, like copayments,
coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that
Original Medicare doesn't cover.
* If you have Original Medicare with a Medigap, Medicare will pay its share
of covered health care costs, then your Medigap policy pays its share.
Why Medigap?
Without Medigap, these are some of the outof-pocket costs you may need to pay:
What Doctors Can I see With Medigap?
With Medigap, you can see
any doctor, whether the
doctor accepts Medicare
assignment or not.
If your doctor “accepts assignment,” meaning he or she agrees
to be paid the Medicare-approved amount for a service, your
Medigap insurance company usually pays your doctor directly.
If your doctor does not accept
Medicare assignment,
you may have to send claims
to your insurance company
and pay the doctor yourself.
Note: however, that
Medigap plans generally
do not pay for care
received outside of the
United States, except for
medically necessary
emergency care that
occurs during the first
60 days of your trip.
What Are My Rights With Medigap?
People who purchase a Medigap policy have
certain rights:
These rights can protect you from
being denied coverage. They also
can protect you from having to
keep a plan that is not right for you.
If you are thinking about buying a
Medigap plan, or if you already
have one, keep these tips in mind.
Free look
periods
Pre-existing
condition wait
periods
Renewals
Guaranteed
issue rights
Will Medigap Cover Me For a
Pre-Existing Condition?
If you have a pre-existing
condition and do not have a
minimum of 6 months creditable
coverage when you enroll in
Medigap, your provider can
impose a “pre-existing condition
waiting period” and refuse to
cover your prior medical
conditions for up to 6 months.
This period depends on how
many months you did not
have creditable coverage.
Most forms of health
coverage count as “creditable”
if there is no break in
coverage for more than 63
days.
So, for example, if you had creditable coverage for only 2 months
prior to enrolling in Medigap, your pre-existing wait period would
be only 4 months, instead of the standard 6-month waiting period.
Do I have the right to buy a Medigap policy
outside of Open Enrollment?
In some situations, you have the right to buy a Medigap policy
outside of your Medigap Open Enrollment Period. These rights
are called “Medigap protections” or guaranteed issue rights
because the law says that insurance companies must sell or
“issue” you a Medigap policy even if you have health problems. And this way, if you lose your current insurance, such as
coverage through your job or a Medicare Advantage plan, you
get the chance again to buy a Medigap policy.
In most cases, you must buy your new Medigap plan within 63 days of the time your
previous health coverage ends. In these cases, you will not have to wait to get covered.
Do I have To Re-Enroll in My Medigap
Plan Every Year?
As long as you pay your Medigap premium, the company
renews your policy automatically each year. This means that
your coverage continues year after year as long as you pay
your bill. Your policy is what is called “guaranteed renewable.”
5 things to Remember about Medigap policies
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 can leave the Medicare
Advantage Plan before your Medigap policy begins.
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.
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.
What Are Medigap Costs?
Medigap pays many of the copays and deductibles you’d otherwise
pay out of your own pocket.
Many different companies sell Medigap
plans. But each company must sell the
exact same benefits, or standard benefits,
of each plan. This means that a Medigap
Plan C sold by Company X must have the
same benefits as Plan C sold by Company .
Where you may see a difference between companies is in the cost, or
premium, that the company charges you for the plan. Be sure to shop
around to make sure you’re not paying more than you need for your
Medigap coverage.
Why are the costs so different if the
benefits are the same?
There are many reasons why the cost varies between companies. It may
be based on;
How old you were when you bought the plan.
Your current age.
Whether you smoke.
The number of people in the plan can change it, too.
Additionally, there are rules for setting policy rates
that vary depending on the state in which you live.
You can compare the differences in premiums,
deductibles and any other costs for all the
Medigap plans in your state. Compare plans.
What are some questions I can ask the
insurance companies I’m comparing?
These questions can help you sort out some of the differences
between companies:
Has the premium for your plan changed in the last 3 years?
If so, by how much?
How often does it change or go up?
Will the premium change as I get older?
Or is it the same for everyone, no matter what age?
How long is your wait for pre-existing conditions?
What if I change my mind after
purchasing my plan?
By law, when you buy a Medigap you have a 30-day “free
look” or “trial” period. If you change your mind, you can
cancel it and get a refund. You must do this within 30
days of the day your policy started.
When you switch from one plan to another plan, be
careful. Do not cancel your first policy until after
your free look period is over. You may have to pay
two premiums for 1 month. But at least you will
have the chance to change back if you need to.
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