You must have Medicare Part A and Part B.
To purchase a Medigap policy, you generally must be enrolled in Medicare Part A and Part B.
The Basics
What is Medicare Supplement Insurance?
Medicare Supplement Insurance, also known as Medigap, is private health insurance designed to help pay some of the health care costs that Original Medicare doesn’t cover. Depending on the Medigap plan you choose, it may help with expenses such as copayments, coinsurance, and deductibles.
Some Medigap policies may also provide benefits that Original Medicare generally does not cover, such as limited coverage for certain health care services when traveling outside the United States.
Medigap works alongside Original Medicare (Part A and Part B). When you have Original Medicare and a Medigap policy, Medicare first pays its share of the Medicare-approved amount for covered services. Your Medigap policy then pays its share of eligible costs according to the policy’s terms.
A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage plans are an alternative way to receive your Medicare Part A and Part B benefits through a private Medicare-approved plan. Medigap, on the other hand, supplements your Original Medicare coverage and does not replace Original Medicare.
Medicare Supplement coverage, explained clearly.
Understand how Medigap works alongside
Original Medicare.
Understanding your coverage
8 Things to Know About Medigap
Medigap and Medicare Advantage are different types of coverage.
If you currently have a Medicare Advantage Plan, you may be able to apply for a Medigap policy. However, you generally cannot use Medigap to pay Medicare Advantage plan costs. If you decide to switch from Medicare Advantage to Original Medicare with Medigap, make sure you understand the timing and that you can leave your Medicare Advantage Plan before your Medigap coverage begins.
You pay a separate monthly premium for Medigap.
Your Medigap policy has its own monthly premium that you pay to the private insurance company. This is in addition to the monthly Medicare Part B premium you pay to Medicare.
Medigap policies cover one person.
A Medigap policy provides coverage for an individual. If both you and your spouse want Medigap coverage, each person must have their own policy.
You can purchase Medigap from a licensed insurance company.
You can generally purchase a Medigap policy from an insurance company that is licensed in your state to sell Medigap policies. Available plans and premiums can vary.
Standardized Medigap policies are generally guaranteed renewable.
Once you have a standardized Medigap policy, the insurance company generally cannot cancel your coverage because of health problems, as long as you continue to pay your premiums and meet the terms of the policy.
Medigap policies generally do not include prescription drug coverage.
Medigap policies sold since January 1, 2006, are not permitted to include prescription drug coverage. If you want Medicare prescription drug coverage, you may be able to enroll in a separate Medicare Prescription Drug Plan (Part D).
Medigap cannot be used with a Medicare Medical Savings Account (MSA) Plan.
Federal rules prohibit insurance companies from selling you a Medigap policy while you have a Medicare MSA Plan.
What Doesn't Medigap Cover?
Medigap policies do not cover every health care expense. Generally, Medigap policies do not cover services such as long-term care, routine vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Coverage varies by standardized plan, so it is important to review the specific benefits and exclusions of any policy before enrolling.
Insurance That Is Not Medigap
Medigap should not be confused with other types of health or Medicare-related coverage. The following are not Medigap policies:
- Medicare Advantage Plans, including HMO, PPO, and Private Fee-for-Service plans
- Medicare Prescription Drug Plans (Part D)
- Medicaid
- Employer or union health plans
- Federal Employees Health Benefits Program (FEHB)
- TRICARE
- Veterans' benefits
- Long-term care insurance
- Indian Health Service, Tribal, and Urban Indian Health plans
Before Dropping a Medigap Policy
If you are considering dropping your Medigap policy, it is important to carefully consider your timing and future coverage options. If you later decide that you want another Medigap policy or want to return to Original Medicare after enrolling in Medicare Advantage, you may not always have the same rights to purchase a Medigap policy at the same price or with the same protections.
Prescription drug coverage is another important consideration. If you drop a Medigap policy and do not have other creditable prescription drug coverage, going without Part D or other creditable drug coverage for 63 days or more may result in a Part D late enrollment penalty if you later enroll in a Medicare Prescription Drug Plan.
Because Medicare rules, enrollment rights, plan availability, premiums, and underwriting requirements can vary, it is important to understand your options before making a change.
Medigap plans are offered by private insurance companies
and are designed to supplement Original Medicare. Plan
availability, premiums, benefits, and eligibility
requirements may vary by state and plan.
