Medicare Supplement Insurance (aka Medigap)
What is a Medicare Supplement (Medigap) Insurance?
A Medicare Supplement or Medigap insurance plan is an elective option designed to assist in paying Medicare Deductibles and increasing medical coverages (specialists, extended hospital stay, travel, etc). (more)
Why Do I Need A Medicare Supplement?
Most people lose their healthcare coverage when they retire. Medicare covers some but not all of the needed healthcare costs. A single hospital stay can leave you responsible for thousands of dollars. A Medicare Supplement (medigap) plan would help pay some of the costs.
For example, some Medicare Supplement plans cover the Medicare Part A deductible and excess doctor’s charges. Excess doctor’s charges (specialist), as defined by Medicare, are charges not approved by Medicare that you are responsible for paying.
All Medicare Supplement plans are regulated by the State Department of Insurance and offered by private insurance companies. These plans are separate from Medicare Part A and Part B. Medicare Part A is a required coverage, Part B is optional. Medicare Supplements can be purchased to provide extra insurance coverage in addition to Medicare Part A, B and Part D. They are designed to assist and help pay deductibles, copay's, specialists & extended hospitalization, etc.
Some Medicare Supplement (Medigap) policies may also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medicare Supplement (Medigap) policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medicare Supplement (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 Medicare Supplement (Medigap) policy only supplements your Original Medicare benefits.
- Some people get Part A & Part B automatically
- If you are already getting benefits from Social Security or RRB
(Railroad Retirement Board. Under 65 years old with a disability
- If you are enrolled in Medicare automatically you'll get a red, white &
blue Medicare card in the mail 3 months before your 65th birthday or
the 25th month anniversary of your disability.
Pre-existing Health Care condition covered under Medicare
1. Understand that under national laws Medicare supplement policies can refuse to cover prior medical conditions for the first six months.
2. The wait time for coverage to start is called a pre-existing condition waiting period. You can avoid waiting periods if you buy
your policy when you have a guaranteed issue right. If you buy your policy when you have guaranteed issue rights, insurers
can never refuse to cover prior medical conditions coverage for any period of time.
a. Make sure you buy a Medigap in advance of enrolling in Medicare so you do not have any gaps in
coverage. If you already had Part B when you turned 65, your open enrollment period to buy a
Medicare Supplement (Medigap) policy begins the month of your 65th birthday.
b. If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed
issue right. If you are age 65 or older, you have a guaranteed issue right within 63 days of when
you lose or end certain kinds of health coverage. This includes:
• If you had group health insurance (through either current or previous employment) that paid after
Medicare and lost it through no fault of your own, you have the right to buy most Medigap policies.
• If you joined a Medicare Advantage plan when you first became eligible for Medicare and dis-enrolled
within 12 months, you have the right to buy any Medigap policy offered in your state by any
• If your previous Medigap policy, Medicare Advantage plan, PACE program ends its coverage or commits
fraud, you have the right to buy most Medigap policies.
c. If you have a Medicare Advantage plan, Medicare SELECT policy or PACE program and you move out of the
plan's service area, you have the right to buy most Medigap policies. When you have a guaranteed-issue
right, companies are required to sell you a policy at the best available rate, regardless of your health
status, an insurance company cannot deny you coverage. The best available rate may depend on number
of factors, including your age, gender, whether you smoke and where you live. Companies cannot make
you wait for coverage of pre-existing conditions if you have a guaranteed issue right.
3. Buying a Medigap outside of Protected Enrollment Periods
a. You may run into problems if you wait until outside the Medigap policy protected enrollment periods.
Insurance companies can refuse to sell you one or may only let you buy one under restricted or certain
medical requirements. If an insurance company agrees to sell you a policy you will probably need to pay
a higher monthly premium and you may need to wait six months before the Medicare Supplement
(Medigap) will cover pre-existing conditions.
b. Contact Medicare Supplement (Medigap) insurers in your state to find out if they will sell you a Medigap
policy outside of protected enrollment periods.
4. Cancelling a Medicare Supplement (Medigap) Policy
You have the right to review a new Medicare Supplement (Medigap) policy for 30 days. You can cancel it within that time for a full refund if it does not meet your needs. After the first 30 days, you can cancel your policy at any time. Beware when cancelling. Depending upon where you live, you may not be able to buy another policy, or Insurance companies can charge you more because of your health.
Due to many Insurance Companies selling Medigap and Advantage policies we are unable to advise until we are aware of your needs.