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Medigap Supplemental Plans
What is Medicare Supplement?
Need help paying your Medicare deductibles, copayments and coinsurance? A Medigap insurance policy (also called Medigap supplemental insurance or Medicare supplemental plans) helps pay the "gap" between what Original Medicare (Medicare Parts A and B) pays for your health care and what you pay out of your own pocket.
You can get a Medicare supplemental plan only if you have Original Medicare. Medigap covers Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). It does not cover Medicare Part C (Medicare Advantage Plans), Medicare Part D (prescription drug plans) or any other private health insurance, Medicaid, Veterans' Administration benefits, or TRICARE.
You can get a Medicare supplement through private insurance companies. The Medigap policy must be clearly identified as "Medicare supplement insurance." There are 10 different Medigap coverage options to choose from. Plans are labeled A, B, C, D, F, G, K, L, M and N to signify the plan differences. Plans E, H, I and J are no longer available.
Because Medigap policies are regulated by state and Federal laws, all benefits for all options are the same regardless of insurer. The differences will be in the price, who administers the plan, and which of the ten options the insurer chooses to offer. You may want to choose a health insurer that you already feel comfortable with. Or you can shop around for the best prices.
If you live in Massachusetts, Minnesota or Wisconsin, you also have the option to buy a Medicare SELECT policy, which is a Medicare supplemental plan that includes a network of doctors and hospitals that you must use.
Open enrollment for Medicare supplemental plans
Your open enrollment for Medigap supplemental insurance begins the first month you are covered under Medicare Part B. You have six months to enroll. If you are under 65, check with your state's Social Security Administration to see if they offer additional open enrollment periods.
As long as you enroll during this six-month open enrollment period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for coverage to begin. You may, however, have to wait up to six months for coverage of a pre-existing condition. That means, if you have a specific health problem when you enroll, you may have to wait up to six months to be covered for medical services associated with that health problem. Original Medicare will still cover that health problem even if your Medicare supplement plan doesn't cover your out-of-pocket costs.
If you do not enroll in a Medicare supplemental plan during your open enrollment period, then the private insurance company may "underwrite" the plan. That means you may be subject to a physical, and the insurance company can either refuse to sell you the plan or they can adjust your premium based on your health status.
If you enroll in a Medicare Advantage Plan, you should cancel your Medigap policy. However, if you later return to Original Medicare (Parts A and B), you have a twelve-month special enrollment period to sign up for a Medigap supplemental plan.
How insurance companies set Medigap premiums
There are three ways an insurance company can set Medigap premium rates:
- "Community-rated" (or "no-age-rated") premiums are the same for everyone, regardless of age.
- "Issue-age-rated" (or "entry-age-rated") premiums are based on your age when you first buy the policy. The sooner you enroll, the less you will pay.
- "Attained-age-rated" premiums are based on your current age, meaning it goes up as you grow older. Other factors impacting the premium rates can include inflation, geography and medical underwriting (if you did not enroll when first eligible) and other discounts. You should check with each specific health insurer to see how it sets Medigap prices before you buy.