Medicare Supplement - AKA Medigap
What's Medicare Supplement Insurance (Medigap)?
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
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Copayments
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Coinsurance
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Deductibles
Most people don’t know that every Medigap policy must follow federal and state laws designed to protect you the consumer and the policy must be clearly identified as a “Medicare Supplement Insurance.” Medigap insurance companies in Arizona can only sell a “standardized” Medigap policy identified by letters A through N.
Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap polices with the same letter sold by different insurance companies.
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Note: As of January 1, 2020, Medigap plans sold to new people with Medicare aren't allowed to cover the Part B deductible. Because of this, Plans C and F are not available to people new to Medicare starting on January 1, 2020.
If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
Some Medigap policies also cover 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 Medigap policy, here's what happens:
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Medicare will pay its share of the Medicare-approved amount for covered health care costs.
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Then, your Medigap policy pays its share.
8 things to know about Medigap policies:
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You must have Medicare Part A and Part B.
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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.
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You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
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A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
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You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
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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.
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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).
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It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.
Medigap policies don't cover everything, they generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Insurance plans that aren't Medigap, they include:
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Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
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Medicare Prescription Drug Plans
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Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
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Veterans' benefits
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Long-term care insurance policies
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Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap policy, (not just the drug coverage)
You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.If you decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:
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You drop your entire Medigap policy and the drug coverage wasn't creditable prescription drug coverage
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You go 63 days or more in a row before your new Medicare drug coverage begins
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Call your State Insurance Department.
Medigap & Medicare Advantage Plans
Medigap policies can't work with Medicare Advantage Plans. If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.
If you want to cancel your Medigap policy, contact your insurance company. If you leave the Medicare Advantage Plan, you might not be able to get the same, or in some cases, any Medigap policy back unless you have a "trial right."
If you have a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. Contact your State Insurance Department if this happens to you.
If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you're able to disenroll.
If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining.
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If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.
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The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Prescription Drug Plan (Part D) .
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If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.
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Some states provide additional special rights.
Medigap & Travel
Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S.
Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.
Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S.
Medigap coverage outside the U.S.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
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Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.
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Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Find out before you go:
Before you travel outside the U.S., talk with your Medigap plan or insurance agent to get more information about your Medigap coverage while traveling.