Now let’s talk about Medigap. Original Medicare pays for many health care services and supplies, but it doesn’t pay all of a person’s health care costs. A Medigap policy is a health insurance policy sold by private insurance companies to fill the “gaps” in coverage under Original Medicare, like
deductibles, coinsurance, and copayments.
Some Medigap policies also cover benefits that Medicare doesn’t cover, like emergency
health care while traveling outside the U.S.
The insurance companies that sell these policies must follow Federal and state laws that
protect people with Medicare. The Medigap policy must be clearly identified as “Medicare
A Medigap policy only works with Original Medicare. If you join a Medicare Advantage
Plan or other Medicare plan, your Medigap policy can’t pay any deductibles, copayments,
or other cost-sharing under your Medicare plan.
In all states except Massachusetts, Minnesota, and Wisconsin, a Medigap policy must be
one of 12 standardized plans (A – L) so people can compare them easily. Each plan has a
different set of benefits. The benefits in any Medigap plan A – L are the same for any
insurance company. It’s important to compare Medigap policies, because costs can vary.
The best time for a person to buy a Medigap policy is during his or her Medigap open enrollment period (OEP) which lasts for 6 months starting on the first day of the month a person is enrolled in Medicare Part B and age 65 or older. During the Medigap OEP, a person has the right to buy any
Medigap policy sold in his or her state. (Some states have additional enrollment guarantees for people under age 65.)
People may also buy some Medigap policies if through no fault of their own, their employer
group health plan coverage ends, if they move out of the service area, or under certain
circumstances, if they leave their Medicare Advantage Plan. People may also buy a Medigap
policy any time an insurance company will sell them one, but their health history may be
used to decide if they can buy one and how much they have to pay.
NOTE: People can no longer buy Medigap policies covering prescription drugs because Medicare now offers prescription drug coverage.
However, people with an existing policy that covers prescription drugs can keep it.
People pay the insurance company a monthly premium for their Medigap policy and also
pay their monthly Part B premium ($96.40 in 2009). After they get a health care service,
they will get a Medicare Summary Notice showing what Medicare paid, and their Medigap
insurance company will send them information on what it paid.