Medigap is a type of extra insurance that helps you pay for costs not fully covered by your Original Medicare policy, aka Medicare Parts A and B.
The “gaps” a Medigap Supplement Insurance policy can cover include:
- Deductibles
- Copayments
- Coinsurance
- Medical emergencies that happen out of the country, as long as that benefit applies in the U.S.
Medigap doesn’t cover services outside your Medicare plan, such as hearing aids, glasses, and vision and dental care.
Am I Eligible For Medigap?
To get a Medigap policy, you must have Medicare Parts A and B, aka Original Medicare. Medigap doesn’t supplement the Medicare Advantage Plan, which is another way to get Medicare benefits.
You’ll buy your supplemental Medigap policy from a private insurance company that’s licensed in your state, and pay a monthly premium. Your Medigap policy only covers you. A spouse must buy separate coverage.
Do I Need Medigap?
You’ll need to study the various Medigap plans to weigh the coverage types and costs against your needs. The plan options might seem simpler when you break them down, too.
As of 2022, here’s how basic Medigap coverage works:
- All plans cover 100% of Medicare Part A coinsurance and hospital costs (up to a year after Medicare benefits are used).
- All but two plans cover 100% of Medicare Part B coinsurance or copayment, and Part A hospice care coinsurance or copayment.
- All plans but two cover your first 3 pints of blood if you need a transfusion.
Other benefits you can add or mix and match include:
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B extra charges
- Foreign travel emergencies (as long as Medicare covers them within the U.S.)
Are Medigap Plans the Same From Company to Company?
Medigap plans are regulated by state and federal laws. They’re standard no matter which company you buy your policy from. They must be identified as “Medicare Supplement Insurance.”
Insurance companies can sell you only the “standardized” plans with variations. They’re labeled A, B, C, D, F, G, and K – N. You’ll get the same basic benefits with any of them, though as shown above, they might differ in percentage of cost covered. Other variations offer additional benefits. While you decide on the right combo for you, keep possible future healthcare needs in mind, too.
What Happened to the Part B Deductible?
The Part B deductible benefit from Original Medicare is only covered under Medigap Plans C and F, which are unavailable to people new to Medicare as of Jan. 1, 2020. But if you were eligible for Medicare before that date, you’re still eligible for a C or F plan. If you already have one of these plans, you can keep it.
What If I Have a Preexisting Condition?
When you first enroll in Medicare Part B you have a 6 month open enrollment period to buy a Medigap plan. If you enroll during that time, the Medigap plan can’t deny you coverage for any reason or restrict coverage for pre-existing conditions. Medigap plans are generally allowed to use medical underwriting to set your premium, however.
If you enroll in a Medigap plan after your open enrollment period, plans can impose a 6 month waiting period before covering pre-existing conditions unless you had other insurance that is considered “creditable coverage.” For example, if you had insurance through your employer for at least 6 months and that coverage ended, you should be able to buy a Medigap plan without any waiting period before pre-existing conditions are covered.
What’s Medicare SELECT?
Medicare SELECT is a type of Medigap policy only sold in certain states. The benefits are the same as other Medigap plans, but your full benefits only apply within a network of specific hospitals -- and sometimes doctors -- unless you have an emergency. You might pay a lower premium because of the restrictions.
If you buy Medicare SELECT and decide you don’t want it, you can switch to standard Medigap. But you have to do so within 12 months of purchase.
What Does Medigap Cost?
Lots of personal factors figure into the cost of Medigap, including:
- Where you live
- Your age
- Your health and marital status
Also, even though private companies are required to provide the exact same array of Medigap plans, the prices can vary. Costs may also increase as you age.
When Should I Buy a Medigap Policy?
You should buy your Medigap Policy during the Medigap Open Enrollment Period. This starts with the first month you have Medicare Part B and lasts for 6 months. If you’re waiting for employee health coverage to end, open enrollment for Medigap will kick in only when you sign up for Part B.
Where Do I Sign Up?
To find out, you can:
- Search by zip code on the Medicare site:
- Call 800-MEDICARE (800-633-4227).
- Call your State Health Insurance Assistant Program (SHIP) or visit its website.
- Call your state insurance department.
Show Sources
Photo Credit: NI QIN / Getty Images
SOURCES:
Medicare.gov: “What's Medicare Supplement Insurance (Medigap)?”, “Medicare and You Handbook 2022,” “4 steps To Buy a Medigap Policy,” “When Can I Buy Medigap?”
National Council on Aging: “What is Medigap?”
New York State Department of Financial Services: “What is Medicare Select?”
