Medigap policies are health insurance policies that offer standardized benefits to work with Original Medicare and are sold by private insurance companies. If you have a Medigap policy, Original Medicare first pays its share for your care, and then Medigap pays all or part of the remaining costs, including deductibles, coinsurance, and copayments. Medigaps may also cover some health care costs that Medicare doesn’t cover at all, like care received when travelling out of the country. Medigaps only work with Original Medicare, if you have a Medicare Advantage Plan you cannot buy a Medigap.
Depending on where you live, you have up to 10 different Medigap plans to choose from, A, B, C, D, F, G, K, L, M, N (plans in Wisconsin, Massachusetts, and Minnesota have different names). Each offers a different set of standardized benefits. Premiums vary, depending on the plan you choose and the company you buy it from.
Before you buy a Medigap policy, be sure to do your research. Use the web pages linked in this section of Medicare Interactive as a guide to help you understand Medigaps and to find the best option for you. Some steps you may wish to take include the following:
- Make sure you’re eligible to purchase a Medigap. Remember that you can only have a Medigap if you have Original Medicare. If you are enrolled in a Medicare Advantage Plan, Medigaps cannot be sold to you. There may be other Medigap eligibility requirements that apply to you, depending on the state in which you live.
- Learn when you have the right to buy a Medigap without restriction so you can time your enrollment wisely. There are minimum federal protections for people over 65 to buy a Medigap-the plan can’t refuse to sell you a policy or charge more because of your health status –when you first have Medicare Part A and Part B and when you lose certain other kinds of coverage. Some states have additional protections for those under 65 or during other times.
- Once you decide you need a Medigap and know you are eligible to enroll in a Medigap, compare the different types of policies that exist. There are 10 different standardized policies in most states, and you should select the best one for you.
- Learn how a Medigap covers prior medical conditions to know if any of your medical costs may be excluded from Medigap coverage. Depending on your circumstances, a Medigap can exclude coverage for prior medical conditions for a limited amount of time.
- Find out how Medigap premiums are priced so you can make adequate cost comparisons. It’s important to understand the ways that insurers set premiums to find the best deal for you.
- Have a list of questions to ask when shopping for a Medigap to remind you what you should consider. Buying a Medigap can be a confusing experience, but using a set of written questions and asking for help when needed can help you stay organized and simplify the process.
If you are confused about Medigaps, how to enroll, or what policy is best for you, contact your State Health Insurance Assistance Program (SHIP). You can find the number for your SHIP by visiting www.shiptacenter.org. For additional information on Medigap policies in your state, you can also contact your State Department of Insurance.