While Original Medicare covers a variety of health services, it doesn’t cover everything. You’ll still have to pay cost-sharing requirements, like deductibles, copayments, and coinsurance. Medicare Supplement (also called Medigap) plans help fill the “gaps” in coverage by paying for some of the costs that Original Medicare doesn’t cover.
To enroll in a Medigap plan, you must be enrolled in Original Medicare, Part A and Part B, and live in the service area of the Medigap plan you want to join. If you and your spouse both want Medigap coverage, you must each purchase separate policies. Medicare Supplement plans only cover one person per policy. Keep in mind that not every state offers Medicare Supplement insurance to individuals under 65 (for example, those who qualify for Medicare because of disability). If you’re under 65 and have Medicare, check with your state insurance department to learn if you’re eligible for Medigap coverage in your state.
In most states, you may choose from up to 10 different Medigap policies, labeled Medigap Plans A through N. Medicare Supplement plans are offered through private insurance companies, but not every plan type is offered in every location. Benefits are standardized across each plan type, meaning that cost is the main difference between insurance companies offering plans of the same letter type. If you live in Wisconsin, Massachusetts, or Minnesota, the Medigap benefits are standardized differently.
Each Medigap plan type varies in the specific benefits it covers, but may include all or some of the following benefits:
Most Medigap plans cover the full cost of the above expenses for covered benefits, but Plan K and Plan L only cover a percentage of certain expenses (either 50% or 75%).
Because benefits are the same regardless of insurance company, it’s important to compare Medigap plan options in your area before enrolling in a plan. Insurance companies determine Medigap costs and decide which policies to sell. Several factors, including the method that the insurer uses to calculate Medigap premiums, can affect how much you pay for a policy, both when you enroll and in the future.
Federal and state laws regulate Medigap policies, and these laws are meant to protect you as a beneficiary.
Guaranteed-issue rights are one of these protections. You have a guaranteed right to join any Medigap plan in your area if you enroll during your Medigap Open Enrollment Period, the six-month period that automatically starts when you’re 65 and enrolled in Medicare Part B. During this time, private insurers must sell you a Medigap policy, regardless of health problems. Insurance companies also can’t charge you more because of health. This is generally the best time to join a Medicare Supplement plan, especially if you have health issues.
After your Medigap Open Enrollment Period, you can join a Medigap plan anytime the plan is accepting new members, but you’ll only have guaranteed-issue rights in limited situations. Unless a guaranteed-issue right applies, if you try to switch Medigap plans, insurers are free to reject you because of your health status or they may require medical underwriting. You may have to pay a higher premium if you have disabilities or pre-existing conditions.
Medicare Supplement plans aren’t meant to provide comprehensive health benefits. You’ll continue to get your hospital and medical coverage through Original Medicare, Part A and Part B.
Medicare Supplement plans also don’t cover benefits like routine vision and dental care, hearing aids, or private duty nursing. You may be able to get coverage for some of these benefits, such as routine dental services, through a Medicare Advantage plan. Medicare Advantage offers a different way to get your Original Medicare coverage and can include additional benefits.
Medigap policies sold today no longer cover prescription drugs. If you bought a Medigap plan that included drug benefits, that drug coverage may not be considered creditable. Keep in mind that you could face a penalty for Medicare Part D if you don’t enroll when you’re first eligible and don’t have creditable drug coverage for more than 63 consecutive days. Creditable prescription drug coverage is coverage that’s expected to pay as much as the standard Medicare Part D prescription drug benefit. Your insurance company should notify you every year whether your drug coverage is creditable.
You can get Medicare Part D coverage through a stand-alone Medicare Prescription Drug Plan if you have Original Medicare. Some Medicare Advantage plans also include drug benefits (these are known as Medicare Advantage Prescription Drug plans).
If your Medigap insurer sends you a notice that your drug coverage isn’t creditable, you have a few options. You can:
Do you have questions about Medicare Supplement coverage, or would you like help exploring Medigap plan options in your area? Contact eHealth to speak with a licensed insurance agent about your Medicare needs. Or, to start comparing plan options right away, simply enter your zip code into the plan finder tool on this page.
To learn about Medicare plans you may be eligible for, you can: