What is a Medigap or
Medicare Supplement Policy
A Georgia Medigap or Medicare Supplement
policy is health insurance designed to
supplement the original Medicare plan, that
is, to help pay some of the health care
costs ("gaps") that the original Medicare
plan doesn't cover (like copayments,
coinsurance, and deductibles). If you are in
the original Medicare plan and you buy a
Georgia Medicare supplement or medigap
policy, then both plans will pay their share
of Medicare-approved amounts for covered
health care costs. Medigap policies are sold
by private insurance companies. Also,
Georgia Medicare insurance or a medigap
policy isn't a "Medicare Health Plan" (such
as an HMO or PPO) because it's not a way to
get Medicare benefits.
Insurance
companies can only sell you a "standardized"
Medigap or Medicare supplement policy.
Standardized Medigap policies are identified by
letters (Medigap Plans A through L). Medigap
Plans F through J also offer a high-deductible
option. In some states, you may be able to buy
another type of Medigap policy called Medicare
Select. Each type of Medicare Supplement or
Medigap policy offers the same basic benefits,
no matter which insurance company sells it.
Usually the only difference between Medigap
policies sold by different insurance companies
is the cost.
Medicare Supplement or Medigap
policies must follow Federal and State laws.
These laws protect you. The front of a Medigap
policy must clearly identify it as "Medicare
Supplement Insurance."
Medicare Supplement or a Medigap policy only
covers one person. If you and your spouse both
want Medigap coverage, you each must buy
separate Medigap Policies.
When is the best
time to buy a Georgia Medicare Supplement or
Medigap Policy?
The best time to buy a
Georgia Medicare supplement or Medigap policy is
during your Medigap open enrollment period. This
period lasts for six months and begins on the
first day of the month in which you are both age
65 or older and enrolled in Medicare Part B.
During this period, an insurance company can't
-refuse to sell you any Medigap policy it
sells,
-make you wait for coverage to start, or
-charge you more for a Medigap policy
because of your health problems.
While the insurance company can't make you
wait for all your coverage to start, it may
be able to make you wait for coverage of
pre-existing condition. A pre-existing
condition is a health problem you have
before the date a new insurance policy
starts. In some cases, the Medicap insurance
company can refuse to cover that health
problem for up to six months. This is called
a "pre-existing condition waiting period."
(Remember, for Medicare-covered services,
the Original Medicare plan will still cover
the condition, even if the Medigap policy
won't cover your out-of-pocket costs.)
If you buy a Georgia Medicare supplement or
Medigap policy during your Medigap open
enrollment period or if you recently had
certain kinds of health coverage called
"creditable coverage," the insurance company
must shorten or eliminate any waiting
period. Creditable coverage is generally any
other health coverage you recently had
before applying for a Georgia Medicare
supplement or Medigap policy. There are many
types of health care coverage that may count
as creditable coverage for Medigap policies.
To find out if your health coverage is
creditable coverage, call a Medigap
insurance company or your State Insurance
Department.
Important: Whether you had
creditable coverage depends on whether you had
any "breaks in coverage"- when you were without
any type of health coverage for more than 63
days in a row. Talk to your Medicare supplement
or Medigap insurance company or State Health
Insurance Assistance Program if you had any
breaks in coverage. They will be able to tell
you if the coverage will count towards your
creditable coverage.
If you buy a Georgia Medicare supplement or
Medigap policy when you have a guaranteed
issue right (also called "Medigap
protections"), the insurance company can't
use a pre-existing condition waiting period.
Note: You can send in your application for a
Georgia Medicare supplement or Medigap policy
before your Medigap open enrollment period
starts. This may be important if you currently
have coverage that will end when your turn ago
65. This will allow you to have continuous
coverage, without any break.
