What is a Medigap or Medicare Supplement Policy
A 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 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,
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 Medicare
Supplement or Medigap Policy?
The best time to buy a 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 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 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 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 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.
