Medicare Supplements:
What is a Medicare Supplement (Medigap) Insurance?
A Medicare Supplement or Medigap insurance plan is an elective option designed to assist in paying Medicare
Deductibles and increasing medical coverages (specialists, extended hospital stay, travel, etc). (more)
Medigap - Medicare Supplement Insurance (they are standardized)
"Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as
"Medicare Supplement Insurance." Insurance companies can only sell you a "standardized" policy identified in most
states by letters.
All policies offer the same basic benefits but some offer additional benefits, so you can choose which one best meets
your needs. In Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized in a different way.
Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones
they offer. Insurance companies that sell Medigap policies:
• Don't have to offer every Medigap plan
• Must offer Medigap Plan A if they offer any Medigap policy
• Must also offer Plan C or Plan G if they offer any plan
* The difference between Plan F (no longer avail.) and Plan G is the insured pays the deductible for Plan B.
(As per Medicare.gov)
Why Would I Need A Medicare Supplement?
Most people lose their healthcare coverage when they retire. Medicare covers some but not all of the needed healthcare
costs. A single hospital stay can leave you responsible for thousands of dollars. A Medicare Supplement (medigap) plan
would help pay some of the costs Medicare doesn't. One of the leading causes of bankruptcy is medical debt.
For example, some Medicare Supplement plans cover the Medicare Part A deductible and excess doctor’s charges.
Excess doctor’s charges (specialist), as defined by Medicare, are charges not approved by Medicare that you are
responsible for paying. Select Medicare Supplement plans are designed to cover specialaists.
All Medicare Supplement plans are regulated by the State Department of Insurance and offered by private insurance
companies. These plans are separate from Medicare Part A and Part B. Medicare Part A is a required coverage, Part B is
optional. Medicare Supplements can be purchased to provide extra insurance coverage in addition to Medicare Part A,
B and Part D. They are designed to assist and help pay deductibles, copay's, specialists & extended hospitalization, etc.
Some Medicare Supplement (Medigap) policies may also offer coverage for services that Original Medicare doesn't cover,
like Specialists and medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medicare
Supplement (Medigap) policy, Medicare will pay its share of the Medicare-approved amount for covered health care
costs. Then your Medicare Supplement (Medigap) policy pays its share.
A Medigap - Medicare Supplement policy is different from a Medicare Advantage Plan. Those plans are ways to get
Medicare benefits,while a Medicare Supplement (Medigap) policy only supplements your Original Medicare benefits.
Some people get Part A & Part B automatically. If you are already getting benefits from Social Security or RRB
(Railroad Retirement Board) or under the age of 65 years old with a disability. If you are enrolled in Medicare
automatically you'll get a red, white & blue Medicare card in the mail 3 months before your 65th birthday or the 25th
month anniversary of your disability.
Pre-existing Health Care condition covered under Medicare
1. Understand that under national laws Medicare supplement policies can refuse to cover prior medical conditions for the
first six (6) months.
2. The wait time for coverage to start is called a pre-existing condition waiting period. You can avoid waiting periods if
you buy your policy when you have a guaranteed issue right. If you buy your policy when you have guaranteed issue
rights, insurers can never refuse to cover prior medical conditions coverage for any period of time.
a. Make sure you buy a Medigap in advance of enrolling in Medicare so you do not have any gaps in coverage. If
you already had Part B when you turned 65, your open enrollment period to buy a Medicare Supplement
(Medigap) policy begins the month of your 65th birthday.
b. If you miss your open enrollment period, you can also buy a Medigap when you have a guaranteed issue right.
If you are age 65 or older, you have a guaranteed issue right within 63 days of when
you lose or end certain kinds of health coverage. This includes:
• If you had group health insurance (through either current or previous employment) that paid after Medicare
and lost it through no fault of your own, you have the right to buy most Medigap policies.
• If you joined a Medicare Advantage plan when you first became eligible for Medicare and dis-enrolled within
12 months, you have the right to buy any Medigap policy offered in your state by any insurance company.
• If your previous Medigap policy, Medicare Advantage plan, PACE program ends its coverage or commits
fraud, you have the right to buy most Medigap policies.
c. If you have a Medicare Advantage plan, Medicare SELECT policy or PACE program and you move out of the
plan's service area, you have the right to buy most Medigap policies. When you have a guaranteed-issue
right, companies are required to sell you a policy at the best available rate, regardless of your health status,
an insurance company cannot deny you coverage. The best available rate may depend on number of factors,
including your age, gender, whether you smoke and where you live. Companies cannot make you wait for
coverage of pre-existing conditions if you have a guaranteed issue right.
3. Buying a Medigap outside of Protected Enrollment Periods
a. You may run into problems if you wait until outside the Medigap policy protected enrollment periods.
Insurance companies can refuse to sell you one or may only let you buy one under restricted or certain
medical requirements. If an insurance company agrees to sell you a policy you will probably need to pay
a higher monthly premium and you may need to wait six months before the Medicare Supplement
(Medigap) will cover pre-existing conditions.
b. Contact Medicare Supplement (Medigap) insurers in your state to find out if they will sell you a Medigap
policy outside of protected enrollment periods.
4. Cancelling a Medicare Supplement (Medigap) Policy
You have the right to review a new Medicare Supplement (Medigap) policy for 30 days. You can cancel it within that
time for a full refund if it does not meet your needs. After the first 30 days, you can cancel your policy at any time.
Beware when cancelling, depending upon where you live, you may not be able to buy another policy, or Insurance
companies can charge you more because of your health.
Due to Governmental regulations and the many different opportunities we are unable to advise
until we are aware of your needs and have your permission.