Medicare Supplement Insurance Plans (Medigap)

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What are Medicare Supplement Insurance plans (Medigap)?

Medicare Supplement Insurance Plans help pay for costs not paid by Medicare Parts A and B, including deductibles, copays, and coinsurance. Medicare Supplement Insurance Plans are also known as Medigap policies, and are offered by private health insurance companies. Medicare Supplement insurance is not the same as Medicare Advantage. Medicare Supplement insurance plans cannot be combined with Medicare Advantage plans and can only be combined with Original Medicare. Medicare Supplement insurance plans are available to those age 65 and older enrolled in Medicare Parts A and B and in some states to those under age 65 eligible for Medicare due to disability or End Stage Renal disease.

 

Who is eligible for Medigap?

To sign up for a Medigap plan you must already have Original Medicare Part A and B. Therefore, the same eligibility requirements for Part A and B apply to Medigap:

In general, people 65 or older are eligible for Medigap.

If you are 65 or older, you are eligible for Medigap if:

• You currently receive retirement benefits from Social Security or the Railroad Retirement Board.
• You are currently eligible for Social Security or the Railroad Retirement Board benefits but you haven’t applied for them yet.

If you are under 65, you are eligible for Medigap if:

• You have received Social Security or the Railroad Retirement Board disability benefits for 24 months
• You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's Disease) and meet certain criteria

 

What does Medigap cover?

Medigap helps cover some of the health care costs which Original Medicare Part A and B do not cover, including deductibles, copays, and coinsurance.

Most States have different Medigap plan options which are defined by a policy letter - A, B, C, D, F, G, K, L, M, N. The table below summarizes the different benefits each Medigap policy covers:

Medigap plans do not include prescription drug coverage. You must sign up for a separate Part D plan for prescription drug coverage.

Clarifications from medicare.gov:

• Plans F and G also offer a high-deductible plan in some states. (Plans C and F aren't available to people who were newly eligible for Medicare on or after January 1, 2020.)
• For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
• Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.

 

Is there a monthly premium cost for Medigap plans?

Yes, Medigap plans typically have a monthly premium which is determined by the health insurance company offering the plan.

 

When can I enroll in Medigap plans?

There is a 6 month initial enrollment period for Medigap. You can enroll starting the month of your 65th birthday to 5 months after your birthday month.

If you try to purchase a Medigap plan after this initial enrollment period, there is no guarantee that the insurance company will sell you the plan.

 

Is there a penalty for signing up late for Medigap?

No, signing up for Medigap is voluntary and there is not a penalty for signing up late. However, if you try to purchase a Medigap plan outside of your initial enrollment period, there is no guarantee that the insurance company will sell you the plan.

 

More information

For more information on this topic, please visit www.medicare.gov

• https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
• https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies