Medigap, Your Medicare Supplemental Insurance Plan

A Medigap policy is a supplemental health insurance plan provided by private insurance to fill the “gaps” in Original Medicare Plan coverage. Insurance services selling Medigap plans must follow all Federal laws as well as state laws that protect people with Medicare. All Medigap policies must clearly be known as “Medicare Supplement Insurance.” The Original Medicare Plan pays for many healthcare services. However, it will not cover all healthcare expenses. There are a number of costs you have to pay, such as co-payments, co-insurance, and your deductibles. These charges are usually called “gaps” in Medicare coverage.

All new Medigap policies sold must be one of twelve standardized insurance plans, A through L. This is true for all states except Wisconsin, Massachusetts, and Minnesota. The exact benefits of any Medigap Plan A through Plan L are required to be exactly the same for every insurance company. For example, the features and benefits in one insurance service’s of Medigap Plan C are exactly the same as every other insurance services of Medigap Plan C. However, the premiums for a Medigap policy can be quite different, and are determined by the insurance service. The twelve plans include two additional plans, K and L which were included in 2005. The insurance services are not required to offer all of the twelve medicare plans.

Some individuals might still own a Medigap policy they bought prior to the plans being standardized. Once you purchase a Medigap plan, you pay your premiums directly to the insurance service. You must still pay your Medicare Part B premiums monthly. So long as you continue to pay your Medigap premiums, any policy bought after is renewed automatically every year. Your Medigap policy works only with the Original Medicare Plan. You may not want to have a Medigap policy if you are a member of a Medicare Advantage Plan or another Medicare plan. The Medigap policies do not work with the Medicare Advantage Plans or any other Medicare plans. In fact, it is actually illegal for anyone to sell you a Medigap policy if you:

  • Are a member of one of the Medicare Advantage Plans (unless your actual enrollment period is about to end)  https://www.medicareadvantageplans2019.org
  • Already own a Medigap policy, unless you are about to cancel your current Medigap policy, or
  • A Medicaid member, unless your Medicare pays the premiums for your Medigap policy, or only pays your Medicare Part B premium.

You may want to think about dropping your Medigap policy if you decide to become a member of a Medicare Advantage Plan or any other type of Medicare plan. You are allowed to keep it, but it cannot pay for any health benefits you receive from your Medicare Advantage Plan or other Medicare plan. Also, it cannot pay any kind of cost-sharing under these other plans.

 

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