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Lesson 09: Supplemental Insurance (Medigap)

Medicare Supplemental Insurance, also known as "MedSup" or "Medigap," is private insurance, not sold by the Government. It is designed to fill the holes in Medicare coverage.

Medigap is defined by State and Federal law and is regulated by each state`s insurance department. Many companies sell Medigap policies and the policies were standardized in 1992, meaning that the benefits in each Plan A-L are the same, no matter what company sells the insurance.

  • Twelve Standardized plans (A-L): Medicare pays primary and Supplemental plan pays all or most of remaining costs
  • No network of providers or facilities
  • Open Enrollment Period: Six months from Part B effective date for those over 65 years of age
  • Guaranteed issue situation: Right to purchase supplemental policy without medical underwriting

Every company that sells Medigap must offer Plan A. All of the other standard plans must include Plan A`s basic benefits.

  • Hospitalization: Part A co-insurance plus coverage for 365 additional days after Medicare benefits end.
  • Medical Expenses: Part B co-insurance (20% of all Medicare-approved expenses).
  • Blood: First three (3) pints of blood each year.
Note: If you join a Medicare Advantage Plan, you don`t need a Medigap policy. If you already have a Medigap policy, you can`t use it to pay for out-of-pocket costs you have under the Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can`t be sold a Medigap policy.

Click here to use Medicare`s search tool to find a Medigap plan offered in your area. 

Click here to read Medicare`s guide to choosing a Medigap policy. 

Medigap Open Enrollment

When is the best time to buy a Medigap policy?
The best time to buy a 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 and enrolled in Medicare Part B.

Open Enrollment means:

  • An applicant must be at least 65 years old to take advantage of the open enrollment period.
  • Enrollment begins the first day of the month in which he/she is both 65 and enrolled in Medicare Part B (usually the day that coverage takes effect). It ends six months later.
  • For those who continue to work past 65 and delay enrolling in Part B, Open Enrollment begins on the day that Part B coverage begins and ends 8 months later.

During Open Enrollment, a company must accept all applications for any Medigap policy it sells. There can be no discrimination on the basis of age or health. Additionally, the sick and the healthy pay the same price, as do smokers and non-smokers. However, an insurance company may impose a six-month pre-existing condition waiting period.

A pre-existing condition waiting period is the time that must pass after becoming insured before the policy will begin to pay benefits for a pre-existing condition or specified illness. Pre-existing conditions are those for which treatment or advice was given during the six months prior to purchasing the policy.

The exception to the pre-existing condition waiting period comes when an applicant has creditable coverage, such as an employer group health plan, leaves the employer group health plan, and then applies for an individual Medigap policy within 63 days of leaving. This exception only applies during the individual`s Open Enrollment period.

Medigap for People with Disabilities

People with disabilities can begin receiving Medicare before they turn 65, however, the Medigap Open Enrollment period does not begin until the first day of the month in which they turn 65 and are enrolled in Part B. Companies are not required to sell Medigap policies to people under 65, but some companies do. However, these customers will still have to pass underwriting guidelines to get coverage. This means some consumers can be denied a plan.

Medicare Select (MedSelect)

Medicare Select is a unique kind of Medigap policy. It combines managed care with the standard Medigap plans. MedSelect plans require the insured to use specific doctors or hospitals (except in emergencies). If the insured does not follow the plan`s rules, Medicare will still pay its full share. The MedSelect company however, may pay less, or nothing at all, leaving the insured with some out-of-pocket expenses.

Because of these restrictions, the premiums for a MedSelect plan may be lower than "regular" Medigap plans. Additionally, if a person has a MedSelect policy and wishes to change to a standard Medigap policy, he/she has the right to buy a policy with equal or lesser benefits from the same company, even if he/she is in poor health.

MedSelect policies must offer the same benefits as the standard Medigap plans. This means that MedSelect cannot offer any benefits that are not in a standard plan.

MedSelect can be sold by insurance companies, as well as by HMOs. Each MedSelect company requires the insured to use specific hospitals, but if an emergency or urgent situation forces you to use a hospital outside of the network, you are still covered.

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