Some Medicare policies, such as Medigap plans, are sold privately to give you a range of choices for your health coverage needs.
Original Medicare, the health coverage you can get when you turn 65 or have a qualifying disability, consists of Medicare Part A and Part B. Part A provides hospital insurance, and Part B (medical insurance) covers doctor visits; preventive services like certain screenings and vaccinations; durable medical equipment; and other services and items. But Part A comes with a substantial annual deductible and copayments or coinsurance for certain inpatient services. Medicare Part B also has copayments, coinsurance, a monthly premium, and an annual deductible. Medigap (also known as Medicare Supplement and MedSupp) insurance can help downsize your Original Medicare cost burden. For example, some plans pay the Medicare Part A deductible.
There are 10 standardized MedSupp plans in 47 states sold by private insurers. These plans are named by letter (Plan A through Plan N; Plans E, H, I, and J are no longer sold). The plans are standardized such that each plan of the same name provides the same coverage no matter where it’s sold; for example, Plan N in North Dakota is the same as Plan N in California. Plan costs, however, may vary regionally and by company. Massachusetts, Wisconsin, and Minnesota have their own standardized MedSupp plans.
You need to keep your Original Medicare insurance and continue paying your Part B premium when you get a Medigap plan. Medicare Supplement insurance only applies to you, so if your spouse is also looking to receive Medigap, he or she will have to purchase a separate policy. If you are unsure whether Medigap is right for you, here are the top 10 reasons why many beneficiaries get Medicare Supplement Insurance.
- Large medical bill protection
Let’s say you regularly need to purchase Medicare-covered, but costly, medical supplies. Under Medicare Part B, 80 percent of your total costs may be taken care of, but 20 percent of the bill is still your responsibility. You’ll need to reach the yearly Medicare Part B deductible before Medicare begins to pay its share; this deductible amount may change from year to year. If you’re protected by a Medigap plan, that extra 20 percent out of your pocket will be at least partly covered (completely covered by many Medigap plans).
- Coverage outside of the United States
If you’re on vacation outside the U.S. and an accident or sudden illness happens to you, some Medicare Supplement plans help cover medical expenses outside of the country.
- Guaranteed acceptance
Depending on when you buy Medicare Supplement insurance, the insurance company has to accept you as a member even if you have health problems, and it can’t charge you a higher rate because of your condition. This is true if you buy your Medigap plan during the Medigap Open Enrollment Period (the six-month period starting the month you turn 65 and have Medicare Part B).
You can apply for a Medigap policy anytime you like, but if you apply after the Medigap Open Enrollment Period, in most cases the health insurer can refuse to sell you a policy, or charge you more, based on a review of your health history.
In some cases—for example, if you’re losing other Medicare coverage—you have “guaranteed issue rights” to get a Medicare Supplement plan if you buy it after the Medigap Open Enrollment Period.
- Guaranteed renewable policies
Even if you have health problems, all standardized Medigap plans are guaranteed renewable, meaning insurance companies can’t cancel your plan if you’re making your premium payments. This also means your policy will automatically renew every year.
- Choice of any doctor who accepts Medicare
Under most Medigap policies, you’ll be covered if you visit any doctor and hospital that participates in Medicare. An exception is a Medicare SELECT policy, which is a type of Medigap plan that may require you to use providers and hospitals in its network.
- Wide variety of plans
The 10 standard Medigap policies offer a wide variety of coverage to help pay your Original Medicare costs. Those plans with the most coverage tend to have higher monthly premiums, while the reverse is also true.
- Standardized policies
All 10 of the standardized Medigap policies are regulated by law; all the benefits from each separate plan are the same, regardless of who your insurer is or (in most states) where you live. This is important to note when comparing prices with various insurance agencies. Plans are standardized somewhat differently in Massachusetts, Wisconsin, and Minnesota.
- Control over your options
With Medicare Supplement insurance, not only do you get to choose a plan that suits your needs—you also have the option of adding Medicare prescription drug coverage. You can buy any stand-alone Medicare prescription drug plan that serves your area. A stand-alone Medicare Part D plan works alongside your Original Medicare coverage and isn’t part of the Medigap plan. (You may have a Medigap plan that offers prescription drug coverage if your plan had that coverage when you bought it, but you can’t buy a new Medigap plan with drug coverage anymore.)
In most cases, you can keep your Medigap policy when you move within the U.S.
- “Free look” period
In some situations, you can switch from one Medigap policy to another. You may not want to drop your former Medigap policy at first—when coverage starts on your new Medigap policy, you will have 30 days to decide whether you wish to continue with that specific plan, or return to the old one.
It’s important to note that Medigap policies don’t generally cover items or services such as (but not limited to) routine vision and dental, long-term care, hearing aids, private nursing care, or eyeglasses. Some of these benefits are covered through Medicare Advantage plans.