Medigap plans, also known as “medical supplement” plans or policies, can provide important medical coverage over and above the basic benefits available under basic Medicare parts A and B. Depending on the plan and your individual circumstances, Medigap insurance can be a valuable asset in helping you access needed medical services while protecting your financial well-being.
To purchase Medigap coverage, you must be enrolled in Part A and Part B.
There are eleven standard Medigap plans available, labeled A through N. These plans and coverage, but not pricing, are identical no matter what agent or broker you go through.
Medicare plans A through G provide more comprehensive coverage. Medigap plans K and L provide more limited coverage, though at a lower premium. Plan F has a high deductible option, which may result in more out of pocket costs if you have a medical need but has lower premiums than other comparable plans with higher deductibles. These are best suited for those in better health who do not need frequent care for existing medical conditions.
Medigap Vs. Medicare Advantage (Medicare Part C)
Medicare Part C, also known as Medicare Advantage, is similar to Medigap coverage in that it provides supplemental coverage over and above Medicare Part A (hospital insurance) and Part B (physicians, lab fees and durable medical equipment). Medicare Advantage provides access to Medicare benefits via a network of managed care providers.
If you have a Medicare Advantage plan and you are happy with it, you do not need a Medigap plan. You should not own both a Medicare Advantage plan and a Medigap policy.
Prescription Drug Coverage
Newly purchased Medigap plans do not provide coverage for prescription drugs. If you want or need prescription drug coverage through Medicare, ask your agent about purchasing Part D coverage, or consider a Medicare Advantage plan that includes it.
Open Enrollment
To get the best possible pricing, it’s important to make your Medigap and other Medicare decisions and make changes to coverage or purchase plans during an open enrollment period. The best time is during the six-month window that starts the month that you are age 65 and enrolled in Medicare Part B. If you purchase Medigap coverage during this time period, you are guaranteed eligibility to purchase any Medigap plan sold in your state, at the best rates available, regardless of your medical condition or history. If you miss this window, you could be turned down, or you may have to pay a higher premium for your plan.
For most individuals, the best course of action is to enroll in Part B as soon as you are eligible, to avoid late enrollment penalties. Once you are enrolled in Part B, arrange your Medigap insurance.
Pricing
Medigap policies are sold via private insurance companies and are standardized nationwide. However, underwriting and pricing may differ from one carrier to another. For example, your carrier may charge smokers higher premiums and nonsmokers lower premiums, or have different premiums depending on your age or membership in an affinity group.
Some plans, called Medicare SELECT plans, may have lower premiums, but limit coverage to medical care from an approved list of providers in your area.
For more information, speak with your health insurance agent or Medicare specialist.
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