Medicare Supplement Insurance Plans
A Medicare Supplement plan, also called Medigap Insurance, may help you pay for the "gap" between what Original Medicare pays and what you pay out of your own pocket. You can apply for Medicare Supplement plans through private insurance companies.
What are Medicare Supplement plans?
- Medicare Supplement plans may help pay for out-of-pocket costs under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
- Medicare Supplement plans sold today don't cover prescriptions. But you can sign up for a stand-alone Medicare Part D prescription drug plan.
- In most states, there are up to 10 different Medigap basic benefits options to choose from.
- Medicare Supplement plans are labeled A, B, C, D, F, G, L, M and N (Plans E, H, I, and J are no longer available).
- In Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized in a different way.
Tip: All insurance companies selling a particular Medicare Supplement plan type in your area must offer the same basic benefits in that plan type, but may offer it at different prices. So, you may want to shop for the best price.
Because Medicare Supplement plans are regulated by state and federal laws, the basic benefits offered by plans of the same letter type are generally the same regardless of insurer.
- The differences will be in the price and who administers the plan.
- Each insurer may not offer all types of Medicare Supplement plans in your area.
- Choose a health insurer you trust, and shop around for the best prices.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT, which may require you to use a specific network of doctors and hospitals.
How do I get a Medicare Supplement plan?
You can buy a Medicare Supplement insurance plan only if you already have Original Medicare, Part A and Part B. You can buy Medicare Supplement plans from private insurance companies.
Tip: Medicare supplement plans work beside Original Medicare to fill in cost gaps. If you are considering a Medicare Advantage plan, be aware that you can't use a Medicare Supplement plan with a Medicare Advantage plan.
When can I get a Medicare Supplement plan?
Your Medicare Supplement Open Enrollment Period (OEP) begins the first day of the month in which you are at least 65 and covered under Medicare Part B. You have six months to buy a Medicare Supplement insurance plan when the company is required to sell it to you. If you wait until after your OEP, you can apply anytime you want, but a plan could reject you or charge you more if you have health problems.
There may be other times after your OEP when you have "guaranteed-issue rights" to a Medicare Supplement plan.
For example, say you sign up for a Medicare Advantage plan. (Medicare Supplement plans don't work with Medicare Advantage plans.)
- Suppose you decide to drop the Medicare Advantage plan and return to Original Medicare.
- Suppose it has been a year or less since you signed up for the Medicare Advantage plan.
- You have a right to buy a Medicare Supplement (Medigap) plan.
- Your "guaranteed issue rights" to a Medigap plan only apply to certain plans.
Medicare Supplement coverage of pre-existing conditions
Medicare Part A and Part B typically cover pre-existing conditions. The same goes for Medicare Supplement insurance. The difference is, a company may be able to refuse to sell you a Medicare Supplement plan in the first place in some cases.
As long as you buy a Medicare Supplement plan during the six-month Medicare Supplement Open Enrollment Period, the insurance company cannot refuse to sell you a plan. The insurance company also can't charge you more because you have health problems or make you wait for basic benefits to begin.
However, you may have to wait up to six months for the Medicare Supplement policy's benefits to include your pre-existing condition*.
If you apply for a Medicare Supplement insurance plan outside of your Medicare Supplement Open Enrollment Period, the private insurance company may "underwrite" the plan.
Underwriting the plan means that you may be subject to a physical exam, and the insurance company can refuse to sell you the plan or they can adjust your premium based on your health status.
How insurance companies set Medigap premiums
There are three ways that an insurance company can set Medigap premium rates for Medicare Supplement plans:
- "Community-rated" (or "no-age-rated") premiums are the same for everyone, regardless of age.
- "Issue-age-rated" (or "entry-age-rated") premiums are based on your age when you first buy the policy. The sooner you buy, the less you will pay.
- "Attained-age-rated" premiums are based on your current age, meaning it goes up as you grow older.
Other factors impacting the premium rates of Medicare Supplement plans can include inflation, geography, medical underwriting (if you did not buy a plan when first eligible), and other discounts.
You should check with each specific health insurer to see how it sets Medigap prices before you buy.
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan's official plan documents to understand how that plan handles pre-existing conditions.
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