Medicare doesn’t have to be so confusing. Below are some common FAQs related to medicare. Remember, you will need to speak with or meet with a Licensed Agent in your state to purchase a Medicare Supplement Plan, so it’s best to give us a call or Contact us with specific questions that are unique to your situation.
What's Medicare Supplement Insurance (Medigap)?
A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like:
- Medigap policies are sold by private companies.
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
- Medicare will pay its share of the Medicare-approved amount for covered health care costs.
- Then, your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
8 things to know about Medigap policies
- You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy. But, make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
3. You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
7. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
8. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
Medigap policies don't cover everything
Medigap policies generally don’t cover the following; long-term care, vision or dental, hearing aids, eyeglasses, or private-duty nursing.
Insurance plans that aren't Medigap
- Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
- Medicare Prescription Drug Plans
- Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
- Veterans’ benefits
- Long-term care insurance policies
- Indian Health Service, Tribal, and Urban Indian Health plans
Medigap & Travel Information
Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S.
Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.
Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
- Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
- Pays 80% of the billed charges for certain medically necessaryemergency care outside the U.S. after you meet a $250 deductible for the year.
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
Find out before you go
Before you travel outside the U.S., talk with your Medigap plan to get more information about your Medigap coverage while traveling.
When can I buy Medigap?
Buy a policy when you’re first eligible
The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.
During open enrollment
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.
Find your Situation Below:
I’m 65 & Older
Your Medigap open enrollment period begins when you enroll in Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B when you’re first eligible, because you might otherwise have to pay a Part B late enrollment penalty.
I’m turning 65
The best time to buy a Medigap policy is the 6-month period that starts the first day of the month you’re 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November. After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. Some states have additional open enrollment periods.
I’m under 65
Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. If you’re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. If you’re able to buy one, it may cost you more.
I have group health coverage through an employer or union.
If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don’t need a Medigap policy. When your employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty. That means your Medigap open enrollment period will start when you’re ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start. Unless you bought a Medigap policy before you needed it, you’d miss your open enrollment period entirely.
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