Medigap, also called Medicare Supplement Insurance, helps pay for costs that Original Medicare (Parts A and B) doesn’t cover—like deductibles, copays, and coinsurance. The specific benefits depend on the plan you choose.
There are 10 standardized Medigap plans available in most states, though Plans C and F are not offered to people who became eligible for Medicare after December 31, 2019. Massachusetts, Minnesota, and Wisconsin offer their own unique versions.
You can apply for Medigap any time if you’re enrolled in Original Medicare, though outside of certain protected periods, insurers may deny coverage or charge more based on your health. Some states allow those under 65 on Medicare to apply as well.
You may also enroll into a Medicare Supplement plan if you have Medicare Advantage but you cannot have both.
In most cases you’re first eligible for Medicare Supplement when you turn 65 and are enrolled in Part B. At that point, you have a 6 month window (Open Enrollment Period) to enroll in a guaranteed issue Medicare Supplement plan which means there is no underwriting.
Medical underwriting is the process insurers use to evaluate your health when deciding whether to approve your Medigap application or determine your premium. It includes questions about your age, weight, blood pressure, medical history, and chronic conditions.
You can avoid underwriting during your Open Enrollment Period or when you qualify for guaranteed issue rights. Outside those periods, your application could be denied or result in higher monthly premiums.
All Medicare Supplement plans cover Medicare Part A coinsurance and extend inpatient hospital care by 365 days. Most plans also cover Part B coinsurance, blood transfusions, and hospice care costs—with some covering additional benefits like skilled nursing, foreign travel, or excess charges.
Costs vary by insurer and are based on one of three pricing models: attained-age (based on your current age), issue-age (based on your age at enrollment), or community-rated (same premium for everyone). Location and health status may also affect your premium.
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Wed, Oct 09, 2024
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