- Medicare will pay its share of the Medicare-Approved Amount for covered health care costs.
- Next, your Medigap policy will pay its share.
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8 things you need to know about Medigap policies
- You must have Medicare Part A and B.
- Medicare Advantage plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
- You pay the private insurance company a monthly premium for your Medigap insurance policy. You pay this monthly premium in addition to the monthly Part B premium you pay to Medicare Insurance.
- A Medigap insurance policy only covers one person. If you and your spouse want to get Medigap coverage, you will need to purchase separate insurance policies.
- You can purchase a Medigap insurance policy from any insurance company that is licensed in your state to sell one.
- Any standardized Medigap insurance policy is guaranteed to be renewable, even if you have health problems. This means that the insurance company cannot cancel your Medigap insurance policy as long as you pay the premium.
- Some Medigap insurance policies sold in the past include prescription drugs. However, Medigap insurance policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can enroll in a Medicare prescription drug insurance plan (Part D). If you purchase Medigap Insurance and a Medicare drug plan from the same company, you may need to make two separate premium payments. Contact the company to find out how you can pay your premiums.
- It is illegal for someone to sell you a Medigap insurance policy if you have a Medicare Advantage insurance plan unless you return to Original Medicare.
Medigap insurance policies don’t cover everythingMedigap insurance policies generally do not include long-term care, dental care, vision care, glasses, hearing aids, or private-duty nursing.
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Insurance plans that aren’t MedigapSome types of insurance policies are not Medigap plans, including:
- Medicare Advantage Insurance Plans (such as HMO, PPO, or private pay-per-service plan)
- Medicare prescription drug insurance plans
- Medicaid employers
- Union insurance plans, including the Federal Employee Health Benefits Program (FEHBP)
- Veterans’ benefits
- Long-term care policies
- Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap insurance policy (not just the drug insurance coverage)You may want a completely different Medigap insurance policy (not just your old Medigap insurance policy without prescription drug coverage). Or, you may decide to switch to a Medicare Advantage plan that covers prescription drugs. If you decide to delete your entire Medigap insurance policy, you have to be careful about the timing. When you join a new Medicare drug insurance plan, you pay a late enrollment penalty if one of these applies:
- You delete your entire Medigap insurance policy and the drug insurance coverage wasn’t creditable prescription drug coverage
- You go 63 days or more in a row before your new Medicare insurance drug coverage begins
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What is the purpose of Medicare supplement or Medigap policies?
What is a Medicare supplement insurance plan?
Is there a Medicare supplement that covers everything?