Extra-Help (LIS)
You may be eligible for “Extra Help” or a low-income subsidy with payments for your prescription drug plan, deductible and copayments. There are many plans that provides the same high-quality medical care for all no matter the income. However, you must continue to pay your Medicare B premium.
Every member is responsible to follow all the rules and procedures in the Evidence of Coverage.
Extra-Help (LIS)
You may be eligible for “Extra Help” or a low-income subsidy with payments for your prescription drug plan, deductible and copayments. There are many plans that provides the same high-quality medical care for all no matter the income. However, you must continue to pay your Medicare B premium.
Every member is responsible to follow all the rules and procedures in the Evidence of Coverage.
Table of Contents
This page is provided with information from the Medicare.gov website that explains all the details and pieces of information that you need to know about Medicare Supplement Insurance (Medigap).
Use this Table of Contents to help you navigate through this page by clicking on the buttons to each topic you wish to read about.
What is Medigap?
Enrolling in Medigap with HealthChoice
8 Things About Medigap
Insurance Plans that Aren't Medigap
Dropping Your Medigap Policy
Medigap Costs
Medigap Helps Pay Part B Bills
Compare the Costs of Medicare Plans
Medigap & Part C Coverage
Enrolling in Part C with HealthChoice
Drug Plans & Medigap Policies
Medigap With & W/Out Drug Plans
10 Illegal Medigap Practices
When Can you Buy Medigap?
What's Your Situations?
If You're Losing Medigap Coverage
Guaranteed Issue rights
Losing your HealthCare Coverage
Click here if you are interested in reading about information on Part A, B, C, or D.
What's Medicare Supplement Insurance (Medigap)?
Medigap is Medicare Supplement Insurance that helps fill "gaps" in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
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Copayments
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Coinsurance
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Deductibles
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:
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Medicare will pay its share of the Medicare-approved amount for covered health care costs.
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Then, your Medigap policy pays its share.
8 Things to Know About Medigap Policy
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You must have Medicare Part A and Part B.
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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.
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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.
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A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
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You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
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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.
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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).
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It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan, unless you're switching back to Original Medicare.
Insurance plans that aren't Medigap
Some types of insurance aren't Medigap plans, they include:
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Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
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Medicare Prescription Drug Plans
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Medicaid
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Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
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TRICARE
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Veterans' benefits
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Long-term care insurance policies
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Indian Health Service, Tribal, and Urban Indian Health plans
Medigap policies don't cover everything
Medigap policies generally don't cover Long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Dropping your entire Medigap policy
(not just the drug coverage)
You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.
If you decide to drop your entire Medigap policy, you need to be careful about the timing. When you join a new Medicare drug plan, you pay a late enrollment penalty if one of these applies:
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You drop your entire Medigap policy and the drug coverage wasn't Creditable prescription drug coverage
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You go 63 days or more in a row before your new Medicare drug coverage begins
Medigap Costs
Medicare doesn't pay any of the costs for you to get a Medigap policy. You have to pay the premiums for a Medigap policy
Medigap Helps Pay your Part B Bills
In most Medigap policies, the Medigap insurance company will get your Part B claim information directly from Medicare. Then, they pay the doctor directly. Some Medigap insurance companies also provide this service for Part A claims.
If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request it.
Compare the Costs of Medicare Plans
Insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you're comparing the same policy. For example, compare Plan A from one company with Plan A from another company.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.
Medigap & Medicare Advantage Plans
Medigap policies can't work with Medicare Advantage Plans. If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.
If you want to cancel your Medigap policy, contact your insurance company. If you leave the Medicare Advantage Plan, you might not be able to get the same, or in some cases, any Medigap policy back unless you have a "trial right."
If you have a Medicare Advantage Plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. Contact your State Insurance Department if this happens to you.
If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you're able to disenroll.
If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy. You have these rights if you return to Original Medicare within 12 months of joining.
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If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.
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The Medigap policy can no longer have prescription drug coverage even if you had it before, but you may be able to join a Medicare Prescription Drug Plan (Part D) .
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If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy.
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Some states provide additional special rights.
You can't Join a Medicare Prescription Drug Plan & have a Medigap Policy with Drug Coverage
If your Medigap policy covers prescription drugs, you'll need to tell your Medigap insurance company if you join a Medicare Prescription Drug Plan. The Medigap insurance company will remove the prescription drug coverage from your Medigap policy and adjust your premium. Once the drug coverage is removed, you can't get that coverage back, even though you didn't change Medigap policies.
The same insurance company may offer Medigap policies and Medicare Prescription Drug Plans.
If you join a Medigap policy and a Medicare drug plan offered by the same company, you may need to make 2 separate premium payments for your coverage. Contact your insurance company for more details.
Your Medigap company must send you a notice each year telling you if the prescription drug coverage in your Medigap policy is creditable. Keep these notices in case you decide later to join a Medicare drug plan.
Medigap Policy with Creditable Drug Coverage
If you have a Medigap policy that includes creditable prescription drug coverage, you can only join a Medicare Prescription Drug Plan between October 15–December 7, unless you lose your Medigap policy (for example, if it isn't guaranteed renewable, and your company cancels it). In that case, you can join a Medicare drug plan at the time you lose your Medigap policy.
Medicare Policy without Creditable Drug Coverage
You'll probably have to pay a late enrollment penalty if you have a Medigap policy that doesn't include creditable prescription drug coverage and you decide to join a Medicare Prescription Drug Plan later. This means you'll pay a higher monthly premium than if you joined when you were first eligible.
Your penalty amount increases for each month you wait to join a Medicare drug plan. In general, you'll have to pay this penalty for as long as you have a Medicare drug plan
10 Illegal Medigap Practices to Watch for
Call the Inspector General's hotline if you believe a federal law has been broken, like if someone tries to:
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Pressure you to buy a Medigap policy or lie to get you to switch to a new company or policy.
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Sell you a second Medigap policy when they know you already have one. (They can sell you a policy if you state, in writing, that you plan to cancel your existing policy.)
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Sell you a Medigap policy if they know you have Medicaid, except in certain situations.
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Sell you a Medigap policy if they know you're in a Medicare Advantage (MA) Plan. (They can sell you a policy if your MA plan coverage will end before the Medigap policy's effective date.)
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Claim that a Medigap policy is part of the Medicare program or any other federal program. Medigap is private health insurance.
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Claim that a Medicare Advantage Plan is a Medigap policy.
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Sell you a Medigap policy that can't legally be sold in your state. Check with your State Insurance Department to make sure the policy you’re interested in can be sold in your state.
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Misuse the names, letters, or symbols of these:
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Any of their programs, like Medicare.
For example, they can't suggest the Medigap policy has been approved or recommended by the federal government:
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Claim to be a Medicare representative if they work for a Medigap insurance company.
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Sell you a Medicare Advantage Plan when you say you want to keep Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn't the same as Original Medicare. If you enroll in a Medicare Advantage Plan, you'll be disenrolled from Original Medicare and can't use a Medigap policy.
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. You generally will get better prices and more choices among policies. 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), and it can't be changed or repeated. 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 due to past or present health problems.
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.
What's Your Situation?
I'm 65 or 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.
Outside Open Enrollment
If you apply for Medigap coverage after your open enrollment period, there's no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you're eligible due to one of the situations below.
In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. If you buy a Medicare SELECT policy, you have rights to change your mind within 12 months and switch to a standard Medigap policy.
If You're Losing Medigap Coverage
In most cases, your Medigap insurance company can't drop you because the Medigap policy is a guaranteed renewable policy. This means your insurance company can't drop you unless one of these happens:
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You stop paying your premiums
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You weren't truthful on the Medigap policy application
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The insurance company becomes bankrupt or insolvent
If you bought your Medigap policy before 1992, it might not be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy. But, the insurance company must get the state's approval to cancel your Medigap policy. If this happens, you have the right to buy another Medigap policy.
Drop your Medigap Policy
If you want to drop your policy, contact your insurance company to cancel it.
Guaranteed Issue Rights
Guaranteed issue rights (also called "Medigap protections") are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:
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Must sell you a Medigap policy
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Must cover all your pre-existing health conditions
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Can't charge you more for a Medigap policy because of past or present health problems
In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a "trial right" to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind.
Can I Buy a Medigap Policy if I Lose my Health Care Coverage?
You may have a guaranteed issue right to buy a Medigap policy. Make sure you keep these items:
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A copy of any letters, notices, emails, and/or claim denials that have your name on them as proof of your coverage being terminated
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The postmarked envelope these papers come in as proof of when it was mailed
You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right.
If you have a Medicare Advantage Plan but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect no later than when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.
Still need more information about Medicare Supplement Insurance Plans? Here is a compilation of videos for you to view to understand Medicare Supplement Insurance Plans (Medigap) along with other Medicare info videos
Medicare Supplement Insurance Plan Videos
Medicare Supplement Insurance Plan Videos
Medicare Supplement Insurance Plans (Medigap Plans)
How To: Enrolling in Medicare
Important Medicare Timelines and Dates
More Resources
Part A
Click here to learn more about Medicare Part A Coverage
Part B
Click here to learn more about Medicare Part B Coverage
Part C
Click here to learn more about Medicare Part C Coverage
Part D
Click here to learn more about Medicare
Part D Coverage