Do I Have to Be Enrolled in Original Medicare to Apply for a Medigap Insurance Plan?
Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) are often referred to as Original Medicare. A Medicare Supplement (Medigap) insurance plan is health insurance sold by private insurance companies that helps pay for out-of-pocket health-care costs that Original Medicare doesn’t pay, such as coinsurance, copayments, and deductibles.
Do I need to have Original Medicare to apply for Medigap?
The short answer is yes. To have a Medigap policy, you must first have Medicare Part A and Part B. Your Medigap Open Enrollment Period begins on the first day of the month that you’re both 65 or older and enrolled in Medicare Part B. During this open enrollment period, your insurer can’t do any of following because of your health problems: deny you coverage, charge you more for a policy, or make you wait for coverage to start, except as related to a pre-existing condition*. Outside of Medigap’s Open Enrollment Period, you may be denied a policy or charged more for a policy if you have health problems.
Even if you are 65, you are not eligible for Medigap Open Enrollment until you are enrolled in Medicare Part B. Keep in mind that Medigap only works with Original Medicare. You can’t use these plans to pay for Medicare Advantage costs.
Can I have a Medicare Supplement insurance plan with Medicare Advantage?
If you have a Medicare Advantage plan but are planning to drop it and sign up for Original Medicare, you can apply for a Medigap policy before your Medicare Advantage coverage ends. The insurer can sell you a Medigap policy if you verify that you are leaving the Medicare Advantage plan and will sign up for Medicare Part A and B. To have continuous coverage, you can start your Medigap policy when your Medicare Advantage enrollment ends.
What types of Medicare Supplement insurance plans are available?
Different Medigap policies may be available to you depending on your state. Insurance companies that sell Medigap don’t have to sell every plan. However, the insurance company must offer Medigap Plan A (which is not the same as Medicare Part A) if it offers any Medigap policy. Medigap Plan A covers 100% of Medicare Part A coinsurance, 100% of Medicare Part B coinsurance, 100% of blood, and 100% of Part A hospice care coinsurance. Medicare Supplement insurance plans are standardized with lettered names (A, B, C, D, F, G, K, L, M, or N) in most states, and all of them cover 100% of Medicare Part A coinsurance. Some Medicare Supplement insurance plans cover foreign travel emergencies, Part B excess charges, Part B deductible, and skilled nursing facility coinsurance. Massachusetts, Wisconsin, and Minnesota have their own standardized Medigap plans.
What are the steps to buying a Medicare Supplement (Medigap) insurance plan?
The steps to buying a Medigap policy are:
- Enroll in Medicare Part B.
- Decide which benefits you want and which Medigap policy covers those benefits.
- Call the insurance companies that sell the Medigap policy you want and compare costs. Costs can differ for the same policy depending on the insurer.
- Buy the Medigap policy.
Choose carefully as you may be subjected to medical underwriting if you wish to change plans later. Medical underwriting could deny you a policy or make you pay more for a policy based on your health conditions.
*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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