Medigap

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Supplemental Insurance

A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like a copayment, coinsurance, and your deductible. Some Medigap policies also offer coverage for 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, Medicare will pay its share of the Medicare-approved amount for covered health care costs, and then your Medigap policy will pay it’s share, minimizing your out-of-pocket costs.

A Medigap policy is different from a Medicare Advantage Plan. Medicare Advantage provides a way to get Medicare benefits, while a Medigap policy is a supplement to your Original Medicare benefits.

Eight things to know about Medigap policies:

  1. 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 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 prescriptions 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.

Some Medigap policy exclusions:

  • Long-term care
  • Vision and dental care
  • Hearing aids
  • Eyeglasses
  • Private duty nursing

These insurance plans are NOT Medigap:

  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
  • TRICARE
  • Veterans benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans