Medicare Supplement, also called Medigap, is a type of supplemental health insurance that complements your primary medical coverage.
While this additional coverage is helpful to have because it can help save you money, enrolling in a Medigap plan can be confusing. Unlike Medicare Open Enrollment, which repeats every year, Medigap enrollment is an individual, one-time window for each person.
Here’s how to know when you can buy a Medigap plan.
How does Medicare Supplement work?
Supplemental health insurance, like Medicare Supplement or Medigap, is a specific type of health insurance policy that’s designed to help fill in the “gaps” of your regular coverage. You purchase supplemental health insurance in addition to your major medical health insurance (whether your major coverage is private, or Medicare).
This supplemental insurance works alongside your other coverage to help pay for out-of-pocket costs for serious illness or hospitalization — any costs your primary insurance won’t cover.
How to get Medigap
When it comes to Medicare, you can only purchase Medigap (a form of supplemental health insurance) if you already have Original Medicare (which encompasses Medicare Parts A and B). This means you will need to sign up for Medicare Part A and Part B before you can shop for a Medigap policy. If you only have Medicare Part C, you will not be able to get Medigap.
Medigap plans, which are sold by private health insurance companies, include:
- Plan A
- Plan B
- Plan C
- Plan D
- Plan F
- Plan G
- Plan K
- Plan L
- Plan M
- Plan N
How Medigap works
Medigap helps with costs of things like:
- Outpatient services
Medigap plans do not cover prescription drugs. For that, you’ll need Medicare Part D.
To use Medigap coverage, you’ll show your provider your Medicare card and your Medigap policy identification card. Then, Medicare will notify the provider when they need to pay part of your medical bill. There’s no need for you to file claims.
When to purchase a Medicare Supplement insurance plan
The time frame for Medigap Open Enrollment works differently from Medicare Open Enrollment. You have a six-month window of time to purchase a Medigap plan. If you don’t, your personalized enrollment period is over — unlike Medicare Open Enrollment, Medigap enrollment does not repeat every year.
Your six-month enrollment period starts the first month that you are at least 65 and have Medicare Part B. This is the best time to enroll in a Medigap policy. Insurers can’t deny you coverage, and they have to sell you a policy at the best rate possible, regardless of the state of your health (for example, they can’t deny you because of pre-existing conditions). During this period, you can purchase any Medigap policy that’s sold in your state.
What if I miss my Medicare Supplement enrollment period?
If you miss your one-time Medigap Open Enrollment period, you might not be able to get a Medigap policy. In other cases, you may still be able to purchase a policy, but it might cost more or you could have less options to choose from. You’ll need to complete a medical underwriting process if you apply for a Medigap plan after your open enrollment period has ended.
Medical underwriting for Medigap
Medical underwriting is a process that allows insurance companies to review your medical history and then decide whether they want to accept you as a customer.
The laws and regulations for medical underwriting are different from state to state. At the end of the day, however, if you don’t meet the insurance company’s requirements, they can deny your application and not allow you to purchase a Medigap plan (or they may charge you a higher cost).
In some cases, when you lose your health care coverage, you might be able to purchase a Medigap policy even outside of your enrollment period. For example, maybe you have a Medicare Advantage plan that is discontinuing coverage in your area, or your Medigap company goes bankrupt. Under these Medigap protections (also known as guaranteed issue rights), an insurance company cannot deny you coverage.
What happens next
After you’ve successfully enrolled in a Medigap plan, you can keep that plan for life (as long as you continue paying premiums). Your coverage will continue to renew at the same price even if you develop a medical condition.
Get help with your Medicare Supplement plan
Medigap plans are a helpful form of supplemental health insurance that can help cover medical costs that go above and beyond the coverage from your primary insurance. If possible, purchase a Medigap plan during your personal six-month enrollment window so you don’t have to deal with medical underwriting. Learn more about Medicare Supplement insurance.