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Medigap Policies Help Supplement Medicare Coverage

Medigap Basics

What is a Medigap Policy? Medigap policies are sold by private insurance companies, but are not like Medicare Advantage Plans (HMOs, PPOs). It is sometimes called "Medicare Supplement Insurance." A basic Medigap policy works with Original Medicare coverage to help pay some of your out-of-pocket costs like co-payments and coinsurance.

There are many Medigap supplemental health insurance plans from which to pick. There can be big differences in the charges of various plans for the same basic benefits. Medigap policies must follow the Federal and State laws that are designed to protect you. Insurance companies must clearly identify their policies as 'Medicare Supplemental Insurance' on the front of the policy. A Medigap policy can only cover one person. If you are married both you and your spouse must buy separate policies.

The following are NOT Medigap policies:

What does a basic Medigap Policy cover?

Medigap insurance companies can only sell you a "standardized" Medigap policy. Letters A through N identify the different policies. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Every insurance company must make Medigap Plan 'A' available if it offers any other Medigap policy. Not all Medigap policies may be available in your state. Not all plans include all basic benefits.

Medigap Benefits:

Medigap policies do not cover:

When do I Enroll in a Medigap Policy

It is highly recommended that you purchase your Medigap policy during open enrollment. Your open enrollment period begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. This period will last for six months. During that 6 month period an insurance company cannot:

The supplemental health insurance company must shorten or eliminate any waiting period if:

What do I do if the open enrollment period has passed?

Once you are past your "open enrollment" period, the insurance companies do not have to sell you a policy. In addition they are allowed to charge you extra for the policy. There are some exceptions to that; for example, your private health care coverage ended or you were in a Medicare Advantage Plan. If you have decided to not sign up for a basic Medigap policy during open enrollment, you will need to have copies of the following paperwork to prove your guaranteed issues rights:

Other words of advice

If you did not get a Medigap insurance policy during open enrollment and are thinking of one now:

Can my Medigap insurance company drop me?

If you bought your Medigap policy after 1992, in most cases the Medigap insurance company can't drop you because the Medigap policy is guaranteed renewable. This means your insurance company can't drop you unless one of the following happens:

However, if you bought your Medigap policy before 1992, it might not be guaranteed renewable. At the time these Medigap policies were sold, state laws might not have required that these Medigap policies be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state's approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy.

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