Medicare Supplement Insurance sometimes called Med Supp or Medigap are sold by private insurance companies. Original Medicare covers about 80% of medical costs. Med Supp can help cover remaining out-of-pocket expenses like deductibles, coinsurance, and co-pays. They do not include Part D drug coverage - you buy that separately. They do cover visits to any doctor who accepts Medicare patients. You must have Part B and keep paying your Part B premium to keep your Medigap policy.
If you travel extensively, opting for original Medicare plus Medigap may be a good option. Many Medigap plans pay for a large portion of emergency medical services you may need when traveling outside the United States.
While Medigap policies can provide significant financial assistance, they do not cover everything. Here are some items and services that are typically not covered by Medigap:
- Medicare Part D Prescription Drugs: Medigap policies do not include coverage for prescription medications. To obtain prescription drug coverage, you'll need to enroll in a separate Medicare Part D plan.
- Medicare Advantage Plan (Part C): If you choose to enroll in a Medicare Advantage plan (Part C), you cannot have a Medigap policy. Medigap only works with Original Medicare, not Medicare Advantage plans.
- Long-Term Care: Medigap does not cover long-term care in a nursing home, assisted living facility, or for in-home care. Separate long-term care insurance is available for such purposes.
- Dental Care: Routine dental services, including cleanings, fillings, and dentures, are generally not covered by Medigap. You may need a separate dental insurance plan for these services.
- Vision Care: Routine eye exams, eyeglasses, and contact lenses are not covered by Medigap. You may require separate vision insurance for such expenses.
- Hearing Aids: The cost of hearing aids is typically not covered by Medigap. You may need a separate hearing insurance plan for hearing-related expenses.
- Cosmetic Surgery: Elective cosmetic procedures or surgeries are not covered by Medigap.
- Private Nursing Care: Medigap does not cover private-duty nursing services.
- Foreign Travel:
- Non-emergency care received while traveling abroad is generally not covered by Medigap.
- Medigap may provide limited coverage for emergency medical care during foreign travel, but this coverage is usually subject to deductibles and maximum limits.
- Other Miscellaneous Services: Medigap does not cover various other services and items, such as acupuncture, chiropractic care, health club memberships, and non-medically necessary services.
The cost of Medigap policies can vary significantly based on several factors, including your location, the insurance company, the specific Medigap plan you choose, and your age when you enroll. Generally, the cost of Medigap includes monthly premiums, which can range widely depending on these variables. It's advisable to shop around and compare prices from different insurance companies to find a policy that fits your budget and healthcare needs.
You can enroll in a Medicare Supplement plan (Medigap) during certain periods, but the most important one is the Medigap Open Enrollment Period. Here are the key enrollment periods for Medigap:
- Medigap Open Enrollment Period (OEP): This is the most favorable time to enroll in a Medigap policy. It starts when you are both 65 or older and enrolled in Medicare Part B. During this six-month period, insurance companies are generally required to sell you any Medigap policy they offer, regardless of your health status, and they cannot charge you higher premiums due to pre-existing conditions.
- Special Enrollment Periods (SEPs): In some situations, you may be eligible for a Special Enrollment Period, which allows you to enroll in a Medigap policy outside the Open Enrollment Period without facing medical underwriting or pre-existing condition exclusions. SEPs are typically related to specific life events, such as losing your current coverage or relocating.
- Guaranteed Issue Rights: These rights allow you to buy a Medigap policy at any time, without regard to pre-existing conditions, in certain circumstances. For example, if you lose your employer group health coverage or your Medicare Advantage plan is discontinued, you may have guaranteed issue rights.
- Annual Election Period (AEP): The Annual Election Period, also known as the Fall Open Enrollment, occurs from October 15 to December 7 each year. During this period, you can make changes to your Medicare Advantage and Part D prescription drug plans. It does not apply to Medigap plans, but you can use this time to compare and potentially switch to a Medigap policy.
- General Enrollment Period (GEP): If you miss your initial Medigap Open Enrollment Period and don't qualify for a Special Enrollment Period, you can still apply during the General Enrollment Period, which runs from January 1 to March 31 each year. However, enrolling during the GEP may lead to medical underwriting, and you may face higher premiums.
You can apply for a Medigap policy after your Open Enrollment Period ends. However, there is no guarantee your application will be accepted if you do not meet medical underwriting requirements, except in certain limited situations.
Even if you have a disability or have health problems, an insurance company cannot do any of the following: Refuse to sell you any Medigap policy it offers, charge you a higher premium than they charge others who are 65 and older or delay the start of your coverage.
You can enroll in Medigap even if you have health problems. However, your ability to obtain a Medigap policy without higher premiums or denial of coverage may depend on when you apply. The most favorable time to enroll is during your Medigap Open Enrollment Period, whe you have guaranteed issue rights. If you apply outside of this period, medical underwriting may be used, potentially affecting your coverage terms and costs.
Each plan has different out-of-pocket maximums, different access to doctors, and other varying features which may change annually. Many Part C plans have a $0 premium. Others can go as high as $200 a month, or more, which is in addition to your monthly Part B premium. In 2023, the standard Part B premium amount is $164.90 (or higher depending on your income). Some people with Social Security benefits pay less.