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What is Medigap Coverage

Medigap coverage comes from private health insurance companies. Medicare Supplement plans allow beneficiaries to see any doctor in the United States that accepts Medicare Assignment. The supplement can’t drop you due to any health issues.

Medigap Coverage Guidelines

It’s important you understand your state’s rules and requirements for Medicare coverage to help you get the best health-care possible. Medigap coverage rules are specific to Medigap plan types, here’s what Medigap beneficiaries need to know. Medicare is in all 50 states and U.S. territories.

Medigap Coverage State Rules

State rules can affect Medicare coverage. Moving out of state means you need to re-examine coverage options and rules as soon as possible.

Some states have a year-round Guarantee Issue for Medigap plans, like New York and Connecticut. Beneficiaries living in these states can apply for a supplement at any time without medical underwriting.

California and Oregon have a “birthday rule”. This is a window of 30 days after a Medigap enrollees’ birthday each year. This rule allows enrollees to change plans during this time without underwriting.

In Maine, Medicare Supplement enrollees can change plans at any time. Similarly, Washington State also allows enrollees to switch Medigap plans (except for Plan A) at any time of the year.

Missouri has a period known as the Anniversary Guaranteed Issue Period. Anyone enrolled in a Medigap plan can use this period to change plans, within 60 days of their enrollment anniversary. This is only when you originally enrolled in a Medigap plan.

What Does a Medigap Policy Cover

A Medigap policy will cover medical costs that are not covered by Original Medicare. This includes additional coverage for deductibles, coinsurance, emergency coverage when traveling outside the U.S., etc.

Medigap Limitations

Medigap plans are identified by letters and each plan has a different level of benefits.

Insurance carriers may choose what Medigap plans they will offer. However, every carrier is required to offer at least a basic benefit Plan A.

Premium rates are higher for plans with comprehensive coverage, like Plan G and F. Medigap plan F coverage is the most complete.

When a benefit is covered by Medicare, your Medicare Supplement plan will also provide coverage. Additionally, some supplement plans have out-of-pocket limits that can change from one year to the next; such as Medigap Plan K or Plan L.

Paying for Medigap Coverage

The private insurance company will give you a monthly premium, paying for Medigap coverage is your responsibility. If you don’t pay your premium, then you’re going to lose coverage.

Losing coverage from non-payment is considered a voluntary loss of coverage. You won’t qualify for a Special Election Period to enroll in coverage.

This means you’ll go through underwriting to obtain a policy; you could experience coverage denial or coverage at a much higher premium. Paying your premium in a timely fashion is necessary with Medicare Supplement plans; however, the benefits are worth the cost.

Choosing or Changing Medigap Coverage

When changing coverage, keep your old plan for 30 days prior to canceling. When filing your application for a new plan, you must promise to cancel your old one after 30 days.

Everyone gets a 30-day free-look period to switch Medigap plans. The free look period will start when your new policy begins. During this period, you’ll be required to pay both premium amounts.

Until you feel secure with your new policy, you should postpone canceling your old one.

Medigap Billing Process

You may be wondering how the coverage billing process works. Well, Medicare makes the first payment, covering allowable costs.

Afterward, coverage kicks in and pays its portion of the costs of health-care services. Of course, if services aren’t covered you must cover the entire cost yourself. So, follow your plan’s rules and guidelines and don’t get stuck with a high bill.

Medigap Coverage & Other Insurance

There are other types of insurance policies and options for health coverage; including Medicare Advantage Plans, Prescription Drug Plans, Employer or union plans, and more.

You can’t be enrolled in both Medigap and Medicare Advantage Plans at the same time. A Medicare Supplement offers coverage for some out-of-pocket expenses that Original Medicare doesn’t cover.

Medicare Advantage Plans provide coverage for specific health-care benefits. Some Advantage plans will offer extra benefits that Original Medicare does not.

A Medigap plan might be your best option if you’re pleased with your Original Medicare benefits but need help with the out-of-pocket expenses.

Enrolling in a supplement plan while having Large employer coverage (20+ employees) could be a waste of money. Medicare Supplement plans can’t cover the costs of anything until Original Medicare is your primary health insurance.

However, if your group plan costs are astronomical, then switching to Medicare could be in your best interest.

Those with small employer coverage (under 20 employees) will need to enroll in Medicare; otherwise, you could incur the Part B late enrollment penalty.

How to Apply for Medigap Coverage

We can help you apply for Medigap coverage. Our Medicare agents will collect some information, then see what plans are available near you and compare rates side by side with all carriers. Give us a call or fill out one of our online forms and get the process going.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.


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