Medigap Policies

Medigap Policies

Medigap policies are the most common form of Medicare Supplements. They cover some needs that Medicare may not. Medigap policies are provided by private insurance companies, not the government.

Medigap policies come in eleven different standardized plans. Each is identified by a letter “A” through “N.” Because they are standardized, the benefits provided in any plan with the same letter will be the same, no matter what company sells you the plan. However, the cost for that plan (premium price) will vary between companies.

It is important to compare the different policy types before buying a Medigap plan. Because the plans are standardized, you can easily shop for the company with the best price. The Medigap Rate Guide from the Missouri DIFP can help you find the best prices in Missouri. You may also want to look that company up on the Complaint Index from Missouri DIFP before purchasing a plan. DIFP has a range of resources on Medigap, including a printable guide.

Companies selling Medigaps must also meet several requirements. They must guarantee the plan is renewable. Benefits must be clearly disclosed. The insurance company must allow you a 30-day period during which you can cancel the policy with no penalties. They also cannot sell a policy to someone that already has one.

Policies

Medigap Plan Options

The current benefits for these plans is explained in the following two tables:

PLANS

A B C D F/F1 G K L M N
Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%* Hospitalization and preventive care paid at 100% ; other basic benefits paid at 75%* Basic Benefits Basic Benefits, except up to $20 co-pay for office visit and up to $50 co-pay for ERª
Part A Deductible Part A Deductible Part A Deductible Part A Deductible Part A Deductible 50% of Part A Deductible* 75% of Part A Deductible* 50% of Part A Deductible* Part A Deductible
Skilled Nursing Coinsurance Skilled Nursing Coinsurance Skilled Nursing Coinsurance Skilled Nursing Coinsurance 50% of Skilled Nursing Coinsurance* 75% of Skilled Nursing Coinsurance* Skilled Nursing Coinsurance Skilled Nursing Coinsurance
Part B Deductible Part B Deductible
Part B Excess (100%) Part B Excess (100%)
Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency
Benefits paid at 100% after out of pocket limit is reached Benefits paid at 100% after out of pocket limit is reached
See Money Tip Sheet See Money Tip Sheet See Money Tip Sheet

Explanation of Medigap Benefits

Basic Benefits(A-N)
  • Coverage for coinsurance for days 61-90
  • Coverage for coinsurance for Lifetime Reserve Days 91-150
  • Coverage for an additional 365 days of inpatient hospital care
  • Coverage for the first three pints of blood
  • Coverage for the 20% coinsurance for Part B services
  • Coverage of the hospice 5% coinsurance for Medicare-approved charges for inpatient respite care and 5% coinsurance for prescription pain medications
Part A Deductible(B-G & N)
  • Coverage for the inpatient hospital deductible for each benefit period
Skilled Nursing Coinsurance(C-N)
  • Coverage for the skilled nursing coinsurance for days 21-100
Part B Deductible(C, F)
  • Coverage for the yearly deductible
Part B Excess(F & G)
  • Coverage for Part B charges over the approved amount
  • Plans F, I, and J pay for 100% of the excess charge
  • Plan G pays for 80% of the excess charge
Foreign Travel Emergency(C-G, M & N)
  • Coverage for emergency care for the first 60 days of a trip outside the US
  • Beneficiary pays for a $250 deductible and 20% of the cost (up to $50,000)
*High Deductible Option–Plans F and J have a high deductible option. Plans with the high deductible option may have a lower monthly premium. For this type of plan, the beneficiary pays a deductible each year before the supplement pays for any services. This deductible amount is subject to increase each year.

Enrolling

When you first enroll in Medicare Part B, you have six months when you can choose whichever policy you want wants and cannot be turned down. This is known as your open-enrollment period.

If you are eligible for Medicare because of a disability, you will have two six-month open-enrollment periods, one when you first enroll in Part B and the other beginning the month you turn 65.

Once you have a Medigap policy, you may switch companies each year during the 60 days surrounding the anniversary date of your policy. You are only guaranteed to be able to change companies, however, not policies. For example, if you have Policy F, the company does not have to let you switch to Policy J.

Beneficiaries under age 65 have the right to suspend or turn off their Medigap policy if she/he becomes eligible for coverage under an Employer Group Health Plan (EGHP). The beneficiary will not pay the premium and the policy will not pay any benefits. With the loss of the EGHP, the beneficiary may reactivate the policy within 90 days without any pre-existing condition exclusions, waiting periods, or underwriting.

Beneficiaries who become eligible for Medicaid also have this right. Beneficiaries are allowed to suspend a Medigap policy for up to two years. Again, the beneficiary must notify the Medigap company within 90 days of the loss of Medicaid benefits to reactivate the policy without any pre-existing condition exclusions, waiting periods, or underwriting.

Medigap Tips

A few things to remember before buying a Medigap Policy:

  • Ask questions of friends and family.
  • Insist on a simple outline of coverage. Know what you are buying.
  • Choose the benefits you want and need. Benefits are standardized in Medigap policies. The “C” policy has exactly the same benefits with any company.
  • Compare benefits for different policies before buying. Consider family and medical history.
  • Call the Missouri Department of Insurance, Financial Institutions & Professional Registration to ask about the company’s rating.
  • Read the policy carefully. If you are unsatisfied, you have a 30-day “free look” period.
  • Keep any proof of prior creditable coverage.
  •  Keep the agent’s name and information for future reference.

There are also some things you should avoid:

  • Don’t feel pressured to buy right away. You have a six-month open enrollment period.
  • Don’t drop a current insurance policy until you are sure about your new coverage.
  • Don’t buy more than one Medigap policy.
  • Never pay cash. Always use a check made out to the insurance company, NOT the agent.
  • Don’t buy from agents that claim to be from the government. The government does not sell insurance.
  • Do not buy a Medigap policy if you are in a Medicare Advantage plan. They will not work together.