Original Medicare pays for many, but not all, health care services and supplies.
A Medicare Supplement or Medigap policy is private insurance that helps supplement Original Medicare.
This means it helps pay some of the health care costs that Original Medicare doesn’t
cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare
coverage. If you have Original Medicare and a Medigap policy, Medicare will pay
its share of the Medicare-approved amounts for covered health care costs. Then
your Medigap policy pays its share. A Medigap policy is different from a Medicare
Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare
benefits, while a Medigap policy only supplements the costs of your Original Medicare
benefits. Note: Medicare doesn’t pay any of your costs for a Medigap policy.
All Medigap policies must follow Federal and state laws designed to protect you, and
policies must be clearly identified as “Medicare Supplement Insurance.” Medigap
insurance companies in most states can only sell you a “standardized” Medigap policy.
Each standardized Medigap policy must offer the same basic benefits, no matter which
insurance company sells it. All plans offer the same basic benefits but some offer
additional benefits. You can choose which plan meets your needs.
Generally, you must have Medicare Parts A and B to be able to buy a Medicare Supplement or Medigap policy.
The best time to buy a Supplement policy is on the first day of the month in which
you’re 65 or older and enrolled in Part B. This time period, called your Medigap
Open Enrollment Period, ends 6 months later. During this period, an insurance
company can’t refuse to sell you a policy or charge you more because of your health.
If you’re under 65, you won’t have this Open Enrollment Period until you turn 65,
but state law might give you a right to buy a policy before then. Note: A Medigap
policy covers only one person. Spouses must each have their own policy.
You pay a monthly premium to the private health insurance company that sells
you the policy. The premiums will be different for plans with different benefits
(for example, Plan A compared to a Plan F), but will also differ among insurance
companies selling the same plan. Therefore, it’s very important to compare policies
and their costs. Note: If you buy Plan K, L, or N, you’ll pay part of the Part B
coinsurance and copayments, which may result in lower premiums for some
Medigap Plans. Also, plans called “Medicare SELECT” may cost less because they’ll
only provide benefits if you use specific hospitals or doctors.
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