MEDICARE SUPPLEMENT
Original Medicare, Part A and B, pays for many of your health-care services and supplies, but it doesn’t pay for everything. That’s why you may want to consider getting a Medicare Supplement plan, also called Medigap. Unlike Original Medicare, a Medicare Supplement plan is offered through private insurance companies. These Medigap plans help pay some of the hospital and medical costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and yearly deductibles.
Some Medicare Supplement plans also help pay for a few services that Original Medicare doesn’t cover, such as emergency overseas travel coverage or Part B excess charges. Two out of ten Medigap plans include a yearly out-of-pocket limit, which Original Medicare doesn’t include. Basically, a Medigap policy fills the “gaps” in Original Medicare coverage.
Here’s an overview of how Medicare Supplement plans work, the types of benefits they cover, and how to enroll.
How do Medicare Supplement (Medigap) plans work with Medicare?
Medigap plans supplement your Original Medicare benefits, which is why these policies are also called Medicare Supplement plans. You’ll need to be enrolled in Original Medicare to be eligible for Medigap coverage, and you’ll need to stay enrolled in Original Medicare for your hospital and medical coverage. Medicare Supplement plans aren’t meant to provide stand-alone benefits.
Depending on the state that you live in, you may not be able to get Medicare Supplement coverage if you’re under 65 and have Medicare because of disability, end-stage renal disease, or amyotrophic lateral sclerosis. States aren’t required to offer Medigap coverage to beneficiaries under 65. If you’re under 65 and enrolled in Original Medicare, check with your state’s insurance department to find out if you’re eligible to enroll in a Medicare Supplement plan.
Keep in mind that Medigap plans don’t include prescription drug coverage (Part D), so if you want help with your medication costs, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan. In addition, you can’t use your Medicare Supplement plan to pay for costs you may have with a Medicare Advantage plan. Medigap insurance can only be used to cover costs in Original Medicare.
If you have Original Medicare and a Medicare Supplement plan, Original Medicare will pay first, and your Medigap policy will fill in the cost gaps. For example, suppose you have a $5,000 ambulance bill, and you have already met the yearly Medicare Part B deductible. Medicare Part B will pay 80% of your ambulance bill. If you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then your Medigap policy would then pay the remaining 20% coinsurance of your $5,000 ambulance bill. Some Medicare Supplement plans may also cover the Part B deductible.
What types of coverage are not Medicare Supplement plans?
As a Medicare beneficiary, you may also be enrolled in other types of coverage, either through the Medicare program or other sources, such as an employer. When you first sign up for Original Medicare, you’ll fill out a form called the Initial Enrollment Questionnaire and be asked whether you have other types of insurance. It’s important to include all other types of coverage you have in this questionnaire. Medicare uses this information when deciding who pays first when you receive health-care services.
Below is a list of other types of insurance you may have. Please note that these types of coverage are different from Medicare Supplement plans:erwise specified.
Medicare Advantage plans (like an HMO or PPO)
Medicare Prescription Drug Plans (Part D)
Medicaid
Employer-or union-sponsored group coverage
TRICARE
Veterans' benefits
Long-term
Care insurance policies
What benefits do Medicare Supplement plans cover?
MEDICARE ELIGIBILITY
AGE
You can qualify for Medicare by age once you are 65 years or older. You will become eligible to enroll three months before your 65th birthday until three months after turning 65. This window is called the Initial Enrollment Period. You can apply for Original Medicare during this period if you are eligible. If you decide to delay your enrollment, you may face a late enrollment penalty whenever you decide to enroll for Medicare at a later time. However, you can avoid these late enrollment penalties as long you qualify and enroll during a Special Enrollment Period.
DISABILITY
People who receive Social Security Disability benefits can qualify for Medicare once they have received benefits for 24 months. Individuals in this category become automatically eligible on the 25th month.
HEALTH CONDITION
People suffering from End-Stage Renal Disease and Amyotrophic Lateral Sclerosis may become eligible for Medicare even when under 65. Those with kidney failure who need a transplant or frequent dialysis qualify for Medicare automatically. Medicare will begin coverage after the first dialysis.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact
Medicare.gov
or 1-800-MEDICARE to get information on all of your options.