Medicare Supplemental Insurance
What is Medicare Supplemental Insurance (Medigap)?
Medicare Supplemental Insurance (also called Medigap) is a form of insurance that is meant to cover what Medicare does not. Remember, Medicare typically
pays up to a certain amount (usually 80%) for hospital care, doctors' visits, etc. and the individual beneficiary is responsible for the remainder. Medicare
Supplemental Insurance covers the remaining costs. When used, Medigap is considered the "secondary insurance," while Medicare is considered the "primary insurance."
Private insurance companies sell Medigap policies, and the policies are standardized and regulated by federal and state laws. In most states, insurance companies
sell the same 10 Medigap plans (Plans A-J); however, the benefits and prices of each may vary.
For detailed information on Medigap, you may want to read the Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy, a booklet published by the Centers for Medicare and
Medicaid Services (CMS) of the U.S. Department of Health and Human Services. To receive a copy, call 1-800-MEDICARE (1-800-633-4227) and ask for publication number 02110. TTY users should call 1-877-486-2048. You can also read, print or order the booklet by visiting www.medicare.gov and selecting "Publications."
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What does Medicare Supplemental Insurance cover?
Coverage benefits depend on which plan you choose. In all states, there are basic standardized benefit plans, each of which has a different set of benefits. Any standardized plan may also be sold as a Medicare Select, which usually costs less because you must use certain doctors and hospitals, except in an emergency.
To learn about the standardized plans and optional benefits that are available in your state, call 1-800-MEDICARE (1-800-633-4227) and ask for a copy of the Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy (publication number 02110). TTY users should call 1-877-486-2048. You can also read, print or order the booklet by visiting www.medicare.gov and selecting "Publications."
In general, the guidelines for coverage are as follows:
Each plan must provide, at a minimum:
- Deductibles for hospitalizations (this is the amount an individual must
pay before Medicare pays for a hospitalization).
- The co-insurance amount (the remaining 20% not covered by the plan) for services covered
by Medicare Part B
 (outpatient services, physical therapy, x-rays, etc).
- The first three pints of blood that may be required for surgery or medical
care (which are not covered by Medicare).
Additional benefits covered by some Medigap plans include:
- Deductibles for nursing home costs (this is the amount an individual must
pay before Medicare pays for a nursing home stay).
- Annual Medicare deductible.
- Additional home-care services (in certain situations).
- Foreign travel emergency costs, which are not covered under Medicare.
- Some prescriptions, which are not generally covered by Medicare.
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What services are not covered by Medicare Supplemental Insurance?
- Long-term/custodial care at home or in a nursing home
- Assisted living
- Vision care
- Dental care
- Hearing aids
- Private-duty nursing
- Unlimited prescription medications
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How much does Medicare Supplemental Insurance cost?
The premiums for Medigap vary in price depending on the following:
- State of residence
- Insurance company that sells the policy
- Age of the individual when the policy is purchased
- Which Medigap plan is selected (some plans have only basic coverage, while
some have added benefits)
Keep in mind that premium costs may increase in the future. ^ Back to Top
How do you apply for Medicare Supplemental Insurance?
All seniors eligible for Medicare are given a six-month window (called "open enrollment") in which they can purchase a Medigap policy. The six-month
period begins when the person turns 65 and enrolls in Medicare Part B or when
he/she retires and signs up for Medicare Part B. During this period, there are, by law, no restrictions on eligibility due to pre-existing health conditions.
If a Medigap policy is not purchased during this "open enrollment" period, you can still apply for one at a later date; however, after the six-month
window, individuals with pre-existing conditions or health problems may be denied coverage.
To apply for Medigap, you can do any of the following:
- Contact a private insurance company that sells Medigap policies. (See below.)
- Speak to the benefits manager at your workplace or union, as many employers or union organizations offer Medigap as a retirement option.
- Contact your state department for insurance regulation (the number can be found in the blue government pages of your phone directory).
- Contact the Medicare Hotline (1-800-633-4227) for a list of insurance companies that sell Medigap.
- Use the Medicare website's interactive Medigap Compare tool to locate a company and search for policies.
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Does Medicare Supplemental Insurance pay for prescription drugs?
Some Medigap policies do cover prescription drugs. Coverage varies by state and by plan.
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How do I find a company that sells Medicare Supplemental Insurance?
There are several ways you can find a company that sells Medigap insurance. You can call your local Medicare office for information, or you can check with your local agency on aging or department of health.
You can search for companies using the Medigap Compare tool on the government's official Medicare site, www.medicare.gov. Medigap Compare is an interactive tool designed to help locate the insurance companies in your state that sell Medigap plans. The website also gives you information on how to contact the insurance companies and provides general information about Medigap insurance to help you with your healthcare choices.
Medigap Compare currently contains some basic information about each reporting insurance company, such as:
- which plans they offer;
- if the plans are offered to persons at or over age 65 as well as those under 65 with disabilities
and/or end-stage renal disease;
- how they price their plans based on what rating method they use; and
- if you need to be a member of a certain organization to buy one of their
plans;
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