Enhanced Care Solutions - Medigap Overview and Senior Care

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Medigap Overview

Links to Information and Resources

“Medigap” is the commonly used name for private supplemental insurance plans, also known as Medicare Supplemental plans, which help fill the "gap" for costs not covered under the Medicare program. For all states except Massachusetts, Minnesota, and Wisconsin*, there are ten standardized Medigap plans (labeled Plan A through J), which private insurance companies may offer. Each plan type offers a varying degree of benefits. Plans H, I, J are the only standardized MediGap plans that offer prescription drug benefits.

When you buy a Medigap policy, you pay a premium to the insurance company. This premium is different than the Medicare Part B premium you must also pay. As long as you pay your premium, your policy is guaranteed renewable, which means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. If you buy a Medigap policy, it only covers your health care costs. It doesn't cover any health care costs for your spouse.

One Important note: In some states, insurance companies may refuse to renew a Medigap policy bought before 1990. At the time these policies were sold, state law was not required to say the Medigap policies had to be renewed automatically each year.

Medigap policies only help pay health care costs if you have the Original Medicare Plan. You don't need to buy a Medigap policy if you are in a Medicare + Choice Plan. In fact, it is illegal for anyone to sell you a Medigap policy if they know you are in one of these plans.

It is also illegal for an insurance company to sell you a Medigap policy if you have Medicaid except in certain situations.

Medicare
Medicare Primer
Equipment Coverage
Resource Links

Prescription Drugs
The right question
Need to know (pdf)
MN Approved Cards (pdf) Resource Links

Medicaid
Medicaid Primer
Medicaid Services
Medicare vs Medicaid
Resource Links

Medigap
Medigap Overview
Standardized Plans
MN Company List (pdf)
Resource Links

Long Term Care Insurance
Overview
Coverage Options
Resource Links

Minnesota Programs
Medical Assistance Elderly Waiver (pdf)

Frequently Asked Questions

What Is Not A Medigap Policy?

A Medigap policy is not:

Coverage you get from your employer or union,
A Medicare + Choice Plan,
Medicare Part B, and
Medicaid.

Who Can Buy A Medigap Policy?

To buy a Medigap policy, you generally must have Medicare Part A and Part B. If you are under age 65 and you are disabled or have End-Stage Renal Disease (ESRD), you may not be able to buy a Medigap policy until you turn 65.

Can I Keep Seeing The Same Doctor If I Buy A Medigap Policy?

In most cases, yes. If you are in the Original Medicare Plan and you have a Medigap policy, you can go to any doctor, hospital, or other health care provider who accepts Medicare. However, if you have the type of Medigap policy called Medicare SELECT, you must use specific hospitals and, in some cases, specific doctors to get your full insurance benefits.

Why Would I Want To Buy A Medigap Policy?

You may want to buy a Medigap policy because Medicare doesn't pay for all of your health care. There are "gaps" or costs that you must pay in the Original Medicare Plan. Remember, no Medigap policy will cover all the gaps in the Original Medicare Plan.

If you are in the Original Medicare Plan, a Medigap policy may help you lower your out-of-pocket costs, and get more health insurance coverage. What you pay out-of-pocket in the Original Medicare Plan will depend on the following:

• Whether your doctor or supplier accepts "assignment" which means takes Medicare's approved amount as payment in full
• How often you need health care,
• What type of health care you need
• Whether you buy a Medigap policy
• Which Medigap policy you buy
• Whether you have other health insurance.

* MA, MN, and WI had Medigap standardization programs in place before the passage of OBRA in 1990 and were granted exemptions allowing continued operation of those plans.

Source: GlaxoSmithKline Reimbursement Resource Center, Medicare.gov

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