Medigap In Plain English: 15 Commonly Asked Questions

Don't allow for Medigap to become a source of confusion. We take a "just the facts, Ma'am" approach to answering the most frequently asked questions.
Medigap insurance written on a yellow sticky note next to a stethoscope

If you’re covered by Medicare, you might be wondering, “Do I really need Medigap?” Faced with volumes of data and the dizzying array of hundreds of pages of information about Medicare, you are not alone.

Here are 15 important things to know about Medigap.

1. What is it?

Medigap pays some or all of the costs that Medicare doesn’t cover.

2. How much does it cover?

Well, it depends. It depends on the level of coverage you choose. Like most insurances, you can expect to pay more for extensive or heightened coverage.

3. What kinds of costs does Medigap cover?

Medigap policies provide a supplement to Medicare. It is designed to cover all or part of the expenses Medicare doesn’t.

The costs may be those occurring from extensive treatment or long-term hospitalization. Medigap plans cover copayments, coinsurance and deductibles. Some plans cover healthcare if you travel outside the United States. The key idea is to get reimbursed for out-of-pocket expenses.

4. What does Medigap not cover?

The plans do not cover expenses such as vision care, dental care, hearing aids, long-term care, and private nursing.

Medigap plans usually do not include prescription drug coverage. You can join a prescription drug plan (Part D) if you need prescription drug coverage.

5. Who offers Medigap?

Private insurance companies offer Medigap plans.

Experts advise consumers to shop around to find the best offers. Talking with friends, family, financial advisors and insurance brokers may help you make an informed decision.

6. What’s with all the letters?

Standard Medigap plans are labeled A through N. Each letter is for different levels of health coverage. Plans E, H, F and I are no longer available to new subscribers.

7. What’s the most comprehensive coverage?

The most comprehensive coverage available is Plan G. This replaces Plan F, which is no longer available to new subscribers.

8. When to purchase?

The open enrollment period is six months from the first day of your 65th birthday, as long as you are also signed up for Medicare Part B; or within six months of signing up for Medicare Part B. During this time you can purchase a policy at the same price as a person in good health.

9. What if you miss the window?

If you try to buy outside this window, there’s no guarantee you’ll get coverage. If you do, the rates may be higher.

10. Can you have Medigap and Medicare Advantage?

No. You can’t have both Medigap and Medicare Advantage.

11. Do you need to purchase coverage for each person?

A Medigap policy covers only one person. This means you and your spouse would need to purchase separate plans to be covered.

12. Can you be refused coverage?

You may have to wait up to six months for coverage if you have a pre-existing health condition. During this period, the insurer can refuse to cover out-of-pocket expenses. After six months the Medigap policy must cover the pre-existing condition.

The exception to this is if you’ve had continuous health insurance for the six months prior to buying a policy. In this case, the insurance company cannot withhold coverage.

13. Can you be dropped?

As long as you pay premiums, your policy is renewable for the rest of your life. It can only be dropped if you stop paying premiums; lied on your original application; or the company goes bankrupt.

14. Can you cancel?

You can cancel by directly contacting the insurance company.

15. What’s next?

Now that you’ve got the basics covered, you may be ready to explore different offers. To find the best plan for you, shop around and be prepared with a list of questions. Medigap experts have outlined a detailed list of key questions to keep in mind before you speak with a representative.

Assistance Club Summary

The #1 thing to keep in mind: If you plan to enroll don’t wait! When you turn 65, enroll within 6 months of the first day of the month of your birthday or the going gets risky.

Medigap plans can offer a way to keep your health care coverage affordable. By reducing out-of-pocket expenses, these plans keep costs down and can give you peace of mind.

Experts recommend shopping around for different options, as insurance companies can charge different premiums for the same policy.