Many retired individuals rely on the federal Medicare program to cover health care expenses. Medicare doesn't cover everything, though, which means you will have out-of-pocket expenses or you'll need to purchase supplemental Medicare insurance, commonly called "Medigap" insurance. Numerous plans are available from which to choose. It's important that you understand the level of coverage each offers and when you are eligible to purchase this insurance.
Medigap Insurance Plans Not Administered by the Government
The first thing to understand about Medigap insurance is that any coverage you purchase is separate from the coverage the federal government provides through Medicare. Supplemental policies are offered by private insurance companies. State governments oversee these insurers. In the majority of states, only 11 standardized Medigap plans can be offered. Insurance companies are required to identify these policies as "Medicare Supplement Insurance."
Medigap Plans Are the Same
All 11 Medigap policies are standardized and identified by a letter. For example, if you are interested in Medigap Plan F, every insurance company offering that policy will provide the same minimum coverage. Additional benefits under each plan can vary, depending on the insurance company.
Deadlines May Apply
You are eligible to obtain Medigap insurance only if you are enrolled in Part B Medicare coverage. You can't purchase a Medigap policy if you are enrolled in a Part C Medicare Advantage Plan. If you are eligible for the supplemental coverage, the policy must be purchased during your open enrollment period. The enrollment period is generally six months, beginning on the day you turn age 65 and enrolled in Medicare Part B, although some exceptions apply.
Federal Law Limits Denials
In 47 states, Medicare recipients are guaranteed the right to purchase Medigap coverage from private insurers in situations when their medical coverage changes. For example, you can't be denied Medigap coverage if you currently participate in a Medicare Advantage Plan that being terminated because the insurer no longer participates in Medicare for some reason. Three other states (Massachusetts, Wisconsin, and Minnesota) also extend guaranteed rights to residents, although the rules in those states differ slightly.
A Medicare Lawyer Can Help
The law surrounding Medicare and supplemental Medicare insurance is complicated. Plus, the facts of each case are unique. This article provides a brief, general introduction to the topic. We hope you found it useful. For more detailed, specific information, please contact a Medicare lawyer.