Medicare Supplement

Medicare Supplement is private Medicare health insurance, also known as MediGap, that helps pay for medical costs not covered by Original Medicare. You could end up with unexpected high medical bills since there is a 20% gap between what Original Medicare covers and what you will be responsible for if you do not have other Medicare coverage such as Medicare Supplement, Medicare Advantage, or Medi-Cal. MediGap insurance generally helps pay for 20% of the following health care costs:

  • Copayments
  • Coinsurance
  • Deductibles

After you sign up for Original Medicare (Parts A & B) and buy a Medicare Supplement policy, like Plan G or Plan N, Original Medicare pays its 80% share of your Medicare-covered services before a your Supplement insurance pays its 20% share.

About Medicare Supplement Plans

  1. Medicare Supplement (MediGap) plans are offered by private insurance companies.
  2. You must have Medicare Parts A and B to apply for a Medicare Supplement plan.
  3. Medicare Supplement plans do not replace Original Medicare benefits.
  4. There is a monthly premium for Medicare Supplement plans.
  5. Each Medicare Supplement plans covers only one person, no exceptions.
  6. Medicare Supplement plans are guaranteed renewable as long as you pay the monthly payment.
  7. Medicare Supplement plans sold after January 1, 2006 are not allowed to cover prescribed medications.
  8. Medicare Supplement and Part D plans purchased from the same company usually require separate monthly payments.

Medicare Supplement Open Enrollment

You can buy a MediGap policy without medical underwriting effective the first day of the month that you turn 65 as long as your Part B is active. If you are still working after age 65 and have group health insurance through your employer or union, your initial Medicare Supplement Open Enrollment Period will not start until you are enrolled in both Original Medicare Part A and Part B whether you stop working or not.

Under federal law, you have a six-month Medicare Supplement Open Enrollment Period that begins the month you are 65 or older and actively enrolled in Medicare Parts A & B. Supplement insurance companies must allow you to buy a policy at the best available rate regardless of your health status and cannot deny you coverage during your initial Medicare Supplement Open Enrollment Period. The best available rate depends on several factors, including your age, gender, whether you smoke, your marital status, and where you live. Private insurance companies are not required to sell Medicare Supplement policies to individuals younger than 65 years of age.

Guarantee Issue Rights

  • The applicant has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that is ending.
  • The applicant has Original Medicare, has a Medicare Select policy and moves out of the Select plan’s service area.
  • The applicant is losing coverage due to their Medicare Supplement insurance company’s insolvency.
  • The applicant has cancelled their Medicare Supplement policy because the company has not followed rules, or has misled the applicant.
  • The applicant was enrolled in a Medicare Advantage plan and that plan is leaving the Medicare program or stops service in the applicant’s area, or the applicant moves out of the plan’s service area (applicant must switch back to original Medicare).
  • The applicant was enrolled in a Medicare Advantage plan and the applicant leaves the plan because the insurance company has not followed rules, or has misled the applicant.
  • The applicant was enrolled in a Medicare Advantage plan and the applicant decided to switch to original Medicare within the first year of joining a Medicare Advantage plan when first eligible for Medicare Part A at age 65.
  • The applicant was enrolled in a Medicare Advantage plan and the applicant dropped their Medicare supplement policy to join a Medicare Advantage plan for the first time, has been on the Medicare Advantage plan less than one year and wants to switch back.

Note: The medical underwriting department of each insurance company will determine your eligibility for “Guarantee Issue” based on information provided on your application. Be sure to keep a copy of any letters, notices, postmarked envelopes, and claim denials in case you need proof that you lost or ended health coverage. MediGap insurers may require these documents before they sell you a policy.