Your Original Medicare insurance covers a wide variety of health services, from flu shots to hospital stays to hospice care. But it doesn’t cover everything, and it doesn’t cover all your out-of-pocket costs.
Many services covered by Original Medicare require co-payments, coinsurance and deductibles. You can purchase extra insurance to cover these “gaps” in Medicare. Such insurance is called Medicare Supplement Insurance, or Medigap. Some Medigap policies also provide coverage that Original Medicare doesn’t, like emergency care in a foreign country.
You have to pay for Medigap yourself, and it’s sold through private insurance companies. You can buy it only if you have Original Medicare, not Medicare Advantage, which is managed care provided by private insurers.
Every Medigap policy has to follow federal and state laws designed to protect you. Insurance companies can sell you only a “standardized” Medigap policy identified in most states by the letters A through N. Each standardized policy must offer the same basic benefits, no matter which company sells it.
So beware when you’re shopping for a Medigap policy: Cost is usually the only difference between Medigap policies with the same letter sold by different companies.
There can be big differences in how much various insurers charge for the same coverage.
Here are some of the costs that Medigap policies often cover:
Medigap policies generally don’t cover long-term care (like care in a nursing home), vision or dental, hearing aids, eyeglasses and private‑duty nursing.
The best time to buy a Medigap policy is during your Medigap open enrollment period. This period lasts for six months and begins on the first day of the month in which you’re 65 or older and enrolled in Medicare Part B.
Why is this important? Because during open enrollment, an insurance company can’t refuse to sell you any Medigap policy it offers due to any health problems you may have. Nor can you be charged more based on your health status.
In some cases, however, an insurer can refuse to cover your out-of-pocket costs for pre-existing health conditions for up to six months. After six months, the Medigap policy will cover the pre-existing condition.
Remember, for Medicare‑covered services, Original Medicare will still cover the condition even if the Medigap policy won’t cover your out‑of‑pocket costs. But you’re responsible for the coinsurance or co-payments.
A few other points to keep in mind:
Although some Medigap policies sold in the past cover prescription drugs, Medigap policies sold after Jan. 1, 2006, aren’t allowed to include prescription drug coverage. If you want such coverage, you can join a Medicare Part D prescription drug plan, offered by private companies approved by Medicare.
David Sayen is Medicare’s regional administrator for Arizona, California, Hawaii, Nevada, and the Pacific Territories. You can always get answers to your Medicare questions by calling 800-MEDICARE (800-633-4227).