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As you may know, Original Medicare Part B covers 80 percent of the cost of most services. But what about the remaining 20 percent? Or the other out-of-pocket costs like deductibles or inpatient copayments? This post reviews Medigaps, which can help cover out-of-pocket costs with Original Medicare.

First, what are Medigaps?

Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare. They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain remaining costs after Original Medicare pays first. Medigaps are designed to cover outstanding deductibles, coinsurance, and copayments. If you have a Medigap, you will generally not have any out-of-pocket costs for an inpatient hospital stay or outpatient doctors’ visits if your providers accept Medicare assignment.

Depending on where you live and when you became eligible for Medicare, you have up to ten different Medigap policies to choose from A, B, C, D, F, G, K, L, M, and N. Do note, though, that policies in Wisconsin, Massachusetts, and Minnesota have different names. Each policy offers a different set of standardized benefits, meaning that policies with the same letter offer the same benefits. However, premiums vary from company to company.

Remember that Medigaps only work with Original Medicare. If you have a Medicare Advantage Plan, you cannot buy a Medigap.

It’s important to know the best times to purchase a Medigap policy. 

If you wish to purchase a Medigap policy, you need to find out the best time to buy one in your state. In most states, insurance companies must only sell you a policy at certain times and if you meet certain requirements. If you miss your window of opportunity to buy a Medigap, your costs may go up, your options may be limited, or you may not be able to buy a Medigap at all. Under federal law, you have the right to buy a Medigap policy if you are at least 65 and enrolled in Medicare, and you buy your policy during a protected enrollment period.

There are two kinds of federally protected enrollment periods. The first is your open enrollment period—the six-month period that begins the month you are 65 or older and enrolled in Medicare Part B. The second type of protected enrollment period is when you have guaranteed issue rights. You have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage.

Some states offer additional protections as well. For instance, residents of New York and Connecticut can buy a policy throughout the year, not just at select times. These two states also require insurers to sell to people with Medicare who are under age 65. This is why it can be important to contact your State Health Insurance Assistance Program (SHIP) to learn about your right to purchase a Medigap policy in your state. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Even if you do not have a guaranteed right to buy a Medigap in your state, you may still be able to buy a policy if a company agrees to sell you one. However, know that companies can charge you a higher price because of your health status or other reasons.

Finally, make these considerations when choosing which Medigap to purchase.

You should think about your monthly budget, expenses, and health care needs when considering if a Medigap is the right choice for you and, if so, which policy best meets your needs. Here are some questions to keep in mind:

  • Am I enrolling while I am in my open enrollment period? If not, do I have a guaranteed issue right?
  • What is the Medigap policy’s monthly premium? How are premiums in my state set?
  • Does the policy impose a waiting period before covering services related to pre-existing conditions?
  • How do my costs and provider access compare with a Medigap vs. a Medicare Advantage Plan in my state?

Remember to keep track of who you spoke with, when you spoke with them, and the outcome of the call. For help comparing Medigap policies, you can call your local SHIP. Find your SHIP by using our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Still have questions?   

Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

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