About Medicare Supplemental Insurance (Medigap)

June 10, 2020 by  

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Medigap, also known as Medicare Supplement Insurance, is a type of insurance plan which supplements an individual’s current Medicare insurance. Individuals on Medicare are of retirement age, at least 65 years of age according to the most recent minimum age requirements. However because Medicare only covers 80% of the medications, doctor visits, procedures, and additional medical expenses, many people choose to supplement this coverage with additional insurance plans to help them cover out-of-pocket expenses. Medigap is one of the most widely used supplemental insurance plans by individuals who also receive Medicare insurance coverage.


In order to be approved for Medigap plans, you must be enrolled in either part A or part B of the Medicare plans. There is an open enrollment period beginning within 6 months of turning 65 in which you can enroll for Medicare and also have the option at this time to enroll in Medigap as well. If you enroll in Medigap during open enrollment, a medical screening examination is not required, however if you delay enrolling and enroll outside of this time period, you may be subjected to medical screening and will need to receive an attending physician’s statement about your current health.


Medigap coverage is available to some individuals who receive Medicare and are under the age of 65, but the process is more selective and Medigap is not required to enroll anyone over the age of 65. Persons who get Social Security Disability Insurance (SSDI) or have end-stage renal disease (ESRD) are automatically approved for Medicare insurance coverage even if they are under 65 years of age, but even these patients with Medicare must go through a medical screening process before being approved for Medigap supplemental insurance coverage. Much of the eligibility for supplemental insurance under the age of 65 depends on your current medical status, the conditions you receive Medicare for, and what state you live in.


There are a variety of Medigap supplemental insurance plans offered by the Centers for Medicare and Medicaid Services (CMS) The plans you can choose from range from plan A to plan N, each which are sold and administered by private companies. Each plan has a different premium, deductible, and different combination of benefits. Generally, the lower the letter of the alphabet, the more expensive the plan but the more benefits received. So if you are willing to pay more for maximum benefit options, plan A would be your best choice. Medigap supplemental insurance is considered private insurance, therefore each state has the ability to provide different benefits and different rates for their individual plans.

Medigap supplemental insurance plans do offer some form of drug coverage, but only if the individual is enrolled in part A or part B of Medicare. Medicare’s part D plan which is their prescription drug plan can be combined with Medigap, but if the person only has part D, without part A or B, they will not be able to use Medigap benefits. If you have the part D prescription plan under Medicare, you can choose to have a Medigap plan with no prescription drug coverage which may save you money by having a lower premium.

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.

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