What no-one tells you about Medigap Insurance


Navigating the Medigap Insurance waters is often complex and hard to navigate. The different types of insurance and when to enroll can be confusing at best. In this post, we cover the top things to look for with researching and selecting Medigap Insurance.

Medigap policies are sold by private insurance companies and help pay some of the health care costs Original Medicare doesn’t include in their coverage. These costs may include, Medicare deductible coinsurance and some extra benefits. If you’re interested in enrolling, you only have a one-time six-month Medigap open enrollment period that starts the first month you’re 65 and enrolled in Part B. No matter what your health status is currently, you have a guaranteed right to enroll in any state.

What is Supplemental Insurance?

According to Medicare.gov, Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments
  • Coinsurance
  • Deductibles

Are you thinking of traveling outside of the United States once officials have deemed it safe to travel? Some Medigap policies also cover you outside of the United States. Medicare.gov also provides a list of everything you need to know about Medigap insurance to help save you time when researching options.

Things to know about Medigap Insurance

  • You must be enrolled in Medicare Part A and Part B.
  • A Medigap policy differs from a Medicare Advantage Plan.  Medicare Advantage plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
  • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  • Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  • A Medigap policy only covers a single person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies
  • Beware of scams. It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan unless you’re switching back to Original Medicare.
  • You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.

Do you live in Massachusetts, Minnesota, or Wisconsin? Be mindful that Medigap policies may be standardized in different ways compared to other states.

Does Medicare Supplement Coverage Apply to Assisted Living?

The short answer is no. Medicare Supplement Coverage does not apply to Assisted Living costs. However, Medicare supplement coverage can cover certain expenses you may accumulate during your stay and an assisted living facility. For example, if you need durable medical equipment, such as a CPAP machine for respiratory assistance. The costs for the CPAP machine would be at least partially covered.