Medigap (Medicare Supplement Health Insurance)A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992.
Insurance companies can only sell you a “standardized” Medigap policy. Medigap policies must follow Federal and state laws. These laws protect you. The front of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.”
It's important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost.
You and your spouse must buy separate Medigap policies.Your Medigap policy won't cover any health care costs for your spouse.
Some Medigap policies also cover other extra benefits that aren't covered by Medicare.
You are guaranteed the right to buy a Medigap policy under certain circumstances.
For more information on Medigap policies, you may call 1-800-633-4227 and ask for a free copy of the publication “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” You may also call your State Health Insurance Assistance Program (SHIP) and your State Insurance Department. Phone numbers for these Departments and Programs in each State can be found in that publication.
NEW! The Sale of Individual Market Policies to Medicare Beneficiaries Under 65 Losing Coverage Due to High Risk Pool Closures
The bulletin below sets forth circumstances under which the Secretary has determined that issuers may sell individual market health insurance policies to certain Medicare beneficiaries under age 65 who lose state high risk pool coverage. As this bulletin explains, for sales to these individuals, HHS will not enforce the anti-duplication provisions of section 1882(d)(3)(A) of the Social Security Act (the Act) from January 10, 2014 to December 31, 2015. Accompanying the bulletin are Frequently Asked Questions.
- Sale of Individual Market Policies to Certain Medicare Beneficiaries [PDF, 47KB]
- High Risk Pool FAQs [PDF, 74KB]
- 2008 NAIC Medigap Model Regulation (PDF, 1074 KB) [PDF, 1MB]
- 12/14/98 Federal Register Notice - Civil Money Penalties, Assessments, Exclusions, and Related Appeals Procedures (PDF, 83 KB) [PDF, 82KB]
- Training Library
- 2011 Choosing A Medigap Policy: A Guide To Health Insurance For People With Medicare - Opens in a new window
- Creditable Coverage
- 2009 Medigap Federal Register Notice - Opens in a new window
- Section 1882 of the Social Security Act - Opens in a new window
- National Association of Insurance Commissioners/State Insurance Departments - Opens in a new window
- Page last Modified: 02/02/2014 1:28 PM
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