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Medigap (Medicare Supplement Insurance)
Policies
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What is a Medigap policy?
Original Medicare pays for many, but not all, healthcare services and supplies.
A Medigap policy, sold by private insurance companies, can help pay some of the
“gaps” that Original Medicare does not cover, such as copayments, coinsurance and
deductibles. Medigap policies do not work with any other type of health insurance,
including Medicare Advantage Plans, employer/union group coverage, Veterans Administration
(VA) benefits or TRICARE. If you have Original Medicare and you buy a Medigap policy,
both plans will pay their share of Medicare-approved amounts for covered healthcare
costs. Some Medigap policies cover certain costs not covered by Original Medicare.
Medicare does not pay any of the costs for you to get a Medigap policy.
Every Medigap policy must follow federal and state laws designed to protect you,
and it must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance
companies can only sell you a standardized Medigap policy identified by letters
A through L. Each standardized Medigap policy must offer the same basic benefits,
no matter which insurance company sells it. Cost is usually the only difference
between Medigap policies sold by different insurance companies. In Georgia, you
may buy another type of Medigap policy called Medicare SELECT which requires you
to use specific hospitals and, in some cases, specific doctors to get full benefits.
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What Are Some Things Not Covered
by Medigap Policies?
Medigap policies do not cover long-term care, vision or dental care, hearing aids,
eyeglasses and private-duty nursing.
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How do insurance companies set prices
for Medigap Policies?
Each insurance company decides how it will set the price or premium for its Medigap
policies. The way they set the price affects how much you pay now and in the future.
Medigap policies can be priced or rated in three ways:
1. Community-rated (also called "No-age-rated") – the same monthly premium is charged
to everyone who has the Medigap policy regardless of age.
2. Issue-age-rated – the premium is based on the age you are when you buy the Medigap
policy.
3. Attained-age-rated – the premium is based on your current age, so your premium
goes up as you get older.
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What Do You Need to Know if You
Want to Buy a Medigap Policy?
- Generally, you must have Medicare Parts A and B.
- You pay a monthly premium for your Medigap policy to the private insurance company
and you pay your monthly Medicare Part B premium.
- A Medigap policy only covers one person. If you and your spouse both want Medigap
coverage, each of you must buy separate Medigap policies.
- It’s important to compare Medigap policies since the costs can vary and may go up
as you get older.
- The best time to buy a Medigap policy is during the 6-month period that begins on
the first day of the month in which you are both age 65 or older and enrolled in
Part B. After this initial enrollment period, your option to buy a Medigap policy
may be limited.
- In Georgia, limited Medigap policies are available to people with Medicare under
age 65.
- If you have Medigap and join a Medicare Advantage Plan, your Medigap policy cannot
be used to pay your Medicare Advantage Plan copayments and deductibles.
- If you already have a Medicare Advantage Plan, it is illegal for anyone to sell
you a Medigap policy unless you are switching back to Original Medicare.
- You have some guaranteed issue rights to purchase a Medigap policy.
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 Call a local GeorgiaCares office
at 1-800-669-8387
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Additional Resources
2010 Medicare & You handbook (PDF 4.02 MB)
2010 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (PDF 555KB)
Office of Insurance and Fire Safety Commissioner
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