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What is Medicare Gap?

Medigap is a supplemental insurance you can get on top of your Medicare Parts A & B. Medicare covers many healthcare costs, but it does not pay for every expense. You are responsible for these costs, sometimes called the “gaps” in Medicare coverage. Medigap helps pay for the gaps, much like retiree insurance.

What are the current gaps in Medicare?

How does Medigap work?

You can buy Medigap from private insurance companies in your state. There are 11 different standard Medigap plans that can be sold in most states. The 11 standard plans are labeled A-D, F, high-deductible F, G and K-N. Each of these plans covers different services.

I live in Massachusetts, Minnesota or Wisconsin. What are my Medigap options?

These states have their own standardized plans you can buy.

To compare plans, visit the Medigap Online Comparison Tool. Compare plans now.

What doctors can I see with Medigap?

With Medigap, you can see any doctor, whether the doctor accepts Medicare assignment or not.

  • If your doctor “accepts assignment,” meaning he or she agrees to be paid the Medicare-approved amount for a service, your Medigap insurance company usually pays your doctor directly.
  • If your doctor does not accept Medicare assignment, you may have to send claims to your insurance company and pay the doctor yourself.

Note, however, that Medigap plans generally do not pay for care received outside of the United States, except for medically necessary emergency care that occurs during the first 60 days of your trip.

What are my rights with Medigap?

Do you have a specific scenario and want to know your rights when buying a Medigap policy? Learn about your rights.

People who purchase a Medigap policy have certain rights:

  • Free look periods
  • Pre-existing condition wait periods
  • Guaranteed issue rights
  • Renewals

These rights can protect you from being denied coverage. They also can protect you from having to keep a plan that is not right for you. If you are thinking about buying a Medigap plan, or if you already have one, keep these tips in mind.

Can I change my mind after purchasing my policy?

By law, when you buy a Medigap policy, you have a 30-day “free look” or trial period. If you change your mind within 30 days of the day your policy started, you can cancel it and get a refund.

If you are switching Medigap plans, do not cancel your first policy until after your free look period is up. You may have to pay two premiums for 1 month. But you will be able to change back to your first plan if you need to.

Will Medigap cover me for a pre-existing condition?

If you have a pre-existing condition and do not have a minimum of 6 months creditable coverage when you enroll in Medigap, your provider can impose a “pre-existing condition waiting period” and refuse to cover your prior medical conditions for up to 6 months. This period depends on how many months you did not have creditable coverage. Most forms of health coverage count as “creditable” if there is no break in coverage for more than 63 days.

A prior or pre-existing condition is a condition or illness you were diagnosed with or treated for before your new healthcare coverage began.

Calculating pre-existing wait periods

So, for example, if you had creditable coverage for only 2 months prior to enrolling in Medigap, your pre-existing wait period would be only 4 months, instead of the standard 6-month waiting period.

How do I avoid pre-existing condition wait periods?

The best way to avoid or shorten pre-existing condition waiting periods is to make sure that you:

  • Do not have a lapse of current coverage for more than 63 days
  • Confirm that your current policy qualifies as creditable coverage
  • Enroll in Medigap as soon as you are eligible during your Open Enrollment Period
  • Keep your current coverage until you have received confirmation from your new policy

Do I have the right to buy a Medigap policy outside of Open Enrollment?

In some situations, you have the right to buy a Medigap policy outside of your Medigap Open Enrollment Period. These rights are called “Medigap protections” or guaranteed issue rights because the law says that insurance companies must sell or “issue” you a Medigap policy even if you have health problems. And this way, if you lose your current insurance, such as coverage through your job or a Medicare Advantage plan, you get the chance again to buy a Medigap policy.

In most cases, you must buy your new Medigap plan within 63 days of the time your previous health coverage ends. In these cases, you will not have to wait to get covered.

Guaranteed Issue Rights: Medigap enrollment for special situations

Do I have to re-enroll in my Medigap plan every year?

As long as you pay your Medigap premium, the company renews your policy automatically each year. This means that your coverage continues year after year as long as you pay your bill. Your policy is what is called “guaranteed renewable.”

The rights in this section are from Federal law. Many states provide additional Medicare rights. Protect yourself by keeping copies of any letters, notices, emails and claim denials from your Medigap insurance company that have your name on them.

Get in contact with your state about Medigap rules and rights with the state insurance department locater. Contact your state.

Keep any postmarked envelopes that these papers came in. Also, keep any papers that prove the date you bought your new Medigap policy. You may need this paperwork later if you have a problem with your plan.

What is Medicare SELECT?

Medicare SELECT policies are sold in some states. They are like regular Medigap policies, with one exception: you may be required to use hospitals and doctors in their network, except in an emergency. A plan can choose to make any Medigap plan a Medicare SELECT plan. They often cost less than other Medigap policies.

What questions should I ask my state insurance department?

  • Does the law require Medigap insurance companies to sell to people who are under age 65 and have disabilities?
  • What is the most number of months a Medigap insurer can make me wait for coverage of a pre-existing condition?
  • Are there Medicare SELECT policies in my state? If so, is my doctor in the provider network?
  • Which companies are licensed to sell Medigap in my state?
  • What plans are available to me (if I live in Massachusetts, Minnesota or Wisconsin)?

Once you purchase a Medigap plan, your first resource should be your Medigap insurance company. Check your plan’s benefits booklet for contact information to get details about coverage and rights.

Next steps:

Explore How to Compare Plans or Learn About Medigap Costs