Medicare Supplement Insurance (also called Medigap) can help you save money by covering some out-of-pocket Medicare costs. These costs can include Medicare copayments, coinsurance and deductibles.
Here is an overview of Medicare Supplement Insurance eligibility requirements, along with some information about how to find the right Medigap plan for you and how to enroll.
There are four main requirements to be eligible for Medicare Supplement Insurance enrollment.
Medicare Supplement Insurance provides coverage for some of the out-of-pocket expenses associated with Original Medicare (Part A and Part B), such as deductibles and coinsurance. You must be enrolled in both parts of Original Medicare in order to apply for a Medigap plan.
Medicare Supplement Insurance is sold by private insurance companies, and the availability of plans can vary from one state to another. You are only eligible to enroll in plans that are offered in the area in which you reside.
MedicareSupplement.com can help you compare plans that are available where you live.
People under 65 years can be eligible for Original Medicare if they have a qualifying condition or disability. But only certain states require insurance companies to sell Medicare Supplement Insurance to people under the age of 65.
The following states require insurance companies to offer at least one Medigap plan to Medicare beneficiaries under 65:
Medicare Advantage plans (Medicare Part C) are an alternative to Original Medicare, offering the same benefits as Medicare Part A and Part B in one single plan.
If you are enrolled in Medicare Advantage, you will not be eligible to sign up for a Medicare Supplement Insurance plan. You must disenroll from your Medicare Advantage plan before you can join a Medigap plan.
|Medicare Supplement Benefits||A||B||C||D||F1||G||K2||L3||M||N4|
|Part A co-insurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|Medicare Part B deductible||✓||✓|
|Medicare Part B excess charges||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
View an image version of this table.
Your Medicare Supplement Insurance plan eligibility can be impacted on when you choose to apply for a plan.
The best time to apply is during your Medigap open enrollment period. Your six-month Medigap open enrollment period begins once you are 65 years old and enrolled in both Part A and Part B of Medicare.
If you sign up for a plan during this period, insurance companies are not allowed to use medical underwriting to determine your premiums. This means that they cannot charge you more for a plan based on your age or your health.
If you apply for a plan outside of your Medigap Open Enrollment Period, the provider may use your health to determine your plan premium rates, and they even reserve the right to deny you Medigap coverage altogether.
There are some special enrollment periods for Medicare Supplement Insurance, though you have to meet specific criteria to qualify for one of these special enrollment periods.
If one of the following situations applies to you, you may qualify for a Medigap special enrollment period:
If you have any further questions about your Medicare Supplement Insurance eligibility and how to enroll in a Medigap plan, you can learn more by visiting Medicaresupplement.com today.
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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
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