Frequently Asked Questions on Medigap Insurance or Medicare Supplemental Insurance
Q: What is a Medigap insurance policy?
A: A Medigap insurance policy is a health insurance sold by private insurance companies to fill the "gaps"
in Traditional Medicare Plan coverage. There are 12 standardized policies called "A" through "L". Each plan has a different set of benefits.
Q: Am I eligible for Medigap insurance policy?
A: Open Enrollment
Medigap companies must sell you a policy – even if you have health problems – if you are at least 65 and apply within six months after
enrolling in Medicare Part B. These six months are called your "open enrollment" period. During open enrollment, a company must
allow you to buy any of the Medigap plans it offers. You can use your open enrollment rights more than once during this six-month period.
For instance, you may change your mind about a policy you bought, cancel it, and still have the right to buy any other Medigap policy,
so long as the sale takes place during the six months after you enroll in Medicare Part B.
Although a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before
covering your pre-existing conditions. Pre-existing conditions are conditions for which you received treatment or medical advice from a
physician within the previous six months.
Your right to open enrollment is absolute, even if you wait for several years after you become 65 to enroll in Medicare Part B because of
continued employment or other reasons.
People with disabilities: People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning
the day they enroll in Medicare Part B. This open enrollment right is only applicable to Medigap Plan *A. Certain states may allow you to
apply for other plans. Companies selling Medicare supplement insurance in Texas may not deny you a Plan A policy because you have pre-existing
conditions. Companies are not required to offer the other plans to Texans with disabilities, but they may do so if they wish. During the first
six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 12 plans.
Guaranteed Issue
You may have the right to buy a Medigap policy outside of your open enrollment period if you lose certain types of health coverage.
For people over age 65, the guaranteed issue right applies to Medigap plans A, B, C, F, K, and L. For people under age 65,
this guaranteed issue right applies only to Medigap Plan A, C or F. In general, this right is for 63 days from the date coverage
ends or from the date of notice that coverage will end. Companies may not place any restrictions, such as pre-existing condition
waiting periods or exclusions, on these policies. This is called "guaranteed issue." You must provide proof of the loss of your
health care coverage. Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights,
but they are only eligible for Medigap coverage under Plan *A. This guaranteed issue right is also extended to people on Medicare who
lose Medicaid because of a change in their financial situation.
Q: Does a Medicare Supplement plan replace Original Medicare?
A: Unlike a Medicare Advantage plan, which is an alternative option to Original Medicare, Medicare Supplement plans are purchased in
addition to your Original Medicare benefits.
Q. Are preexisting conditions covered?
A: Yes. Medicare provides full protection from the very first day of coverage. Most Medigap plans dispense with preexisting waiting periods if a
person enrolls when they are first eligible for Medicare.
Q. How much Medigap insurance costs?
A: The cost of insurance depends upon the age of a person on premium due date. For example, in most cases a 65 year old will pay less
for the same plan held by a 75 year old. You can expect to pay $100 - $165 per month for a Medigap plan.
Q. Which Medigap plan is best for me?
A: It depends on your requirements and preferences. You should consider about benefits, cost, your economic situation,
and current health before opting for a plan.
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