2024
Choosing a Medigap Policy:
A Guide to Health Insurance for People with Medicare
CENTERS FOR MEDICARE & MEDICAID SERVICES
This ocial government guide has
important information about:
• Medicare Supplement Insurance
(Medigap)
• What Medigap policies cover
• Your rights to buy a Medigap policy
• How to buy a Medigap policy
Developed jointly by the Centers for Medicare & Medicaid Services (CMS)
and the National Association of Insurance Commissioners (NAIC)
Important information about this guide
e information in this guide describes the Medicare Program at the time this guide
was printed. Changes may occur aer printing. Visit Medicare.gov, or call
1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY users
can call 1‑877‑486‑2048.
“2024 Choosing a Medigap Policy: A Guide to Health Insurance for People with
Medicare” isn’t a legal document. Ocial Medicare Program legal guidance is contained
in the relevant statutes, regulations, and rulings.
This product was produced at U.S. taxpayer expense.
3
Table of Contents
Medicare Basics 5
What’s Medicare? .....................................................6
e dierent parts of Medicare .........................................6
Your Medicare coverage options ........................................7
Medicare and the Health Insurance Marketplace® ..........................8
Find more information about Medicare ..................................8
Medigap Basics 9
What’s Medigap? .....................................................9
What Medigap policies cover ..........................................10
What Medigap policies don’t cover......................................12
Types of insurance that aren’t Medigap policies ...........................12
What types of Medigap policies can insurance companies sell? ..............12
What do I need to know if I want to buy a Medigap policy?.................13
When's the best time to buy a Medigap policy? ...........................14
What happens if I don’t buy a Medigap policy when I’m rst eligible? ........15
How do insurance companies set prices for Medigap policies? ..............16
What this pricing may mean for you .................................... 17
Comparing Medigap costs ............................................18
What’s Medicare SELECT? ............................................19
How does Medigap help pay my Medicare Part B costs? ...................19
Your Right to Buy a Medigap Policy 21
What are guaranteed issue rights? ......................................21
When do I have guaranteed issue rights? ................................21
Can I buy a Medigap policy if I lose my health coverage? ..................24
Steps to Buying a Medigap Policy 25
Step‑by‑step guide to buying a Medigap policy ...........................25
If You Already Have a Medigap Policy 31
Switching Medigap policies ...........................................32
Losing Medigap coverage .............................................36
Medigap policies and Medicare drug coverage (Part D) ....................36
Section 1:
Section 2:
Section 3:
Section 4
Section 5:
4
Table of Contents
Medigap Policies for People with a Disability or ESRD 39
Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41
Massachusetts benets ...............................................42
Minnesota benets ...................................................43
Wisconsin benets ...............................................44
More Information 45
Where to get more information ........................................45
How to get help with Medicare and Medigap questions ....................46
State Health Insurance Assistance Program (SHIP) and State Insurance
Department .......................................................47
Denitions 49
Where words in BLUE are dened ......................................49
Section 6:
Section 7:
Section 8:
Section 9:
6
Section 1: Medicare Basics
What’s Medicare?
Medicare is health insurance for people 65 or older, certain people who are under 65 with
disabilities, and people of any age with End‑Stage Renal Disease (ESRD) (permanent
kidney failure requiring dialysis or a kidney transplant).
The dierent parts of Medicare
e dierent parts of Medicare help cover specic services.
Part A (Hospital Insurance)
Helps cover:
• Inpatient care in hospitals
• Skilled nursing facility care
• Hospice care
• Home health care
Part B (Medical Insurance)
Helps cover:
• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment (like wheelchairs, walkers,
hospital beds, and other equipment)
• Many preventive services (like screenings, shots or vaccines,
and yearly “Wellness” visits)
Part D (Drug coverage)
Helps cover:
Cost of prescription drugs (including many recommended shots
or vaccines)
Plans that oer Medicare drug coverage (Part D) are run by
private insurance companies that follow rules set by Medicare.
7
Section 1: Medicare Basics
Your Medicare coverage options
When you rst sign up for Medicare, and during certain times of the year, you can choose
how you get your Medicare coverage. ere are 2 main ways to get Medicare:
Original Medicare
• Includes Medicare Part A (Hospital
Insurance) and Part B (Medical Insurance).
• You can join a separate Medicare drug plan
to get Medicare drug coverage (Part D).
• You can use any doctor or hospital that takes
Medicare, anywhere in the U.S.
• To help pay your out‑of‑pocket costs
in Original Medicare (like your 20%
coinsurance), you can also shop for and buy
supplemental coverage.
Part A
Part B
You can add:
Part D
You can also add:
Supplemental
coverage
is includes Medicare Supplement
Insurance (Medigap). Or, you can use
coverage from a former employer or
union, or Medicaid.
Medicare Advantage
(also known as Part C)
• A Medicare‑approved plan from a private
company that oers an alternative to
Original Medicare for your health and drug
coverage. ese "bundled" plans include
Part A, Part B, and usually Part D.
• In many cases, you can only use doctors
who are in the plan’s network.
• In many cases, you may need to get approval
from your plan before it covers certain
drugs or services.
• Plans may have lower or higher
out‑of‑pocket costs than Original Medicare.
You may also have an additional premium.
• Plans may oer some extra benets that
Original Medicare doesn’t cover—like
certain vision, hearing, and dental services.
Part A
Part B
Most plans include:
Part D
Some extra benets
Some plans also include:
Lower out-of-pocket costs
8
Section 1: Medicare Basics
Medicare and the Health Insurance Marketplace®
Even if you have Marketplace coverage (or other individual health coverage that
isn’t based on current employment), you should generally sign up for Medicare
when you’re rst eligible to avoid the risk of a delay in Medicare coverage and the
possibility of a Medicare late enrollment penalty.
You can keep your Marketplace plan without penalty until your Medicare coverage
starts. Once you’re considered eligible for premium‑free Part A, or already have
Part A with a premium, you won’t qualify for help from the Marketplace to pay
your Marketplace plan premiums or other medical costs. If you continue to get help
paying for your Marketplace plan premiums aer that point, you may have to pay
back some or all of the help you got when you le your federal income taxes.
Visit HealthCare.gov to connect to the Marketplace in your state and learn more.
To nd out how to end your Marketplace plan when you become eligible for
Medicare to avoid a gap in coverage, visit HealthCare.gov/medicare/changing‑
from‑marketplace‑to‑medicare. You can also call the Marketplace Call Center at
1‑800‑318‑2596. TTY users can call 1‑855‑889‑4325.
Note: Medicare isn’t part of the Marketplace. e Marketplace doesn’t oer
Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or
Medicare drug coverage (Part D).
Find more information about Medicare
To learn more about Medicare:
• Visit Medicare.gov.
• Read your “Medicare & You” handbook.
• Get free, personalized counseling from your State Health Insurance Assistance
Program (SHIP).
• Call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
Health Insurance Marketplace® is a registered service mark of the U.S. Department of
Health & Human Services.
9
SECTION
Medigap Basics
2
What’s Medigap?
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from
a private health insurance company to help pay your share of out‑of‑pocket
costs in Original Medicare, like copayments, coinsurance, and deductibles.
Generally, you must have Original Medicare to buy a Medigap policy.
Some Medigap policies cover services that Original Medicare doesn’t cover,
like emergency medical care when you travel outside the U.S. (foreign
travel emergency care). Medigap policies don’t cover your share of the costs
under other types of health coverage, including Medicare Advantage Plans,
stand‑alone Medicare drug plans, employer/union group health coverage,
Medicaid, or TRICARE.
If you have a Medigap policy and get care, Medicare will pay its share of the
Medicare‑approved amount for covered health care costs. en, your Medigap
policy will pay its share. Medicare doesn’t pay any of the costs of buying a
Medigap policy.
A Medigap policy is dierent from a Medicare Advantage Plan (Part C).
A Medicare Advantage Plan is another way to get your Medicare coverage
besides Original Medicare, while a Medigap policy only helps pay for the costs
that Original Medicare doesn’t cover.
Insurance companies generally can’t sell you a Medigap policy if you have
coverage through a Medicare Advantage Plan or Medicaid.
Every Medigap policy must follow federal and state laws designed to protect
you, and policies must be clearly identied as “Medicare Supplement
Insurance.” All Medigap policies are standardized. is means, policies
with the same letter oer the same basic benets no matter where you live
or which insurance company you buy the policy from. ere are 10 dierent
types of Medigap plans oered in most states, which are named by letters:
A–D, F, G, and K–N. In Massachusetts, Minnesota, and Wisconsin, Medigap
policies are standardized in a dierent way.
Words in blue
are dened on
pages 49–50.
10
Section 2: Medigap Basics
What Medigap policies cover
e information on page 11 gives you a snapshot of the standardized Medigap plans
available. You can also nd out which insurance companies sell Medigap policies in
your area by visiting Medicare.gov/medigap‑supplemental‑insurance‑plans.
If you need help comparing and choosing a policy, call your State Health Insurance
Assistance Program (SHIP) for help.
• All insurance companies that sell Medigap policies must oer at least Medigap
Plan A. If they want to oer more policies, they must also oer either Plan C
or Plan F to people who were eligible for Medicare before January 1, 2020, but
haven’t yet enrolled. People new to Medicare on or aer January 1, 2020 have the
right to buy Plan D or G instead of Plan C or F. Not all types of Medigap policies
may be available in your state.
• Since January 1, 2020, Medigap plans sold to people new to Medicare can no longer
cover the Part B deductible. Because of this, Plans C and F aren’t available to
people new to Medicare on or aer January 1, 2020.
– If you already have either of these two plans (or the high deductible version
of Plan F) or you were covered by one of these plans before January 1, 2020,
you’ll be able to keep your plan. If you were eligible for Medicare before
January 1, 2020, but haven’t yet enrolled, you may be able to buy one of these
plans.
– For this situation, people new to Medicare are people who turned 65 on
or aer January 1, 2020, and people who get Medicare Part A (Hospital
Insurance) on or aer January 1, 2020.
• Plans D and G with coverage starting on or aer June 1, 2010, have dierent
benets than Plans D or G bought before June 1, 2010.
• Plans E, H, I, and J are no longer sold, but if you already have one, you can
generally keep it.
In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in
a dierent way. (Go to pages 42–44.) In some states, you may be able to buy another
type of Medigap policy called Medicare SELECT. ese are standardized plans that
may require you to use hospitals and, in some cases, doctors within its network to be
eligible for full benets. (Go to page 19.)
11
Section 2: Medigap Basics
Medicare Supplement Insurance (Medigap) Plans
Benets A B C D
F*
G* K L M N
PartA coinsurance and
hospital costs up to an
additional 365 days aer
Medicare benets are used
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
PartB coinsurance or
copayment
✓ ✓ ✓ ✓ ✓ ✓
50% 75%
✓ ✓
***
Blood benet (rst 3 pints)
✓ ✓ ✓ ✓ ✓ ✓
50% 75%
✓ ✓
PartA hospice care
coinsurance or copayment
✓ ✓ ✓ ✓ ✓ ✓
50% 75%
✓ ✓
Skilled nursing facility care
coinsurance
X X
✓ ✓ ✓ ✓
50% 75%
✓ ✓
PartA deductible X
✓ ✓ ✓ ✓ ✓
50% 75% 50%
✓
PartB deductible X X
✓
X
✓
X X X X
PartB excess charge X X X X
✓ ✓
X X X X
Foreign travel emergency
(up to plan limits)
X X 80% 80% 80% 80% X X 80% 80%
Out‑of‑
pocket limit
in 2024**
$7,060 $3,530
is shows basic information about the dierent benets Medigap plans cover.
* Plans F and G oer a high‑deductible plan in some states (Plan F isn’t available to people new to Medicare
on or aer January 1, 2020.) If you get the high‑deductible option, you must pay for Medicare‑covered
costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,800 in 2024 before
your policy pays anything, and you must also pay a separate deductible ($250 per year) for foreign travel
emergency care.
**Plans K and L show how much they’ll pay for approved services before you meet your out‑of‑pocket
yearly limit and Part B deductible ($240 in 2024). Aer you meet them, the plan will pay 100% of your costs
for approved services for the rest of the calendar year.
*** Plan N pays 100% of the costs of Part B services, except for a copayment of up to $20 for some oce
visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
✓ = e plan covers 100% of this benet
X = e plan doesn’t cover this benet
% = e plan covers that percentage of this benet,
and you’re responsible for the rest.
12
Section 2: Medigap Basics
What Medigap policies don’t cover
Medigap doesn’t cover everything. Medigap policies generally don’t cover:
• Long‑term care (like non‑skilled care you get in a nursing home)
• Vision or dental care
• Hearing aids
• Eyeglasses
• Private‑duty nursing
Types of insurance that aren't Medigap policies
• Medicare Advantage Plans (also known as Part C)
• Medicare drug plans (Part D)
• Medicaid
• Employer group health plans (including Federal Employees Health Benets (FEHB)
Program, retiree or COBRA coverage), or union plans
• TRICARE
• Veterans’ benets
• Long‑term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans
What types of Medigap policies can insurance companies sell?
In most cases, Medigap insurance companies can sell you only a standardized
Medigap policy. If you live in Massachusetts, Minnesota, or Wisconsin, go to
pages 42–44.
Insurance companies that sell Medigap policies don’t have to oer every Medigap
plan. Each insurance company decides which Medigap plans it wants to sell, although
federal and state laws might aect which ones they can oer.
In some cases, an insurance company must sell you a Medigap policy if you want one,
even if you have health problems. You’re guaranteed the right to buy a Medigap policy
during certain times:
• When you’re in your Medigap Open Enrollment Period (pages 14 –15)
• If you have a guaranteed issue right (pages 21–23)
You may be able to buy a Medigap policy at other times, but the insurance company
can deny you a Medigap policy based on your health. Also, in some cases, it may be
illegal for the insurance company to sell you a Medigap policy.
13
Section 2: Medigap Basics
What do I need to know if I want to buy a Medigap policy?
• You can only buy Medigap if you have Original Medicare. Generally, that
means you have to sign up for Medicare Part A (Hospital Insurance) and Part B
(Medical Insurance) before you can buy a Medigap policy.
• If you have a Medicare Advantage Plan but are planning to return to Original
Medicare, you can apply for a Medigap policy before your coverage ends. e
Medigap insurance company can sell it to you as long as you’re leaving the
Medicare Advantage Plan. Ask that the new Medigap policy start when your
Medicare Advantage Plan enrollment ends, so you’ll have continuous health
coverage.
• You pay the private insurance company a monthly premium for your Medigap
policy in addition to the monthly Part B premium you pay to Medicare.
• A Medigap policy only covers one person, so if you and your spouse both want
Medigap coverage, you each have to buy your own policy.
• When you have your Medigap Open Enrollment Period, you can buy any
Medigap policy sold in your state from any insurance company that’s licensed in
your state to sell one.
• Any new Medigap policy issued since 1992 is guaranteed renewable even if you
have health problems. is means the insurance company can’t cancel your
Medigap policy as long as you stay enrolled and pay the premium.
• You may have additional rights under state law.
• e premium amount is the only dierence between policies with the same plan
letter sold by dierent companies. ere can be big dierences in the premiums
that dierent insurance companies charge for the same coverage, so be sure you
compare Medigap plans with the same letter (for example, compare Plan A from
one company with Plan A from another company).
• Although some Medigap policies sold in the past covered prescription drugs,
Medigap plans sold aer 2005 don’t include prescription drug coverage. If you want
prescription drug coverage, you can join a separate Medicare drug plan (Part D).
(Go to pages 6–7.) To learn about Medicare drug coverage, visit Medicare.gov, or
call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
14
Section 2: Medigap Basics
When's the best time to buy a Medigap policy?
Your best time to buy a Medigap policy is during your Medigap Open Enrollment
Period. is is a one‑time enrollment period; it doesn’t repeat every year. Your 6‑
month Medigap Open Enrollment Period starts the rst month you have Medicare
Part B and you’re 65 or older. Some states have additional Open Enrollment Periods,
including those for people under 65. If you’re under 65 and have Medicare because
of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the
Medigap policy you want, or any Medigap policy, until you turn 65. (Go to page 39
for more information.)
During the Medigap Open Enrollment Period, you:
• Can enroll in any Medigap policy. An insurance company can't refuse to sell you
any Medigap policy it oers.
• Will generally get better prices and more choices among policies. An insurance
company can’t charge you more for a Medigap policy than they can charge
someone with no health problems.
• Can buy any Medigap policy sold in your state. An insurance company can’t use
medical underwriting to decide whether to accept your application—they can’t
deny you coverage due to pre‑existing health problems.
• Don’t have to wait for coverage to start. An insurance company can’t make you
wait, except for coverage related to a pre‑existing condition.
A pre‑existing condition is a health problem you have before the date a new
insurance policy starts. In some cases, the Medigap insurance company can
refuse to cover your out of pocket costs for these pre‑existing health problems for
up to 6 months. is is called a “pre‑existing condition waiting period.” Aer 6
months, the Medigap policy will cover the pre‑existing condition.
Coverage for a pre‑existing condition can only be excluded if the condition was
treated or diagnosed within 6 months before your Medigap policy coverage
starts. is is called the “look back period.”
Remember: Original Medicare will still cover the condition for Medicare‑covered
services, even if the Medigap policy won’t, but you’re responsible for the Medicare
coinsurance or copayment.
• Can avoid or shorten waiting periods for a pre‑existing condition if you buy
a Medigap policy to replace certain kinds of health coverage that counts as
creditable coverage.
Creditable coverage is generally any other health coverage you recently had before
applying for a Medigap policy. If you’ve had at least 6 months of continuous prior
creditable coverage, the Medigap insurance company can’t make you wait before
it covers your pre‑existing condition.
15
Section 2: Medigap Basics
When's the best time to buy a Medigap policy? (continued)
Many types of health care coverage can count as creditable coverage for
Medigap policies, but they’ll only count if your break in coverage was no
more than 63 days.
Your Medigap insurance company can tell you if your previous coverage will
count as creditable coverage for this purpose. You can also call your State
Health Insurance Assistance Program (SHIP).
If you buy a Medigap policy when you have a guaranteed issue right (also
called “Medigap protection”), the insurance company must cover all your
pre‑existing health conditions without a waiting period (called the pre‑
existing condition waiting period). Go to pages 21–23 for more information
about guaranteed issue rights.
What happens if I don't buy a Medigap policy when I'm
rst eligible?
Outside of your Medigap Open Enrollment Period:
• You may have to pay more for a policy.
• Fewer policy options may be available to you.
• ere’s no guarantee that an insurance company will sell you a Medigap
policy if you don’t meet their medical underwriting requirements. ey
may deny you a policy unless you have a guaranteed issue right (eligible
situations are listed on pages 22–23).
It’s important to understand that your Medigap rights may depend on when
you choose to sign up for Medicare Part B. If you’re 65 or older, your one‑
time Medigap Open Enrollment Period begins when you sign up for Part B,
and it can’t be changed or repeated.
In most cases, it makes sense to sign up for Part B and buy a Medigap policy
when you’re rst eligible for Medicare, because otherwise you might have to
pay a Part B late enrollment penalty or miss your 6‑month Medigap Open
Enrollment Period. However, there are exceptions if you have employer
coverage.
16
Section 2: Medigap Basics
What happens if I don't buy a Medigap policy when I'm rst
eligible? (continued)
Employer coverage
If you have group health coverage through an employer or union, because either
you or your spouse is currently working, you may want to wait to sign up for Part
B. Benets based on current employment oen provide coverage similar to Part B,
so you wouldn’t want to pay for Part B before you need it, and your Medigap Open
Enrollment Period might expire before a Medigap policy would be useful.
When the employer coverage ends, you’ll have a chance to sign up for Part B
without a late enrollment penalty, which means your Medigap Open Enrollment
Period will start when you’re ready to take advantage of it. If you or your spouse is
still working, and you have coverage through an employer, contact your employer
or union benets administrator to nd out how your insurance works with
Medicare. Go to page 24 for more information.
How do insurance companies set prices for Medigap
policies?
Each insurance company decides how it’ll set the price, or premium, for its
Medigap policies. e way they set the price aects how much you pay now and
in the future. Each Medigap policy can be priced or “rated” in one of 3 ways:
1. Community‑rated (also called “no‑age‑rated”)
2. Issue‑age‑rated (also called “entry‑age‑rated”)
3. Attained‑age‑rated
17
Section 2: Medigap Basics
How do insurance companies set prices for Medigap policies? (continued)
Type of
pricing
Community-
rated
(also called
“no-age-
rated”)
How it’s
priced
What this pricing may
mean for you
Examples *
Generally the
same premium
is charged
to everyone,
regardless
of age or gender.
e premium is
based on the age
you are when
you buy the
Medigap policy.
e premium is
based on your
current age, so
your premium
goes up as you
get older.
Your premium isn’t based on
your age. Premiums may go
up because of ination and
other factors but not because
of your age.
Premiums are lower for people
who buy at a younger age and
won’t change as you get older.
Premiums may go up because
of ination and other factors
but not because of your age.
Premiums are low for
younger buyers but go up
as you get older. ey may
be the least expensive at
rst, but they can eventually
become the most expensive.
Premiums may also go up
because of ination and
other factors.
Mr. Smith is 65. He buys a Medigap
policy and pays a $165 monthly
premium.
Mrs. Perez is 72. She buys the same
Medigap policy as Mr. Smith. She also
pays a $165 monthly premium.
Mr. Han is 65. He buys a Medigap
policy and pays a $145 monthly
premium.
Mrs. Wright is 72. She buys the same
Medigap policy as Mr. Han. Since she
is older when she buys it, her monthly
premium is $175.
Mrs. Anderson is 65. She buys a
Medigap policy and pays a $120
monthly premium. Her premium will
go up each year:
• At 66, her premium goes up to $126.
• At 67, her premium goes up to $132.
Mr. Dodd is 72. He buys the same
Medigap policy as Mrs. Anderson.
He pays a $165 monthly premium.
His premium is higher than Mrs.
Anderson’s because it’s based on his
current age. Mr. Dodd’s premium will
go up each year:
• At 73, his premium goes up to $171.
• At 74, his premium goes up to $177.
Issue-age-
rated (also
called “entry
age-rated”)
Attained-age-
rated
*e examples show how your age aects your premiums, and why it’s important to check how much the Medigap policy
will cost you now and in the future. e amounts in the examples aren’t actual costs. Other factors like where you live,
medical underwriting, and discounts can also aect the amount of your premium.
18
Section 2: Medigap Basics
Comparing Medigap costs
e cost of Medigap policies can vary widely depending on the insurance company,
the plan, and where you live. e benets in each lettered plan are the same, no
matter which insurance company sells it. e premium (an amount you pay each
month) is the only dierence between policies with the same plan letter sold by dierent
companies. ere can be big dierences in the premiums that dierent insurance
companies charge for the same coverage.
As you shop for a Medigap policy, be sure you’re comparing the same lettered plan
oered by dierent insurance companies. For example, compare Plan G from one
company with Plan G from another company. Although this guide can’t give actual costs
of Medigap policies, you can get this information by calling insurance companies or
your State Health Insurance Assistance Program (SHIP).
You can nd out which insurance companies sell Medigap policies in your area by
visiting Medicare.gov/medigap‑supplemental‑insurance‑plans.
e cost of your Medigap policy may also depend on whether the insurance company:
• Oers discounts (like discounts for women, non‑smokers, or married people;
discounts for paying yearly; discounts for paying your premiums using electronic
funds transfer; or discounts for multiple policies).
• Uses medical underwriting or applies a dierent premium when you don’t have a
guaranteed issue right or aren’t in a Medigap Open Enrollment Period.
• Sells Medicare SELECT policies that may require you to use certain providers. If you
buy this type of Medigap policy, your premium may be lower.
• Oers a “high‑deductible option” for Plans F or G. If you buy Plans F or G with a
“high‑deductible option,” you must pay the rst $2,800 (in 2024) of deductibles,
copayments, and coinsurance for covered services not paid by Medicare before the
Medigap policy pays anything. You also pay a separate deductible ($250 per year) for
foreign travel emergency care.
19
Section 2: Medigap Basics
What’s Medicare SELECT?
In some states, you may be able to buy another type of Medigap policy called
Medicare SELECT. is policy requires you to use hospitals and, in some
cases, doctors within its network to be eligible for full benets. ese policies
generally cost less than other Medigap policies. However, if you don’t use a
Medicare SELECT hospital or doctor for non‑emergency services, you’ll have
to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of
approved costs no matter which hospital or doctor you choose.
How does Medigap help pay my Medicare Part B costs?
In most Medigap policies, you agree to have the Medigap insurance company
get your Part B claim information directly from Medicare. en, the Medigap
insurance company will pay your doctor whatever amount you owe under
your policy. Some Medigap insurance companies also provide this service for
Part A claims.
If your Medigap insurance company doesn’t get your claims information
directly from Medicare, ask your doctors if they “participate” in Medicare.
is means they “accept assignment” for all Medicare patients. If your doctor
participates, your Medigap insurance company is required to pay the doctor
directly if you ask them to. If your doctor doesn’t participate but still accepts
Medicare, you may be asked to pay the coinsurance amount at the time of
service. In that situation, your Medigap insurance company may reimburse
you directly (based on your policy limits). Check with your Medigap policy
for more details.
If you have any questions about Medigap claim ling, call 1‑800‑MEDICARE
(1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
20
Section 2: Medigap Basics
Notes
21
SECTION
Your Right to Buy a
Medigap Policy
3
What are guaranteed issue rights?
Guaranteed issue rights or “Medigap protections” are your rights to buy
certain Medigap policies in limited situations outside of your Medigap
Open Enrollment Period. In these situations, an insurance company:
• Must sell you a Medigap policy.
• Must cover all your pre‑existing health conditions.
• Can’t charge you more for a Medigap policy because of past or present
health problems.
If you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteed
issue rights to buy a Medigap policy, but the Medigap policies are dierent.
Go to pages 42–44 for your Medigap policy choices.
When do I have guaranteed issue rights?
In most cases, you have a guaranteed issue right when your other health
coverage changes in some way, like if you lose your other coverage. You
may also have a “trial right” to try a Medicare Advantage Plan (Part C)
and still buy a Medigap policy if you change your mind. For information
on trial rights, go to page 23.
Important: e guaranteed issue rights in this section are based on
federal law. ese rights apply to Medigap and Medicare SELECT policies.
You may have additional rights under state law.
Words in blue
are dened on
pages 49–50.
22
Section 3: Your Right to Buy a Medigap Policy
Medigap guaranteed issue right situations
is information describes the most common situations under federal law where you may be able to buy
a Medigap policy outside your Medigap Open Enrollment Period, the kind of policy you can buy, and
when you can or must apply for it. You may have additional rights under state law. Check with your State
Insurance Department about what rights you might have under state law.
You have a guaranteed issue
right if...
You have a Medicare Advantage
Plan, and:
• Your plan is leaving Medicare
• Stops giving care in your area, or
• You move out of the plan’s
service area.
You have Original Medicare and
an employer group health plan
(including retiree or COBRA
coverage) or union coverage that
pays aer Medicare pays and that
plan is ending.
You have Original Medicare and
a Medicare SELECT policy. You
move out of the Medicare SELECT
policy’s service area.
Call the Medicare SELECT
insurance company for more
information about your options.
You have the right
to buy...
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state.
You only have this right if you
switch to Original Medicare
(rather than join another
Medicare Advantage Plan).
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state.
If you have COBRA coverage,
you can either buy a Medigap
policy right away or wait until
your COBRA coverage ends.
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state
or the state you’re moving to.
You can/must apply for a
Medigap policy...
• 60 days before the date your
Medicare Advantage Plan
coverage ends.
• No more than 63 days aer
your Medicare Advantage Plan
coverage ends.
Note: Medigap coverage can’t start
until your Medicare Advantage
Plan coverage ends.
No more than 63 days aer the
latest of these 3 dates:
1. Date your current coverage
ends.
2. Date on the notice you get
telling you that your coverage
is ending (if you get one).
3. Date on a claim denial, if this
is the only way you know that
your coverage ended.
• 60 days before your Medicare
SELECT coverage ends.
• No more than 63 days aer your
Medicare SELECT coverage
ends.
*Note: Plans C and F are no longer available to people new to Medicare on or aer January 1, 2020. However, if
you were eligible for Medicare before January 1, 2020, but haven’t yet enrolled, you may be able to buy Plan C or
Plan F. People new to Medicare on or aer January 1, 2020, have the right to buy Plan D or G instead of Plan C
or F.
23
Section 3: Your Right to Buy a Medigap Policy
You have a guaranteed
issue right if...
(Trial right) You joined a Medicare
Advantage Plan or Program of
All‑inclusive Care for the Elderly
(PACE) when you were rst eligible
for Medicare Part A at 65, and
within the rst year of joining,
you decide you want to switch to
Original Medicare.
(Trial right) You dropped a
Medigap policy to join a Medicare
Advantage Plan (or to switch to a
Medicare SELECT policy) for the
rst time, you’ve been in the plan
less than a year, and you want to
switch back.
Your Medigap insurance company
goes bankrupt and you lose your
coverage, or your Medigap policy
coverage ends through no fault of
your own.
You leave a Medicare Advantage
Plan or drop a Medigap policy
because the company hasn’t
followed the rules, or it misled you.
You have the right
to buy...
Any Medigap policy that’s sold
by an insurance company in
your state.*
e Medigap policy you had
before you joined the Medicare
Advantage Plan or Medicare
SELECT policy, if the same
insurance company you had
before still sells it.
If your former Medigap policy
isn’t available, you can buy
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state.
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state.
Medigap Plan A, B, C*, D*, F*,
G*, K, or L that’s sold by an
insurance company in your state.
You can/must apply for a
Medigap policy...
• 60 days before your coverage
ends.
• No more than 63 days aer your
coverage ends.
Note: Your rights may last for an
extra 12 months under certain
circumstances.
• 60 days before the date your
coverage ends.
• No more than 63 days aer your
coverage ends.
Note: Your rights may last for an
extra 12 months under certain
circumstances.
No more than 63 days aer your
current Medigap coverage ends.
No more than 63 aer your
coverage ends.
Medigap guaranteed issue right situations (continued)
*Note: Plans C and F are no longer available to people new to Medicare on or aer January 1, 2020. However, if
you were eligible for Medicare before January 1, 2020, but haven’t yet enrolled, you may be able to buy Plan C or
Plan F. People new to Medicare on or aer January 1, 2020, have the right to buy Plan D or G instead of Plan C
or F.
24
Can I buy a Medigap policy if I lose my health coverage?
You may have a guaranteed issue right to buy a Medigap policy if you lose your
health coverage, so make sure you keep:
• Copies of letters, notices, emails or claim denials that have your name on them as
proof of your coverage being terminated
• e postmarked envelope these papers come in as proof of when it was mailed
You may need to include a copy of some or all of these papers with your Medigap
application to prove you have a guaranteed issue right.
More information about Medigap rights
If you have questions or want to learn more about Medigap rights in your state, you
can:
• Call your State Health Insurance Assistance Program (SHIP) to make sure that you
qualify for any of these guaranteed issue rights.
• Call your State Insurance Department if you’re denied Medigap coverage in any of
these situations.
ere may be times when more than one of the situations on pages 22–23 applies to
you. When this happens, you can choose the guaranteed issue right that works best
for your situation.
Some of the situations listed include loss of coverage under Program of All‑inclusive
Care for the Elderly (PACE). PACE combines medical, social, and long‑term care
services, and prescription drug coverage for frail older adults who need nursing
home services but are capable of living in the community. To be eligible for PACE,
you must meet certain conditions. PACE may be available in states that have chosen
it as an optional Medicaid benet. If you have Medicaid, an insurance company can
sell you a Medigap policy only in certain situations. To nd a PACE plan in your
area, visit Medicare.gov/plan‑compare/#/pace. For more information about PACE,
visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call
1‑877‑486‑2048.
Section 3: Your Right to Buy a Medigap Policy
25
SECTION
Steps to Buying
a Medigap Policy
4
Step-by-step guide to buying a Medigap policy
Buying a Medigap policy is an important decision. As you shop for
a Medigap policy, keep in mind there can be big dierences in the
premiums that dierent insurance companies charge for the same
coverage, and not all plans are oered in every state.
Before you contact any insurance companies, gure out if you’re in your
Medigap Open Enrollment Period or if you have a guaranteed issue
right. If you have questions, call your State Health Insurance Assistance
Program (SHIP).
Words in blue
are dened on
pages 49–50.
26
STEP 1: Decide which plan you want
Medigap policies are standardized, and in most states are named by letters,
Plans A–N.
• Compare the benets of each lettered plan.
• ink about your current and future health care needs. Decide which benets
you’ll need. Remember, you might not be able to switch policies later.
• Select the plan that meets your needs.
Review the information on page 11 for information about the dierent benets
Medigap policies cover. If you live in Massachusetts, Minnesota, or Wisconsin,
go to pages 42–44.
STEP 2: Pick your policy
Find insurance companies selling the plan you want. As you shop for a policy,
be sure you’re comparing the same lettered plan oered by dierent insurance
companies (for example, compare Plan A from one company with Plan A from
another company).
e benets in each lettered plan are the same, no matter which insurance
company sells it. Price is the only dierence between policies with the same
letter sold by dierent companies. Since costs can vary widely between
companies, contact more than one company that sells Medigap policies in your
state to get an estimate.
Remember, not all plans are oered in every state, and if a state oers a
plan, not all insurance companies sell policies for it. To nd out which
insurance companies sell Medigap policies in your state:
• Visit Medicare.gov/medigap‑supplemental‑insurance‑plans to nd out:
– Which insurance companies sell Medigap policies in your area and how
to contact them
– What each Medigap policy covers
– How insurance companies decide what to charge you for a Medigap
policy premium
• Contact your local State Health Insurance Assistance Program (SHIP) to
get free help choosing an insurance company in your area. SHIPs are state
programs that give free local health insurance counseling to people with
Medicare and their families. Ask if they have a “Medigap rate comparison
shopping guide” for your state. is guide usually lists companies that sell
Medigap policies in your state and their costs.
Section 4: Steps to Buying a Medigap Policy
27
Section 4: Steps to Buying a Medigap Policy
STEP 2: Pick your policy (continued)
• Contact your State Insurance Department. Find out if they have any
complaints against the insurance companies selling the plan you want.
When deciding which Medigap policy is right for you, consider these
complaints, if any.
• Talk to someone you trust, like a family member, your insurance agent,
or a friend who has a Medigap policy from the same insurance company.
If you don’t have a computer, your local library or senior center may be
able to help you nd this information. You can also call 1‑800‑MEDICARE
(1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
STEP 3: Contact the company
• Get an ocial quote from the insurance company. Prices can change at
any time based on when you buy, your health conditions, and more.
28
Section 4: Steps to Buying a Medigap Policy
Use this resource to help you keep track of the information you get from the insurance companies you
contact.
STEP 3: Contact the company (continued)
Community
Issue‑age
Attained‑age
Community
Issue‑age
Attained‑age
Ask each insurance company…
“Are you licensed in ___?” (Say the name of your state.)
Note: If the answer is NO, STOP here, and try another company.
“Do you sell Medigap Plan ___?” (Say the letter of the Medigap Plan
you’re interested in.)
Note: Not all plans are oered in every state, and if a state oers a plan,
not all insurance companies sell policies for it. Make sure the insurance
company sells the plan you want. Also, if you’re interested in a Medicare
SELECT or high‑deductible Medigap policy, tell them.
“Do you use medical underwriting for this Medigap policy?” Note: If
you’re in your Medigap Open Enrollment Period or have a guaranteed
issue right to buy that Medigap policy, you can apply. Otherwise, you can
ask, “Can you tell me if I’m likely to qualify for the Medigap policy?”
“Do you have a waiting period for pre‑existing conditions?”
Note: If the answer is YES, ask how long the waiting period is.
“Do you price this Medigap policy by using community‑rating,
issue‑age‑rating, or attained‑age‑rating?” (Go to page 17.)
Note: Circle the one that applies for that insurance company.
“I’m ___ years old. What would my premium be under this Medigap
policy?”
Note: If it’s attained‑age, ask, “How frequently does the premium increase
due to my age?”
“Has the premium for this Medigap policy increased in the last 3 years
due to ination or other reasons?”
Note: If the answer is YES, ask how much it has increased.
“Do you oer any discounts or additional benets?”
Company 2 Company 1
29
Section 4: Steps to Buying a Medigap Policy
STEP 3: Contact the company (continued)
• Once you decide on the insurance company and you’re ready to buy the Medigap policy,
contact the company for an application.
Fill out the application carefully and completely, including any medical questions. e
answers you give will determine your eligibility for a Medigap Open Enrollment Period
or guaranteed issue rights. If you buy a Medigap policy during your Medigap Open
Enrollment Period or give evidence that you’re entitled to a guaranteed issue right, the
insurance company can’t use any medical answers you give to deny you a Medigap policy
or change the price.
• e insurance company must give you a clearly worded summary of your Medigap policy.
Make sure you read it carefully and keep it for your les.
Watch out for illegal practices
Every Medigap policy must follow federal and state laws designed to protect you. It’s
important to watch out for illegal practices by insurance companies and protect yourself
when you’re shopping for a Medigap policy. It’s illegal if someone tries to:
• Pressure you to buy a Medigap policy or lie to get you to switch to a new company or policy.
• Sell you a second Medigap policy when they know you already have one. ey can sell you a
policy if you state, in writing, that you plan to cancel your existing policy.
• Sell you a Medigap policy if they know:
– You have Medicaid, except in certain situations.
– You’re in a Medicare Advantage Plan, unless you’re switching back to Original
Medicare. ey can sell you a policy if your Medicare Advantage Plan coverage will
end before the Medigap policy’s eective date.
• Claim that a:
– Medigap policy is a part of the Medicare program or any other federal program.
Medigap is private health insurance.
– Medicare Advantage Plan is a Medigap policy.
• Sell you a Medigap policy that can’t legally be sold in your state. Check with your State
Insurance Department to make sure that the Medigap policy you’re interested in can be sold
in your state.
30
Watch out for illegal practices (continued)
• Suggest the Medigap policy has been approved or recommended by the federal
government, or misuse the names, letters, or symbols of these:
– U.S. Department of Health & Human Services (HHS)
– Social Security Administration (SSA)
– Centers for Medicare & Medicaid Services (CMS)
• Claim to be a Medicare representative if they work for a Medigap insurance
company.
• Sell you a Medicare Advantage Plan when you say you want to stay in Original
Medicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the same
as Original Medicare. If you enroll in a Medicare Advantage Plan, you’ll be
disenrolled from Original Medicare and can’t buy a Medigap policy.
• Ask you questions about your family history or require you to take a genetic test.
If you believe that a federal law has been broken, call the Inspector
General’s hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). TTY users can call
1‑800‑377‑4950. Your State Insurance Department can help you with other
insurance‑related problems.
After you buy a policy
• Start your Medigap policy
Ask for your Medigap policy to become eective when you want coverage to start.
Generally, Medigap policies begin the rst day of the month aer you apply.
If it’s been 30 days and you didn’t get your Medigap policy (like your Medigap
card or proof of insurance), call your insurance company. If it’s been 60 days, call
your State Insurance Department.
Note: If you already have a Medigap policy, ask for your new Medigap policy to
become eective when your old Medigap policy coverage ends.
• Pay for your Medigap policy
Your insurance company will let you know what your payment options are for
your particular policy. Many companies oer electronic funds transfer, which lets
you set up a recurring automatic payment from a checking account or credit card.
You may also be able to pay for your Medigap policy by check, money order, or
bank dra. Always direct your payment to the insurance company, not the agent
who sold you the policy (if you used one). If you buy from an agent, get a receipt
with the insurance company’s name, address, and phone number for your records.
Section 4: Steps to Buying a Medigap Policy
31
SECTION
If You Already
Have a Medigap Policy
5
is section may apply to you if:
• You’re thinking about switching to a dierent Medigap policy.
(Go to pages 32–35.)
• You’re losing your Medigap coverage. (Go to page 36.)
• You have a Medigap policy with Medicare drug coverage.
(Go to pages 36–38.)
For a refresher on Medigap basics, go to page 11.
Words in blue
are dened on
pages 49–50.
32
Switching Medigap policies
Can I switch to a dierent Medigap policy?
In most cases, you won’t have a right under federal law to switch Medigap
policies, unless:
• You’re within your 6‑month Medigap Open Enrollment Period,
• You’re eligible under a specic situation or guaranteed issue right.
If your state has more generous requirements, or the insurance company is
willing to sell you a Medigap policy, make sure you compare benets and
premiums before switching.
If you bought your Medigap policy before:
• June 1, 2010: It may oer coverage that isn’t available in a newer Medigap
policy.
• 1992: e company may refuse to renew your Medigap policy any year, and
your policy may cost more than current Medigap policies.
If you decide to switch, don’t cancel your rst Medigap policy until you’ve
decided to keep the second Medigap policy. On the application for the new
Medigap policy, you’ll have to promise that you’ll cancel your rst Medigap
policy.
You have 30 days to decide if you want to keep the new Medigap policy. is
is called your “free look period,” which starts when you get your new Medigap
policy. You’ll need to pay both premiums the month that you have both.
Do I have to switch Medigap policies if I have a Medigap policy that’s no
longer sold?
If you have an older Medigap policy, you don’t have to switch. But if you buy a
new Medigap policy, you have to cancel your old policy (except for your 30‑day
“free look period”). Once you cancel your policy, you can’t get it back.
Section 5: If You Already Have a Medigap Policy
33
Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
Do I have to wait a certain length of time aer I buy my Medigap policy
before I can switch to a dierent Medigap policy?
No, but if you’ve had your current Medigap policy for less than 6 months
and want to switch to a dierent Medigap policy, you may have to wait up to
6 months for the new policy to cover your pre‑existing condition (called the
pre‑existing condition waiting period).
• Your new Medigap policy must subtract the number of months you’ve
had your current Medigap policy or prior creditable coverage (like health
insurance you recently had through your employer) from the time you
must wait before covering your pre‑existing condition.
For example, if someone had a pre‑existing condition and had creditable
coverage (as described above) for 2 months and then gets a new Medigap
policy, the new policy won’t cover that condition for another 4 months
(6‑2=4).
• If your new Medigap policy has a benet that isn’t in your current
Medigap policy, you may still have to wait up to 6 months before that
benet will be covered, regardless of how long you’ve had your current
Medigap policy.
If you’ve had your current Medigap policy longer than 6 months and it
has the same benets as your new policy, the new insurance company can’t
exclude your pre‑existing condition or make you wait before it covers it. If
the insurance company agrees to issue you a new policy, they can’t write
pre‑existing conditions, waiting periods, elimination periods, or
probationary periods into the replacement policy.
34
Switching Medigap policies (continued)
Why would I want to switch to a dierent Medigap policy?
Some reasons for switching may include:
• You’re paying for benets you don’t need.
• You need more benets.
• You want to change insurance companies.
• You want a policy that costs less.
It’s important to compare the benets in your current Medigap plan to
the plan you’re considering switching to. If you live in Massachusetts,
Minnesota, or Wisconsin, go to pages 42–44.
If you decide to switch insurance companies, you can call the new insurance
company and apply for your new Medigap policy. If your application
is accepted, call your current insurance company, and ask to have your
coverage end. e insurance company can tell you how to end your
coverage.
Make sure your old Medigap policy coverage ends aer you have the new
Medigap policy for 30 days (your 30 day “free look period”).
Can I keep my current Medigap policy (or Medicare SELECT policy) or
switch to a dierent Medigap policy if I move out-of-state?
In general, you can keep your current Medigap policy regardless of where
you live as long as you still have Original Medicare. If you want to switch to
a dierent Medigap policy, you’ll have to check with your current or the new
Medigap insurance company about your options.
Remember, you may have to pay more for your new Medigap policy and
answer some medical questions if you’re buying a Medigap policy outside of
your Medigap Open Enrollment Period. (Go to pages 14–16.)
Section 5: If You Already Have a Medigap Policy
35
Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
If you have a Medicare SELECT policy and you move out of the policy’s area, you can:
• Buy a standardized Medigap policy from your current Medigap insurance
company as long as it oers the same (or fewer) benets as your current Medicare
SELECT policy. If you’ve had your Medicare SELECT policy for more than 6
months, you won’t have to answer any medical questions.
• Use your guaranteed issue right to switch to Medigap Plan A, B, C, D, F, G, K, or
L that’s sold by an insurance company in your state or the state you’re moving to.
Note: Plans C and F are no longer available to people new to Medicare on or aer
January 1, 2020. However, if you were eligible for Medicare before January 1, 2020,
but haven’t yet enrolled, you may be able to buy Plan C or Plan F. People new to
Medicare on or aer January 1, 2020, have the right to buy Plan D or G instead of
Plan C or F.
You may have additional rights under state law. Call your State Health Insurance
Assistance Program (SHIP) or State Insurance Department for more information.
What happens to my Medigap policy if I join a Medicare Advantage Plan?
You may want to drop your Medigap policy because you’ll be paying for coverage
you can’t use. If you decide to keep your Medigap policy, you’ll have to pay your
Medigap policy premium. Your Medigap policy can’t pay any Medicare Advantage
Plan deductibles, copayments, coinsurance, or premiums.
You always have a legal right to keep the Medigap policy aer you join a Medicare
Advantage Plan. However, because you have a Medicare Advantage Plan, the
Medigap policy would no longer provide benets that supplement Medicare.
Contact your Medigap insurance company to nd out how to cancel your Medigap
policy. In most cases, if you drop your Medigap policy to join a Medicare
Advantage Plan, you may not be able to get the same policy back (or in some
cases) any Medigap policy unless you leave your Medicare Advantage Plan
during your trial period (you have a “trial right” (page 23)). Contact your State
Insurance Department for more information.
36
Losing Medigap coverage
Can my Medigap insurance company drop me?
All standardized Medigap policies bought aer 1992 are automatically
renewed every year (guaranteed renewable), even if you have health problems.
is means your Medigap insurance company can only drop you if:
• You stop paying your premium
• You weren’t truthful on the Medigap policy application
• e insurance company goes bankrupt or goes out of business
If you bought your Medigap policy before 1992, it might not be guaranteed
renewable. is means the Medigap insurance company can refuse to renew
your Medigap policy, as long as it gets the state’s approval to cancel your policy.
If that happens, you have the right to buy another Medigap policy. Go to pages
21–23 for more information about guaranteed issue rights.
Medigap policies and Medicare drug coverage (Part D)
Medigap plans sold aer 2005 don’t include prescription drug coverage.
If you want prescription drug coverage, you can join a separate Medicare drug
plan (Part D). Medicare oers prescription drug coverage for everyone with
Medicare.
What if I have a Medigap policy that already has prescription drug
coverage?
If you have a Medigap policy with prescription drug coverage, you can still
join a Medicare drug plan. Your situation may have changed in ways that
make a Medicare drug plan t your needs better than the drug coverage in
your Medigap policy.
You can join a Medicare drug plan between October 15–December 7. Your
new coverage will begin on January 1.
Section 5: If You Already Have a Medigap Policy
37
Section 5: If You Already Have a Medigap Policy
Medigap policies and Medicare drug coverage (continued)
What if I have a Medigap policy that has prescription drug coverage and
want to join a Medicare drug plan?
If your Medigap premium or your prescription drug needs were low when you
had your rst chance to join a Medicare drug plan, your Medigap coverage may
have met your needs. However, if your Medigap premium increased or you’ve
started taking more prescription drugs recently, a Medicare drug plan may be a
better choice for you.
In a Medicare drug plan, you may have to pay a monthly premium and a
Medicare drug plan covers certain prescription drugs on its “formulary” or
“drug list”. It’s important to check if your current drugs are on the Medicare drug
plan’s list of covered drugs before you join.
Will I have to pay a late enrollment penalty if I join a Medicare drug plan
now?
If you bought a Medigap policy before January 1, 2006 that includes
prescription drug coverage, you may have to pay a late enrollment penalty
if the policy doesn’t include “creditable prescription drug coverage.” Having
creditable coverage means that the Medigap policy’s drug coverage pays, on
average, at least as much as Medicare’s standard drug coverage and gives the
same value for your prescriptions as Medicare drug coverage (Part D).
If your Medigap policy’s drug coverage isn’t creditable coverage, and you join
a Medicare drug plan now, you’ll probably have to pay late enrollment penalty,
which gets added to your monthly premium.
Your Medigap insurance company must send you a notice each year telling
you if their prescription drug coverage is creditable, or if the drug coverage
in your Medigap policy changes so that it’s no longer creditable. Keep these
notices in case you decide to join a Medicare drug plan later.
38
Will I have to pay a late enrollment penalty if I join a Medicare drug plan now?
(continued)
Before you decide to join a Medicare drug plan (Part D), consider:
• If your Medigap policy includes creditable drug coverage you won’t have to pay a late
enrollment penalty as long as you don’t go 63 or more days in a row without creditable
prescription drug coverage. Don’t stop the drug coverage from your Medigap policy
before you join the Medicare drug plan and the coverage starts.
• If your Medigap policy doesn’t include creditable drug coverage, you’ll probably
have to pay a late enrollment penalty if you join a Medicare drug plan now. e
penalty amount increases for each month you wait to get Part D. In general, you’ll
have to pay this penalty for as long as you have Part D.
Can I join a Medicare drug plan and have a Medigap policy with prescription drug
coverage?
No. If your Medigap policy covers prescription drugs, you must tell your Medigap
insurance company when you join a Medicare drug plan.
If you decide to join a Medicare drug plan:
• You’ll have to tell your Medigap insurance company to remove the drug coverage
from your Medigap policy (and adjust your premium).
• You can’t add drug coverage back to your Medigap policy.
What if I decide to drop my entire Medigap policy (not just the drug coverage)
and join a Medicare Advantage Plan that oers drug coverage?
In general, you can only join a Medicare drug plan or Medicare Advantage Plan
with drug coverage during the Medicare Open Enrollment Period between
October 15–December 7. If you join during Open Enrollment, your coverage will begin
on January 1. In most cases, if you drop your Medigap policy to join a Medicare
Advantage Plan, you may not be able to get the same policy back, so pay careful
attention to the timing.
Section 5: If You Already Have a Medigap Policy
39
SECTION
Medigap Policies for People
with a Disability or ESRD
6
You may have Medicare before turning 65 due to a disability or End‑
Stage Renal Disease (ESRD) (permanent kidney failure requiring
dialysis or a kidney transplant).
If you’re under 65 and have Medicare because of a disability or ESRD,
you might not be able to buy the Medigap policy you want, or any
Medigap policy, until you turn 65. Federal law generally doesn’t
require insurance companies to sell Medigap policies to people who
are under 65. However, in some states insurance companies do oer
Medigap policies to people under 65.
Important: is section provides information on the minimum
federal standards for Medigap policies. Your state may have dierent
requirements. Call your State Insurance Department or State
Health Insurance Assistance Program (SHIP)
to get state‑specic
information.
Words in blue
are dened on
pages 49–50.
40
Which states oer Medigap policies to people with Medicare
under 65?
At the time of printing this guide, these states require insurance companies to
oer at least one kind of Medigap policy to people with Medicare under 65:
Section 6: Medigap Policies for People with a Disability or ESRD
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• New Hampshire
• New Jersey
• New York
• North Carolina
• Oklahoma
• Oregon
• Pennsylvania
• South Dakota
• Tennessee
• Texas
• Vermont
• Wisconsin
Note: Some states provide these rights to all people with Medicare under 65, while others only
extend them to people eligible for Medicare because of disability or only to people with ESRD.
Check with your State Insurance Department about what rights you might have under state law.
Even if your state isn’t listed above, some insurance companies may voluntarily
sell Medigap policies to people who are under 65, although they’ll probably cost
more than Medigap policies sold to people over 65, and they probably use medical
underwriting. Some of the federal guaranteed rights are available to people
with Medicare under 65. (Go to pages 21–24.) Check with your State Insurance
Department about what additional rights you might have under state law.
If you already have Medicare Part B (Medical Insurance), you’ll still get a
Medigap Open Enrollment Period when you turn 65. You’ll probably have more
Medigap policy options and be able to get a lower premium at that time. During the
Medigap Open Enrollment Period, insurance companies can’t refuse to sell you any
Medigap policy due to a disability or other health problem, or charge you a higher
premium (based on health status) than they charge other people who are 65.
Because Medicare Part A and/or Part B is creditable coverage, if you had
Medicare for more than 6 months before you turned 65, you may not have to wait
through a
pre‑existing condition waiting period for coverage you bought during
the Medigap Open Enrollment Period. For more information about the Medigap
Open Enrollment Period and pre‑existing conditions, go to pages 14 –15. If you have
questions, call your State Health Insurance Assistance Program (SHIP).
Words in blue
are dened on
pages 49–50.
41
SECTION
Medigap Coverage in
Massachusetts, Minnesota,
and Wisconsin
7
Massachusetts benefits .............................. 42
Minnesota benefits
..................................43
Wisconsin benefits
................................... 44
Visit Medicare.gov/medigap‑supplemental‑insurance‑plans or call
your State Insurance Department for more information on these
Medigap policies:
• Massachusetts: 1‑877‑563‑4467
• Minnesota: 1‑800‑657‑3602
• Wisconsin: 1‑800‑236‑8517
Words in blue
are dened on
pages 49–50.
42
Section 7: Medigap Coverage Charts
Massachusetts benets
In Massachusetts, Medigap policies are standardized in a dierent way and oer these basic benets:
• Inpatient hospital costs: Covers the Medicare Part A coinsurance plus coverage for 365 additional
days aer Medicare coverage ends
• Medical costs: Covers the Medicare Part B coinsurance (generally 20% of the Medicare‑approved
amount)
• Blood: Covers the rst 3 pints of blood each year
• Part A hospice coinsurance or copayment
Note: Supplement 1 Plan (which includes coverage of the Part B deductible) is no longer available, except
if you were eligible for Medicare before January 1, 2020, but haven’t yet enrolled. If you already have
Supplement 1 Plan, you can keep it.
Check marks mean the benet is covered.
Massachusetts—Chart of standardized Medigap policies
Medigap benefits Core plan Supplement 1 Plan Supplement 1A Plan
Basic benefits
3 3 3
Part A inpatient hospital
deductible
3 3
Part A skilled nursing facility
(SNF) coinsurance
3 3
Part B deductible
3
Foreign travel emergency
3 3
Inpatient days in mental
health hospitals
60 days per
calendar year
120 days per benefit year 120 days per benefit year
State‑mandated benefits
(yearly Pap tests and
mammograms—check with the
plan for other state‑mandated
benefits)
3 3 3
43
Section 7: Medigap Coverage Charts
Minnesota benets
In Minnesota, Medigap policies are standardized in a dierent way and oer these basic benets:
• Inpatient hospital costs: Covers the Part A coinsurance
• Medical costs: Covers the Part B coinsurance (generally 20% of the Medicare‑approved amount)
• Blood: Covers the rst 3 pints of blood each year
• Part A hospice and respite cost sharing
• Parts A and B home health services and supplies cost sharing
Check marks mean the benet is covered.
Minnesota—Chart of standardized Medigap policies
Basic benefits
Part A inpatient hospital
deductible
Part A skilled nursing facility (SNF)
coinsurance
Part B deductible**
Foreign travel emergency
Outpatient mental health
Usual and customary fees
Medicare‑covered preventive care
Physical therapy
Coverage while in a foreign
country
State‑mandated benefits
(diabetic equipment and supplies,
routine cancer screening,
reconstructive surgery, and
immunizations)
Medigap benefits Basic plan Extended
20% 20%
3
3
3
3
80%*
3
3
(Provides 120 days of
SNF care)
3
3
(Provides 100 days of
SNF care)
80%
80%*
20%
20%
80%*
basic plan
3
3
Mandatory riders
Insurance companies
can add more coverage
to a Basic Plan. You
may choose any or all of
these options to design
a Medigap policy that
meets your needs:
1. Part A inpatient
hospital deductible
2. Part B deductible**
3. Usual and
customary fees
4. Preventive care
Medicare doesn’t
cover
* Pays 100% aer you spend $1,000 in out-of-pocket costs for a calendar year.
**Coverage of the Part B deductible is no longer available to people new to Medicare on or after January 1, 2020. However, if
you were eligible for Medicare before January 1, 2020 but haven’t yet enrolled, you may be able to get this benefit.
Minnesota versions of Medigap Plans K, L, M, and N are available. Minnesota versions of high-deductible F are available
to people who had or were eligible for Medicare before January 1, 2020. (Go to page 10 for details.)
Important: e basic and extended basic plans are available when you enroll in Part B, regardless of age or health problems.
If you’re under 65, return to work, and drop Part B to join your employer’s health plan, you’ll get a 6‑month Medigap Open
Enrollment Period aer you turn 65 and retire from that employer (when you join Part B again).
44
Section 7: Medigap Coverage Charts
Basic benets
Part A skilled nursing
facility (SNF) coinsurance
Inpatient mental
health coverage
Home health care
Benets that Wisconsin
must oer (known as state‑
mandated benets)
Wisconsin benets
ere’s only 1 Medigap plan available if you live in Wisconsin, which is standardized in a
dierent way and oers these basic benets:
• Inpatient hospital costs: Covers the Part A coinsurance
• Medical costs: Covers the Part B coinsurance (generally 20% of the Medicare‑approved
amount)
• Blood: 3 pints of blood each year
• Part A hospice coinsurance or copayment
Check marks mean the benet is covered.
Plans known as “50% and 25% cost‑sharing plans” are
available. ese plans are similar to standardized Plans K
(50%) and L (25%). A high‑deductible plan ($2,800 for
2024) is also available.
175 days per lifetime in
addition to what
Medicare covers
3
3
3
40 visits per year in
addition to what
Medicare covers
Wisconsin — Chart of standardized Medigap policies
Medigap benefits Basic plan
Optional riders
Insurance companies can add more
coverage to the Medigap policy.
You may choose any or all of these
options to design a Medigap policy
that meets your needs:
1. Part A deductible
2. Additional home health
care (365 visits including
those paid by Medicare)
3. Part B deductible*
4. Part B excess charge
5. Foreign travel emergency
6. 50% Part A deductible
7. Part B copayment or coinsurance
*Coverage of the Part B deductible is
no longer available. However, if you
were eligible for Medicare before
January 1, 2020, but haven’t yet
enrolled, you may be able to get this
benet.
45
SECTION
More Information
8
Where to get more information
On pages 47– 48, you’ll nd phone numbers for your State Health
Insurance Assistance Program (SHIP) and State Insurance
Department.
• Call your SHIP for free help with:
–
Buying a Medigap policy or long‑term care insurance
– Dealing with payment denials or appeals
– Medicare rights and protections
– Choosing a Medicare plan
– Questions about Medicare bills
• Call your State Insurance Department if you have questions about
the Medigap policies sold in your area, rights that are specic to your
state, or any insurance‑related problems.
Words in blue
are dened on
pages 49–50.
46
How to get help with Medicare and Medigap questions
If you have questions about Medicare, Medigap, or need updated phone
numbers for the contacts listed on pages 47– 48:
• Visit Medicare.gov
To nd Medigap policies in your area, visit
Medicare.gov/medigap‑supplemental‑insurance‑plans.
• Call 1-800-MEDICARE (1-800-633-4227)
Customer service representatives are available 24 hours a day, 7 days a week.
TTY users can call 1‑877‑486‑2048. If you need help in a language other
than English or Spanish, let the customer service representative know the
language.
Section 8: More Information
47
Section 8: More Information
State Insurance
Department
State State Health Insurance
Assistance Program
Alabama 1‑800‑243‑5463 1‑800‑433‑3966
Alaska 1‑800‑478‑6065 1‑800‑467‑8725
American Samoa Not available 1‑684‑633‑4116
Arizona 1‑800‑432‑4040 1‑800‑325‑2548
Arkansas 1‑800‑224‑6330 1‑800‑282‑9134
California 1‑800‑434‑0222 1‑800‑927‑4357
Colorado 1‑888‑696‑7213 1‑800‑930‑3745
Connecticut 1‑800‑994‑9422 1‑800‑203‑3447
Delaware 1‑800‑336‑9500 1‑800‑282‑8611
Florida 1‑800‑963‑5337 1‑877‑693‑5236
Georgia 1‑866‑552‑4464 1‑800‑656‑2298
Guam 1‑671‑735‑7415 1‑671‑635‑1835
Hawaii 1‑888‑875‑9229 1‑808‑586‑2790
Idaho 1‑800‑247‑4422 1‑800‑721‑3272
Illinois 1‑800‑252‑8966 1‑888‑473‑4858
Indiana 1‑800‑452‑4800 1‑800‑622‑4461
Iowa 1‑800‑351‑4664 1‑877‑955‑1212
Kansas 1‑800‑860‑5260 1‑800‑432‑2484
Kentucky 1‑877‑293‑7447 1‑800‑595‑6053
Louisiana 1‑800‑259‑5300 1‑800‑259‑5301
Maine 1‑800‑262‑2232 1‑800‑300‑5000
Maryland 1‑800‑243‑3425 1‑800‑492‑6116
Massachusetts 1‑800‑243‑4636 1‑877‑563‑4467
Michigan 1‑800‑803‑7174 1‑877‑999‑6442
Minnesota 1‑800‑333‑2433 1‑800‑657‑3602
Mississippi 1‑844‑822‑4622 1‑800‑562‑2957
Missouri 1‑800‑390‑3330 1‑800‑726‑7390
Montana 1‑800‑551‑3191 1‑800‑332‑6148
Nebraska 1‑800‑234‑7119 1‑800‑234‑7119
State Health Insurance Assistance Program (SHIP) and
State Insurance Department
48
Section 8: More Information
Nevada 1‑800‑307‑4444 1‑800‑992‑0900
New Hampshire 1‑866‑634‑9412 1‑800‑852‑3416
New Jersey 1‑800‑792‑8820 1‑800‑446‑7467
New Mexico 1‑800‑432‑2080 1‑888‑427‑5772
New York 1‑800‑701‑0501 1‑800‑342‑3736
North Carolina 1‑855‑408‑1212 1‑855‑408‑1212
North Dakota 1‑888‑575‑6611 1‑800‑247‑0560
Northern Mariana Not available 1‑670‑664‑3064
Islands
Ohio 1‑800‑686‑1578 1‑800‑686‑1526
Oklahoma 1‑800‑763‑2828 1‑800‑522‑0071
Oregon 1‑800‑722‑4134 1‑888‑877‑4894
Pennsylvania 1‑800‑783‑7067 1‑877‑881‑6388
Puerto Rico 1‑877‑725‑4300 1‑888‑722‑8686
Rhode Island 1‑888‑884‑8721 1‑401‑462‑9520
South Carolina 1‑800‑868‑9095 1‑803‑737‑6160
South Dakota 1‑800‑536‑8197 1‑605‑773‑3563
Tennessee 1‑877‑801‑0044 1‑800‑342‑4029
Texas 1‑800‑252‑9240 1‑800‑252‑3439
Utah 1‑800‑541‑7735 1‑800‑439‑3805
Vermont 1‑800‑642‑5119 1‑800‑964‑1784
U.S. Virgin Islands 1‑340‑772‑7368 (St. Croix) 1‑340‑773‑6449
1‑340‑714‑4354 (St. Thomas) 1‑340‑774‑2991
Virginia 1‑800‑552‑3402 1‑877‑310‑6560
Washington 1‑800‑562‑6900 1‑800‑562‑6900
Washington D.C. 1‑202‑727‑8370 1‑202‑727‑8000
West Virginia 1‑877‑987‑4463 1‑888‑879‑9842
Wisconsin 1‑800‑242‑1060 1‑800‑236‑8517
Wyoming 1‑800‑856‑4398 1‑800‑438‑5768
State Insurance
Department
State
State Health Insurance
Assistance Program
49
SECTION
Denitions
9
Assignment—An agreement by your doctor, provider, or supplier
to be paid directly by Medicare, to accept the payment amount
Medicare approves for the service, and not to bill you for any more
than the Medicare deductible and coinsurance.
Coinsurance—An amount you may be required to pay as your share
of the cost for benets aer you pay any deductibles. Coinsurance is
usually a percentage (for example, 20%).
Copayment—An amount you may be required to pay as your share
of the cost for benets aer you pay any deductibles. A copayment is
a xed amount, like $30.
Deductible—e amount you must pay for health care or
prescriptions before Original Medicare, your Medicare Advantage
Plan, your Medicare drug plan, or your other insurance begins to pay.
Excess charge—If you have Original Medicare, and the amount a
doctor or other health care provider is legally permitted to charge is
higher than the Medicare‑approved amount, the dierence is called
the excess charge.
Guaranteed issue rights (also called “Medigap protections”) —
Rights you have in certain situations when insurance companies
are required by law to sell or oer you a Medigap policy. In these
situations, an insurance company can’t deny you a Medigap policy,
or place conditions on a Medigap policy, like exclusions for pre‑
existing conditions, and can’t charge you more for a Medigap policy
because of a past or present health problem.
Where words in BLUE are dened
50
Section 9: Denitions
Guaranteed renewable policy—An insurance
policy that can’t be terminated by the insurance
company unless you make untrue statements to
the insurance company, commit fraud, or don’t pay
your premiums. All Medigap policies issued since
1992 are guaranteed renewable.
Medicaid—A joint federal and state program that
helps with medical costs for some people with
limited income and (in some cases) resources.
Medicaid programs vary from state to state, but
most health care costs are covered if you qualify
for both Medicare and Medicaid.
Medical underwriting—e process that an
insurance company uses to decide, based on
your medical history, whether to take your
application for insurance, whether to add a
waiting period for pre‑existing conditions (if
your state law allows it), and how much to
charge you for that insurance.
Medicare Advantage Plan (Part C)—A type
of Medicare health plan oered by a private
company that contracts with Medicare. Medicare
Advantage Plans provide all of your Part A and
Part B benets, with a few exclusions, for example,
certain aspects of clinical trials which are covered
by Original Medicare even though you’re still
in the plan. Medicare Advantage Plans include:
Health Maintenance Organizations, Preferred
Provider Organizations, Private Fee‑for‑Service
Plans, Special Needs Plans, and Medicare Medical
Savings Account Plans. If you’re enrolled in a
Medicare Advantage Plan, most Medicare services
are covered through the plan and aren’t paid for
by Original Medicare. Most Medicare Advantage
Plans oer prescription drug coverage.
Medicare-approved amount—e payment
amount that Original Medicare sets for a covered
service or item. When your provider accepts
assignment, Medicare pays its share and you pay
your share of that amount.
Medicare drug plan (Part D)—Part D adds
prescription drug coverage to Original Medicare,
some Medicare Cost Plans, some Medicare
Private‑Fee‑for‑Service Plans, and Medicare
Medical Savings Account Plans. These plans are
offered by insurance companies and other private
companies approved by Medicare. Medicare
Advantage Plans may also offer prescription drug
coverage that follows the same rules as Medicare
drug plans.
Medicare SELECT—A type of Medigap policy
that may require you to use hospitals and, in
some cases, doctors within its network to be
eligible for full benets.
Medigap Open Enrollment Period—A
one‑time‑only, 6‑month period when federal law
allows you to buy any Medigap policy you want
that’s sold in your state. It starts in the rst month
that you’re covered under Medicare Part B, and
you’re 65 or older. During this period, you can’t be
denied a Medigap policy or charged more due to
past or present health problems. Some states may
have additional Open Enrollment rights under
state law.
Premium—e periodic payment to Medicare, an
insurance company, or a health care plan for health
care or prescription drug coverage.
State Health Insurance Assistance Program
(SHIP)—A state program that gets money from
the federal government to give free local health
insurance counseling to people with Medicare.
State Insurance Department—A state agency
that regulates insurance and can provide
information about Medigap policies and other
private health insurance.
CMS Accessible Communications
Medicare provides free auxiliary aids and services, including information in accessible formats like braille, large
print, data or audio les, relay services and TTY communications. If you request information in an accessible
format from CMS, you won’t be disadvantaged by any additional time necessary to provide it. is means you’ll
get extra time to take any action if there’s a delay in fullling your request.
To request Medicare or Marketplace information in an accessible format you can:
1. Call us:
For Medicare: 1‑800‑MEDICARE (1‑800‑633‑4227) TTY: 1‑877‑486‑2048
For Marketplace: 1‑800‑318‑2596 TTY: 1‑855‑889‑4325
2. Email us: altformatrequest@cms.hhs.gov
3. Send us a fax: 1‑844‑530‑3676
4. Send us a letter:
Centers for Medicare & Medicaid Services
Oces of Hearings and Inquiries (OHI)
7500 Security Boulevard, Mail Stop DO‑01‑20
Baltimore, MD 21244‑1850
Attn: Customer Accessibility Resource Sta (CARS)
Your request should include your name, phone number, type of information you need (if known), and the
mailing address where we should send the materials. We may contact you for additional information.
Note: If you’re enrolled in a Medicare Advantage Plan or Medicare drug plan, contact your plan to request its
information in an accessible format. For Medicaid, contact your State or local Medicaid oce.
Nondiscrimination Notice
e Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benets to, or otherwise discriminate
against any person on the basis of race, color, national origin, disability, sex (including sexual orientation and
gender identity), or age in admission to, participation in, or receipt of the services and benets under any of its
programs and activities, whether carried out by CMS directly or through a contractor or any other entity with
which CMS arranges to carry out its programs and activities.
You can contact CMS in any of the ways included in this notice if you have any concerns about getting information
in a format that you can use.
You may also le a complaint if you think you’ve been subjected to discrimination in a CMS program or activity,
including experiencing issues with getting information in an accessible format from any Medicare Advantage Plan,
Medicare drug plan, State or local Medicaid oce, or Marketplace Qualied Health Plans. ere are three ways to
le a complaint with the U.S. Department of Health and Human Services, Oce for Civil Rights:
1. Online:
HHS.gov/civil‑rights/ling‑a‑complaint/complaint‑process/index.html.
2. By phone:
Call 1‑800‑368‑1019. TTY users can call 1‑800‑537‑7697.
3. In writing: Send information about your complaint to:
Oce for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244‑1850
Official Business
Penalty for Private Use, $300
CMS Product No. 02110
March 2024
To get this publication in braille, Spanish, or large print (English),
visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227).
TTY users can call 1‑877‑486‑2048.
¿Necesita una copia en español? Visite Medicare.gov en el sitio
Web. Para saber si esta publicación esta impresa y disponible (en
español), llame GRATIS al 1‑800‑MEDICARE (1‑800‑633‑4227).
Los usuarios de TTY deben llamar al 1‑877‑486‑2048.
