Medicare Supplement Questions

Search the FAQs

Use the form below to search the FAQs

Search for in

What is a Medigap insurance policy?

A Medigap insurance policy (also commonly known as a Medicare Supplement) is a health insurance policy sold by private insurance companies to fill the “gaps” in the Original Medicare coverage (Medicare Parts A and B). Currently, there are 10 standardized Medigap plans called A, B, C, D, F, G, K, L, M and N. Each plan has a different set of benefits.

Does a Medicare Supplement plan replace Original Medicare?

No, Medicare remains your primary insurance. 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.

When can I make changes to my Medicare Supplement - Medigap coverage?

There are no time restrictions as to when you can make changes to a Medicare Supplement or Medigap policy or plan.  Really, the only restriction is making sure you are qualified for the changes you are trying to make to your plan.  For example, you may be wanting to switch to a plan with more benefits and it may require underwriting...and your health would need to qualify.

Note on Medicare Advantage (Part C) and Prescription Drug Plans (Part D):  You can only make changes to your Medicare Advantage plan or Prescription Drug Plan coverage between November 15—December 31 each year. If you are eligible for a Medicare Advantage  plan, you can also join a Medicare Advantage Plan between January 1—March 31 each year. Depending on your situation, there may be other times when you can change your Medicare Advantage  plan health or prescription drug coverage.

Does a Medicare Supplement or Medigap plan replace Original Medicare?

No, Medicare remains your primary insurance. A Medicare Supplement or Medigap policy is secondary insurance to Medicare that is designed to cover many of the costs or "gaps" not paid by Medicare.  A Medicare Supplement or Medigap policy is offered by private insurance companies and is purchased in addition to your Original Medicare benefits.  Unlike a Medicare Advantage plan (Part C), which is an alternative option that essentially replaces Original Medicare (Part A and B).

Do all Medicare Supplement - Medigap plans offered by different Insurance Companies offer the same mandated benefits?

Yes, the standardized plans A-N are sold in Texas.  Every company that offers one of the standardized plans in Texas must offer the same mandated benefits with each plan.  This means that Company A’s Plan F must provide the same mandated benefits as Company B’s Plan F (or any other plan), and both must conform to the Standardized Texas Medicare Supplemental Plans that can be legally sold.

Costs can vary widely between companies for the exact same or similar coverage so it is important to compare rates.

Why do your Medicare Supplement premiums go up?

(1) Your attained age can cause your rates to go up, and the insurance company may raise your rates based on these statistics.  (2) The financial stability of your Insurance Company can be another, if a company sustains large losses they may raise premiums to remain solvent.  (3) The overall rising cost of healthcare is another reason for higher premiums.  (4) If the claims against the group of people in your “block of business” increase.  When the group of people on which your rates are based get older and have more claims, the entire group may pay higher premiums to offset the insurance companies rising healthcare costs.

Costs can vary widely between companies for the exact same plan, so it is important to compare rates occasionally.

What is the Part B Excess Charge?

Not all doctors that see Medicare patients accept Medicare’s “assigned” rate for each Medicare approved service.  These doctors will charge above the assigned amount approved by Medicare, if your doctor or hospital does not accept assignment.  The “excess” charge is usually limited to 15% above Medicare’s assigned rate.  Although most physicians will accept assignment, some specialists, and specialty hospitals do not.  Standardized Medicare Supplement Plan F, G, I, and J cover all or a portion of these excess charges...while plans A-E, H, M and N leave you vulnerable to these excess charges.

What is “Guaranteed Issue” for Medicare Supplement - Medigap?

Guaranteed issue rights allow you to purchase a Medicare Supplement Policy without using underwriting considerations if you have existing health care coverage that qualifies as creditable coverage. For example if you have an employer group plan that pays after Medicare pays, and your coverage is ending you may qualify for guaranteed issue. There are several scenerios where you may qualify for guaranteed issue. If you qualify for guaranteed issue no company can deny you a Medigap policy and must cover all of your pre-existing conditions. It is important to discuss guaranteed issue with your agent if you are past your open enrollment period. You must apply for a Medigap policy no later than 63 days after your coverage ends to qualify, and under most circumstances you may only purchase a Plan A, B, C, F, K, or L.

What is the “open enrollment period” and why is it so important?

Your open enrollment period begins on the first day of the month you are both 65 and have Medicare Part B, and extends for 6 months from that date.  The reason this period is so important is that no company can deny you any Medicare Supplement Policy that they sell for any reason.  If you wait until your open enrollment period expires companies are allowed to use medical underwriting to decide whether to accept your application, and what rates they may charge.  Due to certain health conditions that may arise it may make it very difficult and expensive to obtain coverage after your open enrollment period expires.

I am under 65 and have Medicare Part A and B because of a disability, can I get a Medicare Supplement Policy?

Yes, but with some considerations.  Texas only requires insurance companies that offer Medigap policies in this state sell a Plan A to someone under 65 that qualifies for Medicare.  It varies from company to company which plans in addition to a Plan A can be offered to someone on disability.  Click here for a detailed description of the coverage that the various Medigap insurance plans provide.

Are there any Government publications available to help me choose a Medicare Supplement - Medigap Policy?

Yes, there is a booklet published by the Centers for Medicare & Medicade Services (CMS) called “Choosing a Medigap Policy”.   This official government guide details all of the “ins and outs” of buying a Medicare Supplement - Medigap policy.  In order to download and view a free copy, please click the following link and visit our Medicare and Medicare Supplement Guides page.

What is “Open Enrollment” for Medicare Supplement - Medigap insurance?

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 offered Medicare Supplement - Medigap plans.

Ask a Question

Use the form below to ask a question