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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare: What Are Medigap Plans?

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For a Medigap plan, you pay a monthly premium to the insurance company in addition to your Medicare Part B premium. The cost of your Medigap policy depends on the type of plan you buy, the insurance company, your location, and your age. A standardized Medigap policy is guaranteed renewable -- even if you have health problems -- if you pay your premiums on time.

However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs during that period. After six months, the Medigap policy will cover the pre-existing condition. The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous "creditable coverage," or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in that case. 

Insurance companies set their own prices and rules about eligibility, so it's important to shop around.

Most Medigap plans help pay for some of your Medicare co-payments, co-insurance for hospital stays, and some other services.

Less expensive plans have fewer benefits and higher out-of-pocket costs. More expensive plans include extra benefits, like coverage for routine checkups, some Medicare deductibles, at-home recovery, and more. You have to decide what sort of plan makes the most sense for you. In most cases, if you drop your Medigap policy, you won't be able to get it back.

  • Some Medigap plans used to cover prescription drugs. Since the introduction of the Medicare Prescription Drug Plan (Part D), you can no longer sign up for these plans. If you already have a Medigap plan that covers drugs, however, you can keep it.
  • For more information about Medigap plans, see the Medicare web site at www.medicare.gov or call 1-800-MEDICARE.
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