CENTERS FOR MEDICARE & MEDICAID SERVICES 2020
CENTERS FOR MEDICARE & MEDICAID SERVICES2020Choosing a Medigap Policy:A Guide to Health Insurance for People with MedicareThis official government guide hasimportant information about: Medicare Supplement Insurance(Medigap) policies What Medigap policies cover Your rights to buy a Medigap policy How to buy a Medigap policyDeveloped jointly by the Centers for Medicare & Medicaid Services (CMS)and the National Association of Insurance Commissioners (NAIC)
Who should read this guide?This guide can help if you’re thinking about buying a Medicare Supplement Insurance(Medigap) policy or already have one. It’ll help you understand how Medigap policieswork.Important information about this guideThe information in this guide describes the Medicare Program at the time thisguide was printed. Changes may occur after printing. Visit Medicare.gov, or call1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY userscan call 1‑877‑486‑2048.The “2020 Choosing a Medigap Policy: A Guide to Health Insurance forPeople with Medicare” isn’t a legal document. Official Medicare Programlegal guidance is contained in the relevant statutes, regulations, and rulings.Paid for by the Department of Health & Human Services.
Table of ContentsSection 1: Medicare Basics35A brief look at Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5What’s Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6The different parts of Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Medicare and the Health Insurance Marketplace . . . . . . . . . . . . . . . . . . . . . . . . . . 8Section 2: Medigap Basics9What’s a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10What Medigap policies don’t cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Types of coverage that are NOT Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . 12What types of Medigap policies can insurance companies sell? . . . . . . . . . . . . . 12What do I need to know if I want to buy a Medigap policy? . . . . . . . . . . . . . . . . 13When’s the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . 14Why is it important to buy a Medigap policy when I’m first eligible? . . . . . . . . . 16How do insurance companies set prices for Medigap policies? . . . . . . . . . . . . . 17Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19What’s Medicare SELECT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20How does Medigap help pay my Medicare Part B bills? . . . . . . . . . . . . . . . . . . . 20Section 3: Your Right to Buy a Medigap Policy21What are guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21When do I have guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Can I buy a Medigap policy if I lose my health care coverage? . . . . . . . . . . . . . . 24Section 4: Steps to Buying a Medigap Policy25Step-by-step guide to buying a Medigap policy . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Section 5: If You Already Have a Medigap Policy31Switching Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36
4Table of ContentsSection 6: Medigap Policies for People with a Disability or ESRD39Information for people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Section 7: Medigap Coverage in Massachusetts, Minnesota, and Wisconsin41Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Wisconsin benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Section 8: For More Information45Where to get more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . 46State Health Insurance Assistance Program and State Insurance Department . 47Section 9: Definitions49Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
51SECTIONMedicare BasicsA brief look at MedicareA Medicare Supplement Insurance (Medigap) policy is healthinsurance that can help pay some of the health care costs that OriginalMedicare doesn’t cover, like coinsurance, copayments, or deductibles.Private insurance companies sell Medigap policies. Some Medigappolicies also cover certain benefits Original Medicare doesn’t cover,like emergency foreign travel expenses. Medigap policies don’tcover your share of the costs under other types of health coverage,including Medicare Advantage Plans (like HMOs or PPOs), standalone Medicare Prescription Drug Plans, employer/union group healthcoverage, Medicaid, or TRICARE. Insurance companies generally can’tsell you a Medigap policy if you have coverage through Medicaid or aMedicare Advantage Plan.The next few pages provide a brief look at Medicare. If you alreadyknow the basics about Medicare and only want to learn about Medigap,skip to page 9.Words in blueare defined onpages 49–50.
6Section 1: Medicare BasicsWhat’s Medicare?Medicare is health insurance for people 65 or older, certain people under 65 withdisabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanentkidney failure requiring dialysis or a kidney transplant).The different parts of MedicareThe different parts of Medicare help cover specific services.Part A (Hospital Insurance)Helps cover: Inpatient care in hospitals Skilled nursing facility care Hospice care Home health carePart 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 (Prescription drug coverage)Helps cover: Cost of prescription drugs (including many recommendedshots or vaccines)Part D plans are run by private insurance companies that followrules set by Medicare.
Section 1: Medicare Basics7Your Medicare optionsWhen you first enroll in Medicare and during certain times of the year, you can choose howyou get your Medicare coverage. There are 2 main ways to get Medicare.Original Medicare Original Medicare includes MedicarePart A (Hospital Insurance) and Part B(Medical Insurance). If you want drug coverage, you can join aseparate Part D plan.Medicare Advantage(also known as Part C) Medicare Advantage is an “all in one”alternative to Original Medicare. These“bundled” plans include Part A, Part B,and usually Part D. To help pay your out-of-pocket costsin Original Medicare (like your 20%coinsurance), you can also shop for andbuy supplemental coverage. Plans may have lower out-of-pocket coststhan Original Medicare. Can use any doctor or hospital that takesMedicare, anywhere in the U.S. Most plans offer extra benefits thatOriginal Medicare doesn’t cover— likevision, hearing, dental, and more.Part APart BYou can add:Part DYou can also add:Supplementalcoverage(Some examples includecoverage from a MedicareSupplement Insurance(Medigap) policy, or coveragefrom a former employer orunion.) In most cases, you’ll need to use doctorswho are in the plan’s network.Part APart BMost plans include:Part DExtra benefitsSome plans also include:Lower out-of-pocket-costs
8Section 1: Medicare BasicsMedicare and the Health Insurance MarketplaceIf you have coverage through an individual Marketplace plan (not through anemployer), you may want to end your Marketplace coverage and enroll in Medicareduring your Initial Enrollment Period to avoid the risk of a delay in futureMedicare coverage and the possibility of a Medicare late enrollment penalty. Formost people, their Initial Enrollment period is the 7-month period that starts 3months before the month they turn 65, includes the month they turn 65, and ends3 months after the month they turn 65.You can keep your Marketplace plan without penalty until your Medicare coveragestarts. Once you’re considered eligible for premium-free Part A, you won’t qualifyfor help paying your Marketplace plan premiums or other medical costs. If youcontinue to get help paying your Marketplace plan premium after you haveMedicare, you may have to pay back some or all of the help you got when you fileyour taxes.Visit HealthCare.gov to connect to the Marketplace in your state, or find out howto terminate your Marketplace financial help or plan to avoid a gap in coverage.You can also call the Marketplace Call Center at 1-800-318-2596. TTY users cancall 1-855-889-4325.Note: Medicare isn’t part of the Marketplace. The Marketplace doesn’t offerMedicare Supplement Insurance (Medigap) policies, Medicare AdvantagePlans, or Medicare prescription drug coverage (Part D).For more informationRemember, this guide is about Medigap policies. To learn more about Medicare, visitMedicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE(1-800-633-4227). TTY users can call 1‑877‑486‑2048.
92SECTIONMedigap BasicsWhat’s a Medigap policy?A Medigap policy is an insurance policy that helps supplementOriginal Medicare and is sold by private companies. A Medigiappolicy can help pay some of the remaining health care costs thatOriginal Medicare doesn't pay for covered services and supplies, likecopayments, coinsurance, and deductibles. Original Medicare paysfor much, but not all, of the cost for covered health care services andsupplies. These are “gaps” in Medicare coverage.If you have Original Medicare and a Medigap policy, Medicare willpay its share of the Medicare-approved amounts for covered healthcare costs. Then your Medigap policy pays its share. A Medigap policyis different from a Medicare Advantage Plan (like an HMO or PPO)because those plans are ways to get Medicare benefits, while a Medigappolicy only supplements the costs of your Original Medicare benefits.Note: Medicare doesn’t pay any of your costs for a Medigap policy.All Medigap policies must follow federal and state laws designedto protect you, and policies must be clearly identified as “MedicareSupplement Insurance.” Each standardized Medigap policy mustoffer the same basic benefits, no matter which insurance companysells it.Cost is usually the only difference between Medigap policies withthe same letter sold by different insurance companies.
10Section 2: Medigap BasicsWhat Medigap policies coverThe chart on page 11 gives you a quick look at the standardized MedigapPlans available. You’ll need more details than this chart provides to compare andchoose a policy. Call your State Health Insurance Assistance Program (SHIP) forhelp. See pages 47–48 for your state’s phone number. Insurance companies selling Medigap policies are required to make Plan Aavailable. If they offer any other Medigap policy, they must also offer eitherPlan C or Plan F to individuals who are not new to Medicare and either Plan D orPlan G to individuals who are new to Medicare. Not all types of Medigap policiesmay be available in your state. Plans D and G with coverage starting on or after June 1, 2010, have differentbenefits 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 cangenerally keep it. Starting January 1, 2020, Medigap plans sold to people new to Medicare won’t beallowed to cover the Part B deductible. Because of this, Plans C and F will nolonger be available to people who are new to Medicare on or after January 1,2020.–– If you already have either of these two plans (or the high deductible versionof Plan F) or are covered by one of these plans prior to January 1, 2020, you'llbe able to keep your plan. If you were eligible for Medicare before January 1,2020 but not yet enrolled, you may be able to buy one of these plans.–– People new to Medicare are those who turn 65 on or after January 1, 2020,and those who get Medicare Part A (Hospital Insurance) on or afterJanuary 1, 2020.In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in adifferent way. (See pages 42–44.) In some states, you may be able to buy another typeof Medigap policy called Medicare SELECT. Medicare SELECT plans are standardizedplans that may require you to see certain providers and may cost less than other plans.(See page 20.)
11Section 2: Medigap BasicsThis chart shows basic information about the different benefits that Medigap policiescover. If a percentage appears, the Medigap plan covers that percentage of the benefit, andyou must pay the rest.Medicare Supplement Insurance (Medigap) PlansBenefitsMedicare Part Acoinsurance and hospitalcosts (up to an additional365 days after Medicarebenefits are used)Medicare Part Bcoinsurance or copaymentBlood (first 3 pints)Part A hospice carecoinsurance or copaymentSkilled nursing facility carecoinsurancePart A deductiblePart B deductiblePart B excess chargesForeign travel emergency(up to plan limits)ABCDF*G*KLMN100% 100% 100% 100% 100% 100% 100% 100% 100% 100%100% 100% 100% 100% 100% 100%50%75%100% 100% 100% 100% 100% 100%100% 100% 100% 100% 100% 100%50%50%75%75%100% 100%***100% 100%100% 100%100% 100% 100% 100%50%75%100% 100%100% 100% 100% 100% 100%100%100%100% 100%80% 80% 80% 80%50%75%50%100%80%80%Out-ofpocket limitin 2020** 5,880 2,940* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay forMedicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of 2,340 in 2020 before your policy pays anything. (Plans C and F won’t be available to people who arenewly eligible for Medicare on or after January 1, 2020.)**For Plans K and L, after you meet your out-of-pocket yearly limit and your yearlyPart B deductible ( 198 in 2020), the Medigap plan pays 100% of covered services for the rest of thecalendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to 20 for some office visitsand up to a 50 copayment for emergency room visits that don’t result in an inpatient admission.
12Section 2: Medigap BasicsWhat Medigap policies don’t coverGenerally, Medigap policies don’t cover long-term care (like non-skilled care you getin a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑dutynursing.Types of coverage that are NOT Medigap policies Medicare Advantage Plans (also known as Part C), like an HMO or PPOMedicare Prescription Drug Plans (Part D)MedicaidEmployer or union plans, including the Federal Employees HealthBenefits Program (FEHBP)TRICAREVeterans’ benefitsLong-term care insurance policiesIndian Health Service, Tribal, and Urban Indian Health plansQualified Health Plans sold in the Health Insurance MarketplaceWhat types of Medigap policies can insurancecompanies sell?In most cases, Medigap insurance companies can sell you only a “standardized”Medigap policy. All Medigap policies must have specific benefits, so you cancompare them easily. If you live in Massachusetts, Minnesota, or Wisconsin, seepages 42– 44.Words in blueare defined onpages 49–50.Insurance companies that sell Medigap policies don’t have to offer every Medigapplan. However, they must offer Plan A if they offer any Medigap policy.If they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Eachinsurance company decides which Medigap plan it wants to sell, although state lawsmight affect which ones they offer.In some cases, an insurance company must sell you a Medigap policy if you wantone, even if you have health problems. Here are certain times that you’re guaranteedthe right to buy a Medigap policy: When you’re in your Medigap Open Enrollment Period. (See pages 14 –15.) If you have a guaranteed issue right. (See pages 21–23.)You may be able to buy a Medigap policy at other times, but the insurance companycan deny you a Medigap policy based on your health. Also, in some cases it may beillegal for the insurance company to sell you a Medigap policy (like if you alreadyhave Medicaid or a Medicare Advantage Plan).
Section 2: Medigap Basics13What do I need to know if I want to buy a Medigap policy? You must have Medicare Part A (Hospital Insurance) and Medicare Part B(Medical Insurance). If you have a Medicare Advantage Plan (like an HMO or PPO) but are planningto return to Original Medicare, you can apply for a Medigap policy before yourcoverage ends. The Medigap insurer can sell it to you as long as you’re leaving thePlan. Ask that the new Medigap policy start when your Medicare Advantage Planenrollment ends, so you’ll have continuous coverage. You pay the private insurance company a premium for your Medigap policy inaddition to the monthly Part B premium you pay to Medicare. A Medigap policy only covers one person. If you and your spouse both wantMedigap coverage, you each will have to buy separate Medigap policies. When you have your Medigap Open Enrollment Period, you can buy a Medigappolicy from any insurance company that’s licensed in your state. Any standardized Medigap policy is guaranteed renewable even if you havehealth problems. This means the insurance company can’t cancel your Medigappolicy as long as you stay enrolled and pay the premium. Different insurance companies may charge different premiums for the sameexact policy. As you shop for a policy, be sure you’re comparing the same policy(for example, compare Plan A from one company with Plan A from anothercompany). Some states may have laws that may give you additional protections. Although some Medigap policies sold in the past covered prescription drugs,Medigap policies sold after January 1, 2006, aren’t allowed to include prescriptiondrug coverage. If you want prescription drug coverage, you can join a MedicarePrescription Drug Plan (Part D) offered by private companies approved byMedicare. (See pages 6–7.) To learn about Medicare prescription drug coverage,visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call1-877-486-2048.
14Section 2: Medigap BasicsWhen’s the best time to buy a Medigap policy?The best time to buy a Medigap policy is during your Medigap Open EnrollmentPeriod. This period lasts for 6 months and begins on the first day of the monthin which you’re both 65 or older and enrolled in Medicare Part B. Some stateshave additional Open Enrollment Periods including those for people under 65.During this period, an insurance company can’t use medical underwriting todecide whether to accept your application. This means the insurance companycan’t do any of these because of your health problems: Refuse to sell you any Medigap policy it offers Charge you more for a Medigap policy than they charge someone with nohealth problems Make you wait for coverage to start (except as explained below)While the insurance company can’t make you wait for your coverage to start, it maybe able to make you wait for coverage related to a pre-exis
Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare prescription drug coverage (Part D). For more information . Remember, this guide is about Medigap policies. To learn more about Medicare, visit Medicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE (1‑800‑633‑4227).
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Medicare Advantage Plans, stand‑alone Medicare drug plans, employer/ union group health coverage, Medicaid, or TRICARE. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the . Medicare‑approved amounts for covered health care costs. Then, your Medigap policy pays its share. Medicare doesn't pay any of the
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