Dear Marci, I’m considering buying a Medigap to help cover some of my costs under Original Medicare. I heard that the Medigap rules are changing, though. Will I still be able to purchase a policy? -Maureen (Portland, OR) Dear Maureen, Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage). They are sold by private insurance companies. Medigaps pay for part or all of certain remaining costs after Original Medicare pays first. If you want to purchase a Medigap policy, you should find the best time to buy one in your state. In most states, insurance companies must only sell you a policy at certain times and if you meet certain requirements. If you miss your window of opportunity to buy a Medigap, your costs may go up, your options may be limited, or you may not be able to buy a Medigap at all. Your state may also have additional Medigap enrollment rights. Contact your State Health Insurance Assistance Program (SHIP) to learn about your right to buy a Medigap policy in your state. You can contact your SHIP by calling 877-839-2675. Depending on where you live, you have up to 10 different Medigap policies to choose from: A, B, C, D, F, G, K, L, M, and N (policies in Wisconsin, Massachusetts, and Minnesota have different names). Each policy offers a different set of standardized benefits that ranges from basic to more comprehensive. Standardization means that policies with the same letter name offer the same benefits. However, premiums can vary from company to company. Starting in 2020, some Medigaps will no longer be available for sale to some Medicare beneficiaries. As a result of federal legislation, individuals who are newly eligible for Medicare on or after January 1, 2020 will not be able to purchase Medigap Plan C or Plan F (including the Plan F high deductible option). This is because after January 1, 2020, this law prevents individuals new to Medicare from purchasing Medigaps that pay for the Part B deductible ($185 in 2019). Both Plan C and Plan F cover the Part B deductible.   This law also applies to the three states (Massachusetts, Minnesota, and Wisconsin) that operate their own Medigap systems. People new to Medicare in those states will not be allowed to purchase Medigaps that pay for the Part B deductible.   If you are eligible for Medicare before January 1, 2020 These Medigap changes only affect individuals who are newly eligible for Medicare in 2020 and after.   If you are eligible for Medicare before January 1, 2020, you will still be able to purchase Plan C or Plan F. If you were eligible for Medicare before this time but you did not enroll, you will be able to purchase Plan C or Plan F as long as you are within your Medigap open enrollment period or have a guaranteed issue right once you enroll in Original Medicare (see question 6). (Remember that only those with Original Medicare can purchase a Medigap. Medigaps do not work with Medicare Advantage.)   If you currently have Medigap Plan C or Plan F, you can continue to renew it from insurers in your state. As always, premiums for Medigaps can change from year to year, and Medigap issuers may choose to discontinue plan offerings. Your right to switch plans if your premiums increase depends on your state’s laws. If your Medigap is terminated, you will have a guaranteed issue period.   If you are eligible for Medicare on or after January 1, 2020 If you are newly eligible for Medicare on or after January 1, 2020, you will not be able to purchase Plan C or Plan F. However, Plan D and Plan G currently provide coverage for all the same out-of-pocket costs, except for the Part B deductible coverage. -Marci

Dear Tanya,

Medicare supplement insurance policies, often called Medigaps, are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage). If you have a Medigap, it pays part or all of certain cost-sharing gaps that remain after Original Medicare pays first. Medigaps help cover outstanding deductibles, coinsurance charges, and copayments, to varying degrees. Some Medigaps also cover health care costs that Medicare does not cover at all.

Beneficiaries who enroll in certain Medigaps and see providers who accept assignment (accept Medicare’s approved amount as full payment for items and services) can eliminate most of the out-of-pocket costs for covered services. Remember, Medigaps only work with Original Medicare. People who have Medicare Advantage Plans cannot buy Medigaps.

Depending on where you live, you have up to 10 different Medigap policies to choose from: A, B, C, D, F, G, K, L, M, and N (policies in Wisconsin, Massachusetts, and Minnesota have different names). Each policy offers a different set of standardized benefits that ranges from basic to more comprehensive. Standardization means that policies with the same letter name offer the same benefits. However, premiums can vary from company to company.

Some costs are covered by all Medigaps. These include:

• Part A hospital coinsurance: The daily coinsurance change for days 61 through 90 you spend as a hospital inpatient during each benefit period. All Medigap policies also cover the full cost of 365 additional inpatient hospital days during your lifetime.
• The Part B coinsurance: All Medigaps cover at least some part of the 20% coinsurance for Medicare-covered outpatient medical services and items, like x-rays, durable medical equipment, and doctors’ visits.
• The first three pints of blood, if you are hospitalized and the hospital needs blood for a medical procedure or blood transfusion.
• Part A hospice care coinsurance or copay: All Medigaps cover the full cost of hospice coinsurance charges and copays for hospice-related drugs and respite care, as long as the Medigap was purchased on or after June 1, 2020.

Some Medigaps cover all or part of the following costs:

• Part A skilled nursing facility (SNF) coinsurance: Some Medigaps pay for your SNF coinsurance for all of your covered days in a benefit period.
• Part A deductible: Some Medigaps pay for your Part A inpatient hospital deductible, which is the amount you owe out of pocket at the beginning of a benefit period.
• Part B deductible: The Part B deductible is the amount you owe out of pocket before Part B begins to cover the cost of your outpatient care.
• Part B excess charges: Excess charges may only be charged by non-participating providers. These providers can charge up to 15% more than the Medicare-approved cost for services. If you have a Medigap that covers excess charges, your Medigap will reimburse you if you see a non-participating provider who bills for excess charges.
• Foreign travel: With very few exceptions, Medicare does not cover services you receive in a foreign country, but some Medigaps cover emergency health care when you are abroad. These Medigaps cover 80% of the cost of emergency health care abroad during the first two months of your trip, up to a lifetime limit of $50,000, after you meet a deductible.

Click here for a table that compares the different costs that Medigaps supplement

-Marci