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How Medigap Works
Medigap can be purchased from private insurance companies in each state. There are 11 different standard Medigap plans that can be sold in most states. The 11 standard plans are labeled A-D, F, high-deductible F, G and K-N. Each of these plans covers different services. Starting 2020, Plan C and Plan F (including high deductible F) are no longer being sold to new Medicare beneficiaries including those who turn 65 or become eligible due to disability or diagnosis (ESRD, ALS) on or after January 1, 2020.
Massachusetts, Minnesota and Wisconsin all have their own standardized plans that can be purchased.
What doctors can be seen with Medigap?
With Medigap, any doctor can be seen whether they accept Medicare assignments or not.
If the doctor “accepts assignment,” meaning they agree to be paid the Medicare-approved amount for a service, Medigap insurance companies usually pay doctors directly.
If the doctor does not accept Medicare assignments, send claims to the insurance company and costs must be paid out-of-pocket.
Medigap plans generally do not pay for care received outside of the United States, except for medically necessary emergency care that occurs during the first 60 days of a trip.
Do you have a specific scenario and want to know your rights when buying a Medigap policy? Learn about your rights.
People who purchase a Medigap policy have certain rights which include:
Free look periods
Pre-existing condition wait periods
Guaranteed issue rights
These rights offer protection from being denied coverage. They also protect from having to keep a plan that is not a good fit. If consideration are being made about purchasing a Medigap plan, or already owned, keep these tips in mind.