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How soon after I enroll will my Medicare benefits begin?
Medicare beneficiaries need to know when their plan will be effective so they can avoid coverage gaps that could leave them without access to care they need.
The ‘birthday rule’: a gift to Medigap enrollees?
Medigap plan changes are limited, but 11 states offer Medigap enrollees special enrollment – and five do it with a 'birthday rule.'
Do Medicare supplement plans include prescription drug coverage?
Modern Medigap plans do not include prescription drug benefits. Instead, Medicare offers prescription drug coverage under Part D. Medicare enrollees can get prescription coverage either by switching to a Medicare Advantage plan or by purchasing a stand-alone Medicare Part D plan (PDP) to go along with Original Medicare.
Because Original Medicare covers a significant portion of its recipients’ healthcare expenses, eligibility for Medicare is a welcome milestone. But for all that Medicare covers, its enrollees learn quickly that Original Medicare doesn’t pick up the tab for everything.
Medigap plans limit Medicare enrollees’ out-of-pocket exposure, covering some or all of an enrollee’s copays, coinsurance, and deductibles (benefits vary by plan). Some Medigap plans also cover a portion of emergency medical expenses incurred during travel outside the United States and its territories. Medigap plans are sold by private insurance companies that agree to abide by federal Medicare guidelines.
A Medicare enrollee can only purchase a Medigap policy if he or she has Medicare Part A and Part B. Depending on where you live, you may or may not be able to enroll in a Medigap plan if you’re eligible for Medicare but not yet 65 years old. Medigap policies only cover one person — so if you and your spouse are both eligible for Medicare, you’ll each need to select an individual Medigap plan. (Some carriers offer a discount if both spouses select one of their plans.)
Medicare A and B both have deductibles. After the deductibles, Part A also has copays (and coinsurance for respite hospice care), while Part B has coinsurance. Part A copays start to accrue after 60 days in the hospital, or after 20 days of a covered stay in a skilled nursing facility. Part B coinsurance is 20% of the Medicare-approved amount. In both cases, there is no cap on how high the out-of-pocket costs can be. Medigap plans cover some or all of these deductibles, copays, and coinsurance, but the specifics vary from one plan to another.
Medigap Plans C, D, F, G, M, and N pay for a portion of emergency medical care when the enrollee is traveling in a foreign country. Also, Plans F and G can pay for excess doctor fees you may be charged under Medicare Part B if the doctor doesn’t accept assignment with Medicare.
Medigap plans H, I, and J cover prescription drug costs, but those plans have not been sold since 2005. They can still be used by people who bought them prior to 2006 and opted to keep them, but as of 2020, those three plans accounted for less than 3% of total Medigap enrollment.
Medigap plans are designed to cover some or all of the out-of-pocket expenses for services that Medicare covers. But with limited exceptions for care received outside the U.S., they do not cover care that’s not covered at all by Medicare.
The list of expenses that Medigap policies don’t cover includes long-term care in a nursing home, vision and dental care, hearing aids, eyeglasses, private-duty nursing care, or prescription drugs. Medigap plans sold since 2006 cannot include prescription coverage, as that’s when Medicare Part D became available. (Neither modern Medigap nor Original Medicare will cover outpatient prescription drugs, so enrollees can also purchase Part D prescription drug coverage, which is a separate policy with a separate monthly premium.)
Medigap policies are specifically designed to work with Original/Traditional Medicare. Medigap plans do not coordinate with other types of coverage, including:
Although Medigap plans are issued by private insurance carriers, the policies are standardized. In all but three states, there are up to ten different Medigap plans currently available: A, B, C, D, F, G, K, L, M, and N (not all plans are available in all areas), and there are also high-deductible versions of Plan F and Plan G.
A note about a potential point of confusion: Medicare has a Part A (inpatient coverage), Part B (outpatient/physician coverage), and Part C (Medicare Advantage). These are not at all the same as Medigap Plan A, Plan B, and Plan C.
Also note that Medigap Plans C and F can only be purchased by a person who became eligible for Medicare prior to 2020.
Medigap plans are standardized, so a Plan G in Colorado provides the same coverage as a Plan G in California – although the insurers that offer the plans will be different, and the pricing will be different.
However, there are three states where Medigap plans are standardized differently:
America’s Health Insurance Plans (AHIP) reported that total Medigap enrollment in late 2020 stood at 14.4 million people – up from 13 million in 2016, but slightly lower than enrollment had been in 2019. (Medicare Advantage enrollment has been growing more sharply than overall Medicare enrollment, and Medigap plans cannot be used with Medicare Advantage plans.)
Plan F has long been the most popular Medigap plan, as it covers all of the out-of-pocket costs for services that are covered under both Part A and Part B. But it’s no longer available to newly eligible enrollees, and it also tends to be the most expensive of the Medigap plans (carriers set their own prices, so although the benefits are standardized, the prices can vary from one carrier to another).
As of 2018, more than half of all Medigap enrollees had Plan F, according to an AHIP analysis. But Plan G is quickly becoming a popular alternative – it covers everything Plan F covers except the Part B deductible, and it continues to be available to new enrollees, which is not the case for Plan F.
Although Medigap plans are standardized the same way in nearly every state – meaning that the benefits they provide are the same, regardless of which insurance company offers the plan – the prices vary considerably from one insurer to another. And of course, the prices also vary from one plan level to another, as each plan level provides different benefits. (For instance, Plan K will cost less than Plan G, because out-of-pocket costs are much higher under Plan K.)
You can see Medigap plan costs in your area by entering your zip code, age, gender, and tobacco status into Medicare’s plan finder tool. But just to give you an idea, Medigap Plan A for a 65-year-old non-smoker tends to range from around $70 or $80 per month to as much as $300/month or more. But in New York, where Medigap premiums don’t vary based on age, Plan A pricing starts at around $150. However, the same premiums would apply to an 85-year-old in New York, whereas an 85-year-old in most states would pay more than a 65-year-old.
Plan G, which is the most comprehensive Medigap policy available to newly eligible Medicare beneficiaries, tends to have premiums (for a 65-year-old) that start around $110 to $130 per month, and range well above $300 per month, depending on the insurance company that’s offering the plan.
But the high-deductible version of Plan G is much less expensive (because it has a $2,700 deductible that the enrollee has to pay before the plan starts to cover out-of-pocket Medicare costs in 2023), with premiums that can be as low as $30 per month. And Plan K, which splits costs 50/50 with the beneficiary (for most services) until the person’s out-of-pocket reaches $6,940 in 2023, also has premiums that can start as low as about $30/month, depending on the state and the insurance company. Plan L also tends to be less expensive, because it splits costs 75/25 with the beneficiary, up to an out-of-pocket limit of $3,470 in 2023.
The cost of a Medigap policy can vary with each insurance company. There are three ways in which insurers set Medigap rates:
Make sure you enroll as soon as you’re eligible, in order to get coverage that’s guaranteed issue with no premium rate-ups based on your medical history. This means signing up for Medigap during the six-month window that starts when you’re at least 65 and enrolled in Part B (in many states, disabled Medicare beneficiaries under age 65 also get a six-month window to enroll in Medigap, but that’s not universally available). See more details about this below.
Some Medigap carriers offer discounts that might apply to you. Some insurers offer discounts for women, non-smokers, married people, and for paying annually. States also offer a health insurance assistance program, providing up-to-date Medigap insurance information and a list of qualified private insurers. Learn about your state’s assistance programs.
Medigap premiums are paid directly to the private insurance carrier that provides the plan. You may opt to receive an invoice and pay the bill yourself, or have the premium automatically drafted from your bank account. You can generally opt to pay monthly, quarterly, or annually.
Note that your Medigap premium will be in addition to your Medicare Part B premium (and Part A if you have a premium for that, although most people do not). And if you have a stand-alone Part D prescription drug plan, that will have another separate premium. For most enrollees, the Part B premium is simply deducted from their Social Security check, whereas the Medigap and Part D premiums have to be paid separately to the insurance companies that provide the coverage.
Medigap policies are available in every state, from private health insurance carriers. All Medigap insurers must abide by strict state and federal laws. In most states, Medigap carriers must offer standardized policies that are identified by the letters “A” through “N.” There are a total of ten different plan designs: A, B, C, D, F, G, K, L, M, and N (plus high-deductible versions of plans F and G).
It’s important to note that insurance companies offering Medigap policies are not required to offer every Medigap policy. However, if a carrier offers any Medigap policy, it is required to also offer at least Medigap Plan A, as well as either Plan D or Plan G if the enrollee is new to Medicare, and either Plan C or Plan F if the enrollee became eligible for Medicare prior to 2020.
Although the price varies from one carrier to another, the plan benefits are the same from one state to another and from one carrier to another, within each letter. So all plan Ks, for example, offer the same benefits — regardless of where you live or what insurance carrier you use. But as described above, insurers can use different rating rules in terms of how premiums change over time.
In some states, not all types of Medigap coverage will be available. In other states, you may be able to purchase Medicare SELECT – a Medigap policy that requires plan holders to use specific hospitals and, in some cases, specific doctors. Any of the ten Medigap plan designs can be offered as a Medicare SELECT plan, and they tend to be less expensive than typical Medigap policies due to the restricted network. If you choose a Medicare SELECT plan and use a provider that’s not in the network, your Medigap plan won’t pick up your Medicare out-of-pocket costs unless it’s an emergency.
No, unless you had a Medicare SELECT plan and you’ve moved out of the plan’s service area (in that case, you’ll have a guaranteed-issue right to purchase any Medigap Plan A, B, C, D, F, G, K, or L that’s sold by any insurance company in your state (keeping in mind that Plans C and F are only available to people who became eligible for Medicare prior to 2020). If you have a standardized Medigap plan, you’ll be able to keep it in the new state. But you’ll need to notify the insurer of your new address, and your premium will likely change at that point.
Instead of keeping your existing plan, you have the option to apply for a new Medigap plan in your new state. But in most cases, the insurer will be able to use medical underwriting to determine your eligibility and pricing. Here’s more about what you need to know about Medicare if you move to a new location.
The best window of time in which to buy a Medigap policy begins on the first day of the month in which you’re at least 65 and enrolled in Medicare A and B. (You have to be enrolled in both Medicare A and B in order to get a Medigap plan.) This is the start of your initial enrollment period, and it lasts for six months. Under federal rules, Medigap coverage in every state is guaranteed during this window.
If you’re eligible for Medicare because of a disability, the majority of the states offer at least some sort of guaranteed issue enrollment periods for those under 65. (In many cases the coverage is more expensive for those under 65. (Contact your state SHIP office or Department of Insurance for more details).
If you wait to buy a policy until after your initial enrollment period, your carrier generally has the option of denying the application or charging a higher premium based on the company’s underwriting requirements, as there is no federal requirement that Medigap plans be guaranteed-issue outside of the initial enrollment window and very limited special enrollment periods. But states can set their own regulations for Medigap plans, and several have added annual opportunities that allow people to switch to a different Medigap plan without medical underwriting:
Check with your state SHIP or your state’s Department of Insurance for more information about state-based regulations regarding Medigap.
An insurer can’t make you wait for your coverage to start, but it can make you wait for coverage of a pre-existing condition – and may also refuse to cover your out-of-pocket costs for that pre-existing condition for up to six months during a pre-existing condition waiting period. That said, if you recently had “creditable coverage” – or if you have guaranteed issue “Medigap protection” – you may be able to shorten or avoid entirely the waiting period.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.