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Your Medigap Rights

Medigap rights ensure that you are able to obtain insurance in situations where it would have otherwise been impossible. In short, your rights include:

– The ability to purchase Medigap insurance even if you have a pre-existing condition
– Medigap insurance must cover your pre-existing condition
– Medigap rates cannot be raised based on present or past health conditions
– Additionally, in many cases a Medigap insurance company is obligated to sell you a policy if you have lost or dropped some other form of health care coverage

Following are some more important facts about your Medigap rights. This information can help you know when you are entitled to Medigap insurance and which forms of insurance you cannot be prevented from buying.

If you are in a Medicare Advantage Plan and this plan leaves Medicare, goes bankrupt or stops providing coverage for your area, you have the right to buy a Medigap A, B, C, F, K, or L health care plan. This can be done as early as sixty days before the end of your present health care coverage or as late as 63 days after your former plan has expired.

If you are enrolled in an Original Medicare plan, employer ground health plan, COBRA coverage, retiree plan or union plan and said plan is ending, you have the right to buy Medigap plan A, B, C, F, K, or L. What is more, you may have additional rights under state law.

When you have an original Medicare and Medicare SELECT policy and move out of this policy’s service area, you have the right to purchase any one of the Medigap plans noted above. You can buy one of these policies either from the state you are presently residing in or the state you are moving to.

It is important to note that there are some cases where a person who drops or loses health care coverage is not entitled to purchase a Medigap policy. In order to ensure that your Medigap insurance purchase is not rejected, it is advisable for you to keep a copy of any letters, notices and/or claim denials that you have received from your present or former health care provider. Be sure to keep the envelope as well, as it will prove when the papers in question were mailed to you. Whenever possible, purchase your new Medigap policy before your current policy expires, as doing so ensures that you have the health coverage you need, when you need it.

Medigap – the official Medicare supplemental insurance program – is used by nearly 25% of individuals who are on Medicare. Due to the gaps in coverage found in the traditional program, Medigap insurance helps to make medical expenditures a bit more predictable for those who it covers. This particular document covers not only the basics of Medigap, but also covers some of the information that would-be recipients may need to know before purchasing a plan.


Medigap insurance enrollment numbers have changed relatively little over the last few years. About one in four individuals who receive Medicare have this sort of policy, but these numbers vary by state – some states see less than five percent enrollment, while others exceed fifty percent. Most recipients have plans that cover Part A and B deductibles, covering so-called “first-dollar” costs.

Medigap Rates

For most, Medicare rates are under two-hundred dollars per month. Premiums vary, of course, but most costs are fairly low. As you might expect, plan costs tend to see the most variation across states, with prices varying from about one-hundred and fifty dollars a month to two-hundred dollars per month. Premiums do seem to be rising, but at the same rate as general Medicare spending.

Premium Variations

As with most types of insurance, Medigap plans do tend to vary in cost by factors such as gender, age, and whether or not you smoke. Costs are higher for those under 65, while costs tend to be particularly lower for those eighty-years old or older. Men have higher rates than women, and (as expected) smokers see greater costs than those who do not smoke.

Enrollment Distribution

Most people who have gap coverage tend to have plans with low premiums. Most beneficiaries actually enroll in the plans that have the lowest overall costs. Regardless of other coverage, it seems that most individuals who seek out this sort of coverage tend to do so in a way that minimizes their costs.


Medigap insurance is an incredibly important supplemental program for those with Medicare but without retirement coverage. One in four individuals has this form of coverage, and those who live in rural states tend to be more likely to have coverage than those elsewhere. As the future unfolds, it seems particularly likely that that this form of coverage will remain important. The only foreseeable issues will arise if those in the government seek to actively discourage the use of these products.

Medicare Supplement Plan F is popular and definitely the most comprehensive policy offered under Medigap insurance. The details of this ‘first dollar’ coverage remain the same no matter what state regulates its implementation. However, there are differences in the Medicare Plan F Premiums insurance and two factors that impact the cost.

The Gender Issue
An analysis of Plan F across five states showed a difference in premium payments between men and women. There was also a link to age as the premiums for younger female adults were higher than the male young adults. However, once the focus shifted to premiums paid by 65-year olds, there was a dramatic change in gender-specific payments.

On the average, men in the five states reviewed were paying eight percent higher than women for the same policy and benefits. The actual range of differences in premium costs according to gender is quite large. There are companies which charge the same rate for both genders and there are other insurance providers which charge men up to 20 percent more than women. Specific moderate examples are the six percent men are charged more than women in Florida and the ten percent more in Louisiana.

It is interesting to note the findings reported in the 2009 Medicare Current Beneficiary Survey (MCBS) released by the Centers for Medicare & Medicaid Services. Medicare costs per male policyholder are eight percent more than for a female policyholder of Medigap benefits. The fact that male beneficiaries of Medigap receive more healthcare services might be a rationalization for increased premiums.

The Smoking Factor
The MCBS 2009 Cost and Use File also reported that Medigap insurance policyholders who were smokers cost Medicare 16 percent more than the non-smokers. This significant discrepancy in cost of healthcare services is reflected in the range of Medigap rates charged to smokers and non-smokers. Although there are some Medigap plans that charge the same premium for smokers and non-smokers, the smokers usually have to pay more for the same coverage. There are some premiums that are 50 percent higher for smokers.

The average premium is 12 percent higher for smokers given the same policy and benefits. Two specific examples are the differences of 6 percent in Florida and 14 percent in Louisiana in the non-smokers’ favor. It is easy to conclude that gender and smoking have an impact on the Medigap rates for insurance, particularly Plan F. However, it must be noted that neither factor is as significant as age.

Medigap insurance policies can range in pricing. The same amount of coverage and policy limits can vary from one insurance company to the next. If you are shopping around to compare prices, make sure you are comparing the same type of Medigap policies.

Premiums are set in place by each individual insurance company for Medigap plans. You can inquire with each company as to how they price their Medigap plans. Their method of pricing can make a difference in how much they charge for policies now and in the future. There are three separate ways that Medigap plans can be priced or “rated”:

Community-Rated or No-Age Rated
With this type of pricing, everyone who is insured under the policy will see the same monthly premium, no matter their age. However, premiums can increase due to inflation and other factors. This means that if you are 65, but your spouse is 75, you will both still pay the same monthly Medigap policy premium.

Issue-Age-Rated Policies
For this type of policy the premium is based on the age of the policy holder at purchase. Younger policy buyers will see lower prices. The premiums will not change as you get older, but can increase for other reasons, such as inflation or other factors. For example, you buy a Medigap plan at age 65 for $140 per month. However, your neighbor is 78 when he purchases his policy, so his monthly premium is $185.

Unlike the other two pricing policies, this plan is based on your current age. This means that your policy premium will go up as you get older. In addition, they can increase based on other factors, such as inflation. For example, you are 65 when you buy your Medigap policy. You will pay $120 per month to maintain your coverage. Your premium will go up each year as you get older. At age 66, you may pay $126 per month. At age 67, it might increase to $132. At age 72, you might be paying $165 per month. However, if your sister is 72 at the time she purchases her Medigap plan, her premium might start higher at $165 per month. It will then go up from $165 each year as she gets older.

Other Factors that Influence Cost
Many other factors can contribute to the price of your Medigap rates, either at the time of purchase or anytime throughout the life of your policy. Certain insurance companies can offer various discounts based on gender, marital status and whether or not the policy-holder smokes. Some will offer discounts if you pay with electronic funds transfer. Selecting a policy that requires you to use certain care providers may reduce your monthly Medigap premium amount. Increasing your deductible for Medigap Plan F can also decrease the monthly premium amount.

For most people over 65, Medicare coverage is vital, to ensure you are able to receive the basic medical services you need as you get older. However, there are several areas of medicine for which Medicare doesn’t cover you, and in order to provide this additional coverage, you can choose to buy a separate policy, called Medigap. There is a choice of 10 different Medigap plans, plans A-N, and the one chosen by the largest number of people is Plan F.

What it Covers
So what makes this plan so right for so many people? Medicare coverage has gaps in 9 specific areas, many of which could be very important as you get older, and if you find you need these, you will have to pay for them yourself, unless you have Medigap insurance. Plan F is actually the only one of the Medigap plans that covers all 9 of these areas.

Even Plan F doesn’t cover everything — you still have to pay your Part B premiums every month, plus your premiums for Part D drug coverage. However, the great thing is that all these are taken directly from your Social Security payments once they start, so you don’t need to worry about them. What’s more, when you receive a service that’s covered by the plan, you don’t have to file a separate claim — Medicare sends your claim directly to your Medigap insurance provider for payment. So Plan F is made as stress-free as it possibly could be.

Alternatives to Plan F
Although Plan F is the most popular, it may actually turn out that a different plan is more advantageous for you. One reason this may happen is if the difference in Medigap rates between Plan F and another plan is greater than the extra benefit you receive from Plan F. For instance, the only difference in coverage between Plan F and Plan G is the Part B deductible of $147 per year, but if the premiums for Plan G cost you $20 less per month, this would work out at $240 less per year, which would more than cover the $147 difference — so Plan G would be more beneficial for you. In order to find the plan that is best for you, you can let us help you get a Medigap quote.

All this no doubt seems incredibly complicated, but we at are here to help you. Our aim is to ensure you find the best Medigap insurance plan for your needs, whether it’s Plan F or a different one. Please feel free to get in touch with us at any time, with any questions or concerns you may have.

Medigap aims to provide additional medical insurance coverage for people on a Medicare plan, especially those who do not have the option to enjoy pensioner benefits (as provided by employers). This also applies to people who do not meet the requirements for Medicaid insurance. Just under a quarter of all Medicare clients have supplemented their medical insurance with Medigap insurance policies. Not surprisingly, there are a higher number of Medigap clients living in rural areas. Between 2006 and 2010, the rate of Medigap enrolment has remained mostly stable, even though other forms of medical insurance coverage have become available. Most people under the swathe of Medigap plans enjoy the benefit of being covered for Plan A and B deductibles as well as a few other Medicare cost-sharing obligations. These plans are fairly popular because they drastically reduce the potential for unexpected additional costs.

A few policymakers have suggested that Medigap coverage be discouraged. This would be their attempt at lowering the debt and deficit which causes the company so much trouble. The aforementioned restrictions would in turn necessitate more cost-sharing responsibilities. Naturally, these additional obligations could push policyholders to avoid looking for additional services provided by Medicare. Some want to charge the maximum allowable price for both Medigap and employer-sponsored pensioner health schemes. Others would only prohibit a first-dollar policy to new customers, leaving existing policyholders in the clear.

For beneficiaries, there would be cost implications hand in hand with proposals aimed to restrict Medigap plans coverage. If a premium surcharge happens, as many as five million 2010 first-dollar policy holders could have raised medigap rates. Premium surcharges would not affect current policyholders and fewer beneficiaries would choose the first-dollar option in the future. As could be expected some beneficiaries may experience lower out-of-packet costs while others who suffer comparatively poorer health or who have multiple hospital visits could be faced with more expensive care in years to come.

In the future, Medigap might continue to do great work in supplementary medicare, especially if Medicare Advantage crumbles in the face of reduced ACA payment or if employees slow on providing pensioner coverage. If cost-sharing needs rise to lower deficits, the demand for Medigap may rise as people seek more financial protection. Alternatively, demand could slow as time goes on if policymakers bring about changes to discourage or totally prohibit the purchase of Medigap policies in a part of a wider effort to stop an increase in Medicare spending.

For many seniors, the combination of Medicare and Medigap policies means freedom from worry about medical treatment costs. A Medigap policy typically pays “first dollar,” which means that these plans cover the deductibles and coinsurance that Medicare does not. Seniors with a good Medigap policy can receive the treatment they need, both inpatient and outpatient, at no additional cost to the premium payments.

Recently, these policies have been blamed by some analysts as a cause for rising government debt, since critics feel that some policy holders may seek unnecessary treatment and their doctors may order unnecessary tests. They believe that seniors who have to pay deductibles and coinsurance will be unlikely to seek unnecessary medical attention simply because they will not be able to afford the doctor visits.

As proponents of Medigap insurance point out, these additional costs may well discourage seniors from seeking necessary medical help. Low Medigap rates allow seniors to seek care when they need it and not when they can afford it. Financial constraints can certainly cause the elderly to ignore physical symptoms that should be treated, resulting in serious illness and lengthy hospital stays.

Since states have standardized the benefits of Medigap plans, seniors face simplified choices for coverage. Many choose the most inexpensive plans simply due to family budget constraints. However, some in government have suggested these policy holders be required to partially share in the cost of their deductibles and coinsurance, but The National Association of Insurance Commissioners (NAIC) studied the proposals for cost sharing and decided that no such plan was currently necessary.

The number of people who will need Medigap insurance may well be on the rise, since many employers no longer give coverage to those on Medicare. Also, the cost of Medicare Advantage fluctuates, and seniors cannot afford uncertainty where their medical expenses are concerned. The safest route for most to take is the combination of Medicare Part A, Part B, and Medigap. Prescription coverage through Part D is also a wise choice for many.

Medigap insurance enables those on Medicare Part A and Part B to receive the medical attention they need without worrying about the cost of deductibles and coinsurance. These plans are affordable for many and play a vital role in maintaining the health of the nation’s elderly. While some abuse of the system may occur due to this “first dollar” coverage, the benefits of these plans currently outweigh the negative consequences of this system.

Many people, even those eligible for the four-part program, are confused about Medicare. They have crucial questions about coverage, such as the cost of hospital stays and the prices of prescription drugs. They also do not understand the differences between Medicare, Medigap other insurance options.

The Medicare program is divided into four parts. Every Medicare plan automatically includes Parts A and B, which cover hospital costs and general health insurance respectively. Medicare Advantage is Part C and it offers an alternative form of coverage that includes certain extra benefits. Those who do not choose Part C may use Part D to cover the costs of their prescription drugs.

Medigap is a separate type of coverage for people using Medicare. It is a private insurance which helps clients to pay for things not covered by any type of Medicare. Such gaps in coverage might include co-payments or coinsurance costs at a rehabilitation hospital.

Medigap offers 10 plans. Like Medicare, each plan is represented with an alphabetical letter. They range in coverage from the most comprehensive to the least.

Most states permit you to purchase Medigap plans through insurance companies while requiring the plans to be equivalent to those offered in other states. Massachusetts, Minnesota and Wisconsin have made some alterations to the way that these plans are used. Premiums differ according to the benefits included and these prices remain separate from Medicare premiums.

Even if you suffer health problems, you can renew your Medigap insurance. Insurance carriers cannot terminate policies as long as clients continue paying premiums. However, Medigap rates do differ depending on age, location and do not cover a variety of circumstances, such as long-term care or hearing aids.

Medicare Advantage is a good alternative to the combination of Medicare and Medigap. The Advantage alternative offers the benefits found in Medicare A and B but usually with lower co-payments. However, there are sections of the Advantage Plan which cost more. Furthermore, Advantage plans typically require clients to see in-network providers and require referrals from primary doctors.

Medigap plans offer a larger network of providers but it may cost a little more upfront than Medicare Advantage. However, it can save you in the long-run if you expect a lot of treatments.

Once you turn 65, you have six months to choose a Medigap plan. After that juncture, there are some possibilities of still signing up but your options will be limited.

Medicare helps a large number of Americans be able to receive the healthcare that they need. However, sometimes there are still gaps in Medicare plans that still require patients to pay deductibles, copayments, and coinsurance amounts. For some patients, it can be a large burden to fill in these financial gaps.

With this in mind, some private insurance companies have created Medigap insurance plans, also known as a Medicare supplement. Medigap plans can help cover what Medicare does not, including medical care when traveling outside of the United States. Purchasing a Medigap policy will allow a patient to continue to use all of their Medicare benefits, in addition to the extra benefits provided by the extra policy.

It is also important to understand that a Medigap insurance plan is different from a Medicare Advantage Plan. A Medicare Advantage Plan is a way to receive Medicare benefits. A Medigap policy is a supplement to the Medicare benefits already in place.

Important Things to be Aware of Concerning Medigap Plans

  1. To qualify, you must have Medicare Part A and Part B.
  2. You can apply for a Medigap plan while still under a Medicare Advantage Plan. However, you must leave the Medicare Advantage Plan before the Medigap policy commences.
  3. You will pay a monthly premium for the Medigap policy, along with the monthly premium you pay for Medicare Part B.
  4. Medigap policies only cover one person. Each spouse will be required to have his or her own plan in place.
  5. Medigap plans can be purchased from any insurance company that is licensed in your state to sell them.
  6. Most Medigap policies are guaranteed to be renewable, even if you have additional health problems. As long as you continue to pay the premium, your policy cannot be cancelled.
  7. Medigap policies purchased after January 1, 2006 do not include prescription drug coverage. To receive this coverage, you must join a Medicare Prescription Drug Plan (Part D).
  8. If you already have a Medicare Medical Savings Account (MSA) Plan, it is illegal for any company to provide you with a Medigap policy.

It is also important to understand that Medigap policies do not generally cover everything. Most do not provide coverage for long-term care, vision, hearing aids, dental care, private-duty nursing, or eyeglasses.

Non-Medigap Plans
The following are not Medigap plans:

Cancelling Your Medigap Policy
Some patients decide they want a different Medigap policy or that they want to use a Medicare Advantage Plan that provides prescription medication coverage instead. If, for whatever reason, you decide to drop your entire Medigap policy, be aware of the timing.

If you cancel your Medigap plan policy and the coverage was not creditable, or you go more than 63 days before your new Medicare plan starts, you will be required to pay a late enrollment fee for the Medicare Prescription Drug Plan, if you choose one.

One of the innovations within the Medicare program is the addition of Medigap policies. Medigap is designed as a separate insurance supplement to Medicare and pays some of the health care costs that are not covered by Medicare. Some Medigap insurance provides additional benefits beyond what Medicare covers.

Medigap plans are sold by insurance companies and are required to follow all related federal and state laws and are sold under specified guidelines:

Medicare Parts A and B must be in force to qualify for a Medigap plan. Medicare Part A is free and Part B carries a monthly premium. Medigap supplements both parts.
Plans must be “standardized.” In other words, these plans must provide a standard set of benefits and have “Medical Supplemental Insurance” clearly printed on the policy.
Spouses must purchase separate Medigap insurance because their coverage is attached to their individual Medicare accounts.
In many circumstances, insurance companies cannot refuse coverage due to preexisting conditions.
As long as the premium is paid, the coverage is renewable.

It is important to distinguish between Medigap and Medical Advantage Plans. Medigap supplements Medicare while a Medical Advantage Plan provides a means to get Medicare benefits. A person covered by a Medical Advantage Plan cannot purchase Medigap coverage.

Purchasing a Medigap Plan

There are several critical issues in the Medigap program surrounds that consumers need to understand. Medigap plans do not cover:

long-term care
vision care
dental care
hearing aids
private nursing care

The easiest and most advantageous time to enroll in Medigap is during the Medigap Open Enrollment Period. During this time frame, an application cannot be denied because underwriting is not permitted – even if the applicant has a preexisting illness. Coverage must also be provided to persons with a “guaranteed issue right.” A guaranteed issue right covers certain health care policies that change in some way such as losing coverage under another Medicare related policy. Under some conditions, Medigap policy holders have to wait six months before a preexisting condition is covered.
Medigap rates are another major consideration because rates do vary with insurance issuers and the types of policies they offer. The three most common types of rate structuring are:

Community rated – Under this structure age is not considered. The age covered persons enter at, regardless of age, is the same.
Issue rated – These rates vary with the entry age of individuals and remain constant.
Attained age – This type of coverage sets the premium when coverage begins and increases over time as covered individual’s age.

There are at least two more detailed and informative sources of information on Medigap insurance. One source is online at and in a publication titled “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.” This publication, along with several other relevant publications can be viewed at the website provided above.

Compare Medigap Plans Online