Retirement Medigap

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A Medigap policy is a health insurance policy sold by private insurance companies to fill the "gaps" in the Original Medicare Plan. Medigap policies help you pay some of the health care costs that the Original Medicare Plan does not cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare will pay its share and your Medigap policy will pay its share of your health care costs. Separate Medigap policies must be purchased for both you and your spouse. Your Medigap policy won't cover any health care costs for your spouse.

Currently, there are twelve standardized Medigap plans called "A" through "L." Each plan, A through L, has a different set of benefits. Plan A covers only the basic (core) benefits. Medigap Plans B through L offer extra benefits. Typically, Medigap policies do not cover long-term care, vision or dental care, hearing aids or private-duty nursing. If you live in Massachusetts, Minnesota, or Wisconsin, different types of standardized Medigap policies are sold in your state.

In order to buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium to Medicare. In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable.

You may not be able to purchase a Medigap policy if:

  • You are in a Medicare Advantage Plan (like an HMO, PPO, or PFFS).
  • You have Medicaid (there are certain exceptions).
  • You already have a Medigap policy (unless you are canceling your old Medigap policy).
  • You are under age 65 and you are disabled or have End-Stage Renal Disease (ESRD).

The Medicare Modernization Act of 2003 (MMA) provides Medicare recipients more choices in health care coverage and better health care benefits.  One of the new benefits under the MMA is that Medicare will start to offer prescription drug coverage starting January 1, 2006. Some Medigap policies offer prescription drug coverage, and the new Medicare prescription drug coverage will affect those policies. Beginning January 1, 2006, when Medicare prescription drug plans start, you will not be able to buy a new Medigap policy covering prescription drugs. These same policies may still be sold, but without prescription drug coverage.  If the Medigap policy that you have now covers prescription drugs, you will get detailed information in the mail from your Medigap insurance company about your drug options. You will need to decide which drug option best meets your needs.

To learn more about Medigap policies:

  • Read the joint publication by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners titled - Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.
  • Read Medicare & You - available through the Department of Health & Human Services
  • Call 1-800-MEDICARE
  • Visit the official Medicare website at

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