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In short What Medigap actually does Your one-time buying window If you miss the window What it costs How to choose Common questions SourcesMedigap, also called Medicare Supplement Insurance, is a private policy that helps pay your share of costs in Original Medicare, like deductibles and coinsurance. The most important thing to know is timing: you get one 6-month window, starting the first month you have Part B, when companies must sell you a policy regardless of health. Miss it, and they can usually turn you down.
What Medigap actually does
Original Medicare (Part A and Part B) leaves you paying deductibles, coinsurance and copayments. A Medigap policy, sold by private insurance companies, pays some or all of those costs depending on the plan letter you choose. Medicare.gov notes that Medigap only works with Original Medicare: you cannot use it with a Medicare Advantage plan.
Your one-time buying window
Your Medigap Open Enrollment Period starts the first month you have Part B and are 65 or older, and ends 6 months later. It does not repeat every year. During this window, an insurance company cannot refuse to sell you a policy, charge you more because of health problems, or make you wait for coverage to start, beyond limited rules for pre-existing conditions.
If you miss the window
After your Medigap Open Enrollment Period, companies can generally use medical underwriting: they can deny you a policy or charge more based on your health. There are exceptions called guaranteed issue rights, for example when you lose certain other coverage, and some states give you additional rights. Medicare.gov suggests checking with your State Insurance Department.
What it costs
You pay the insurance company a monthly premium for the Medigap policy, on top of your Part B premium. Prices vary by company, plan letter, where you live and how the company prices its plans, so comparing several companies for the same plan letter is worth the effort: the benefits for a given letter are standardized in most states, but the premiums are not.
How to choose
First decide between Original Medicare plus Medigap and Medicare Advantage, because they are different ways to get coverage; our guide on Medicare Open Enrollment covers switching. If you go the Medigap route, compare plan letters by what they cover, then get quotes from several companies for the same letter. People with Medicaid or certain other coverage usually do not need Medigap.
Common questions
Is Medigap the same as Medicare Advantage?
No. Medicare Advantage is an alternative way to get your Medicare benefits through a private plan. Medigap is add-on insurance that only works alongside Original Medicare. You generally have one or the other.
When exactly is my 6-month window?
It starts the first month you have Medicare Part B and are 65 or older, and runs for 6 months. Medicare.gov describes it as a one-time period that does not repeat each year.
Can I be denied a Medigap policy?
During your 6-month window, no. After it, companies can generally deny you or charge more based on health, unless you have guaranteed issue rights or your state gives extra protections.
Can Pymander answer Medigap questions?
Pymander can explain common Medicare terms and help you list what to compare, but it is not an insurance company or broker and does not sell or manage any policy. Pymander is available in all 50 states.