What is Supplement / Medigap Coverage?

What is Supplement / Medigap Coverage?The best definition comes directly from Medicare.gov:  “Original Medicare pays for most , but not all, of the cost for health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the remaining health care costs, like co-payments, coinsurance, & deductibles. Medicare Supplement Insurance policies are also called MEDIGAP policies. Some Supplement/Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Supplement/Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.”

Understanding the “Rules” Behind Supplement / Medigap Coverage:

Supplement/Medigap policies are required to follow Federal & State laws which have been specifically designed to protect you.  These policies must be clearly identified as “Medicare Supplement Insurance.” In most states, including Florida, Insurance companies are only permitted to sell you a “standardized” policy. All policies offer the same basic benefits, but some offer additional benefits, so you can choose which one meets your needs.

Supplement/Medigap Coverage FACTS:

    • A Medicare Supplement/Medigap Insurance policy can help to pay some health care costs that Original Medicare does not cover, such as Copayments, Coinsurance, Deductibles, or medical care you may need if you become ill or injured while traveling outside of the United States.
    • Supplement/Medigap policies are not part of the the Federal Medicare insurance program. They are sold by private health insurance companies.
    • Things Supplement/Medigap policies usually DO NOT COVER are: long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
    • You must have Medicare Part A and Part B to be eligible to purchase a Supplement/Medigap policy.
    • Medicare Advantage Plan is NOT a Supplement/Medigap policy.
    • If your purchase a Supplement/Medigap policy you will pay a monthly premium for this coverage AND the monthly Part B premium that you pay to Medicare.
    • Supplement/Medigap policies ONLY cover one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
    • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
    • Supplement/Medigap policies sold after January 1, 2006 are NOT allowed to include prescription drug coverage. You can get prescription drug coverage with a Medicare Prescription Drug Plan (Part D).
    • If you have a Medicare Advantage Plan (instead of Original Medicare) it is illegal for anyone to sell you a Supplement/Medigap policy (Exception:  unless you are switching back to Original Medicare Coverage).


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These Plans


    • Medicare Advantage Plans (HMO, PPO, or Private Fee-for-Service Plan)
    • Medicare Prescription Drug Plans
    • Medicaid
    • Employer or Union Plans, (including the Federal Employees Health Benefits Program – FEHBP)
    • Veterans’ Benefits
    • Long-Term Care Insurance Policies
    • Indian Health Service, Tribal, and Urban Indian Health Plans

Medicare Help Florida Featured in Florida Today: "Making Sense of Medicare Part D"

In order to help retirees sensibly afford their medications, the federal government added Prescription Drug coverage, Medicare Part D, in 2006 to go along with Original Medicare Parts A (hospitalization) and B (medical). Part D is an optional United States federal-government program administered by private insurance companies to help Medicare beneficiaries pay for self-administered prescription drugs.

Mike R.
Senior Insurance Agent

Have a Quick Question about Supplement/Medigap? Ask Mike & Kim!

Kim A-C.
Senior Insurance Agent