Topics on this page:
- Companies that Sell Medigap Policies
- Health Screenings
- Waiting Periods
- Medicare SELECT Plans
- Medigap & Medi-Cal
Medigap policies are sold through licensed insurance agents, sponsoring groups or through the mail by private insurance companies. You only need one policy, and it is illegal for an insurer to sell you more than one.
By law, companies can only offer 10 standardized Medigap policies, known as plans A-N. (These plans are labeled A, B, C, D, F, G, K, L, M and N. Previous plans labeled E, H, I and J are no longer sold. If you have one of these plans you can still use your benefits as long as you continue to pay the premium.) Standardized plans have the same benefits, regardless of which company sells them. This makes it easy for you to compare premiums for the same lettered policy, quickly and easily.
For more info on the Medigap changes, see: FAQs on the New Standardized Medigap Policies Available June 2010.
The California Department of Insurance regulates the companies that sell most Medigap policies. The Department of Managed Health Care regulates Medicare SELECT policies, which are a combination of a Medigap policy and a managed care plan.
Note: Retiree plans offered by former employers and unions are not required to conform to the standardized Medigap requirements. These plans are not called Medigap policies, even though they work in much the same way as a Medigap policy.
Once you buy a Medigap policy, the company that sold it to you cannot change the benefits covered by the plan or cancel the policy unless you fail to pay the monthly premium. The company can, however, increase the premium you pay. For more information, see Medigap Premiums.
You may apply for a Medigap policy at any time, but companies selling these policies can refuse to sell you one because of a past or current health condition. Insurance companies may require that you undergo a health screening (also known as medical underwriting) before they sell you a Medigap policy.
During certain times, however, companies are required to sell you a Medigap plan, regardless of your health condition. These are:
- Open Enrollment, the 6-month-period that begins on your Medicare Part B effective date.
- Guaranteed-Issue Periods, which follow specific events that result in the loss of existing coverage.
- Other Guaranteed-Issue or Open Enrollment Periods under California Law.
Note: Beneficiaries younger than age 65 who have Medicare because of a disability have the right to buy a Medigap policy without a health screening during the first 6 months of their Part B coverage, unless they have End-Stage Renal Disease (ESRD). Companies are permitted to charge a higher premium for people who are younger than 65. For more information, see Medicare for People with Disabilities.
Certain companies that sell Medigap plans impose a waiting period before paying benefits for pre-existing conditions. By law, the waiting period may last up to 6 months, and only applies to conditions that were treated in the 6 months prior to the date you bought the plan. During this time, the company is not required to cover costs associated with your pre-existing condition. Some companies use a shorter waiting period of 30 or 60 days.
Companies may not impose a waiting period if:
- You had health coverage during the 6 months prior to purchasing a Medigap plan
- You are in a guaranteed-issue period
- You are buying a new Medigap policy to replace another one
Medicare SELECT plans must cover the same benefits as any non-SELECT lettered Medigap plan if you use the plan’s network for care. If you receive health care outside the plan’s network, you may need to pay for most or all of the costs. This is different from standardized Medigap policies, in which you can see any doctor or use any hospital that accepts Medicare. Certain Medicare SELECT policies may also require you to make a copayment when you visit a doctor, which is not permitted in standardized Medigap polices, except for the new Plan N (see chart for details).
Once you have purchased a Medicare SELECT policy, the company cannot change the benefits covered by the policy or cancel it unless you fail to pay the monthly premium.
If you have full benefits from Medi-Cal (California’s Medicaid Program), you do not need a Medigap policy. In fact, it is illegal for companies to sell you one.
If you have Medi-Cal with share of cost (SOC), you can buy a Medigap policy to fill in the coverage gaps or to see medical providers that don’t accept Medi-Cal patients. You must apply for it, though, during a month before you meet your share of cost.
If you have a Medigap policy when you become eligible for Medi-Cal, you have the option to keep it so you can see providers that don’t accept Medi-Cal. You can also request that your insurance company place your Medigap benefits on hold for up to 24 months (during this time, you will not be required to pay the premium). If you lose your Medi-Cal eligibility before the end of this period, you can reinstate your Medigap policy, but you must notify the company within 90 days of losing your Medi-Cal benefits. Your policy can be reinstated or you can buy a similar one. You will only be charged a premium from the date your Medigap benefits are reinstated or a new policy is issued. For more information, see Medi-Cal and Medicare Savings Programs.