Medicare Supplement (Medigap)

What is Medicare Supplement

Medicare Supplement Insurance — also known as Medigap — is private insurance that helps pay the “gaps” in Original Medicare (Parts A and B).
It is designed to cover out-of-pocket costs such as deductibles, copayments, and coinsurance that Medicare doesn’t pay.

Medigap policies are standardized and regulated by the Centers for Medicare & Medicaid Services (CMS) and are offered by private insurance companies.

Each Medigap plan is identified by a letter (A, B, C, D, F, G, K, L, M, N) and offers a different level of coverage, but the benefits for each lettered plan are identical across all insurers.

Medicare Supplement Coverage

Medigap Covered Services

Part A – Hospital & Inpatient Services:

Inpatient hospital costs and coinsurance, plus up to 365 additional days after Medicare benefits are used.
Part A deductible.
Hospice care coinsurance or copayments.
Skilled Nursing Facility (SNF) coinsurance.
Blood (first 3 pints each year).
Foreign travel emergency coverage (up to plan limits).

Part B – Medical & Outpatient Services:

Part B coinsurance or copayments for medical services.
Part B deductible (covered only by Plans C and F; not available to new enrollees after January 1, 2020).
Part B excess charges (100% covered by Plans F and G).

Medicare Supplement Standardized Plans

Medicare Supplement (Medigap) plans are standardized policies labeled A–N that help pay Original Medicare’s gaps (deductibles, coinsurance). For the same lettered plan, benefits are identical across insurers; what varies are premium, underwriting, rating method, and discounts—not provider networks (you can see any doctor who accepts Medicare). Medigap does not include Part D drug coverage. Due to MACRA, Plans C and F (including High-Deductible F) aren’t available to people newly eligible for Medicare on/after 1/1/2020; Plan G/HD-G are the closest alternatives. Policies are guaranteed renewable as long as premiums are paid.

Medicare Supplement Premium Cost

What is Medicare Access and CHIP Reauthorization Act (MACRA)
It’s a federal law passed by Congress that prohibited Medigap plans from covering the Part B deductible for people newly eligible for Medicare on or after January 1, 2020, leading to the phaseout of Plans C, F, and High-Deductible F for those new beneficiaries.

If you were newly eligible on/after 1/1/2020, you can’t buy C/F/HD-F. Most people choose Plan G (or High-Deductible G) as the closest alternative—same benefits as F except it does not pay the Part B deductible.

Rating Type	How It Works
Community-rated	Same premium for everyone, regardless of age.
Issue-age-rated	Based on your age when you first buy the policy; doesn’t increase due to age.
Attained-age-rated	Starts low but increases as you getolder. (Most common)

Monthly Premium Determination Factors

Here are the main factors that drive a Medicare Supplement (Medigap) monthly premium:

Age & rating method: Attained-age (rises as you age), issue-age (based on age when you buy), or community-rated (everyone pays same) — varies by state/carrier.
Tobacco use: Smoker rates are higher.
Gender & marital/household status: Where allowed, male rates can be higher; household discounts can lower premiums.
Health/underwriting: Outside guaranteed-issue windows, health history/height-weight can affect approval and price (or lead to a denial).
Enrollment timing: Applying during your Medigap Open Enrollment or a GI right avoids underwriting and sometimes yields better pricing.

Medicare Supplement Enrollment

When to Enroll in Medicare Supplement

To enroll in a Medicare Supplement (Medigap) plan, you must have Medicare Parts A and B and live in the plan’s service area. The best time to enroll is during your 6-month Medigap Open Enrollment Period, which starts when you’re 65 or older and enrolled in Part B. During this time, you have guaranteed acceptance—no health questions or denials. After this window, you can still apply, but insurers may use medical underwriting and charge more or deny coverage. Some people qualify for Guaranteed Issue rights if they lose coverage or leave a Medicare Advantage plan. Plans and costs vary by state, and under MACRA, Plans C and F are unavailable to those newly eligible for Medicare after January 1, 2020.

Enrollment Period	When You Can Enroll	Underwriting Rules
Medigap Open Enrollment Period	6-month window starting the month you are 65+ and enrolled in Part B	Guaranteed Issue: No health questions or denials
Special Guaranteed Issue Rights	Within 63 days of losing certain coverage (e.g., MA plan trial right, employer coverage ends)	Guaranteed Issue applies
Outside Open Enrollment	Any time of year	Medical underwriting may apply

Medigap Open Enrollment Period

What it is: It is a 6-month window that starts the first month you’re 65+ and enrolled in Part B.
Why it matters: You have guaranteed issue—you can buy any Medigap plan (A–N) sold in your state with no medical underwriting (no health questions, no denials).
Pricing: You’ll generally get the best available rate for your age/class; pre-existing conditions can’t be excluded.
If you delay Part B: Your 6-month window begins when Part B starts, even if that’s after age 65.
After it ends: You can still apply, but underwriting may apply (possible denial or higher premium) unless you qualify for a Guaranteed Issue right.
Under 65 (disability): Medigap availability/rules vary by state; many states offer a separate OEP at 65.

Special Guaranteed Issue Rights

What it is: A limited-time right to buy certain Medigap plans with no medical underwriting (no health questions/denials).
When it applies (common triggers): You lose employer/retiree coverage, your Medicare Advantage plan ends or you move out of its area, you use the 12-month “trial right” after first joining MA, or your insurer misleads/stops offering coverage.
Deadline: You typically must apply within 63 days of the qualifying event—keep your notices/creditable coverage letters.
What you can buy: A subset of standardized plans allowed in your state (often A, B, D, G, K, L; C/F only if you were Medicare-eligible before 1/1/2020 per MACRA).
Tips: Apply promptly, submit proof of the qualifying event, and compare carriers—premiums vary by company and state even under GI rules.

Outside Open Enrollment

You can do: You can apply anytime, but medical underwriting usually applies: insurers may deny coverage, rate you higher, or impose waiting periods (up to 6 months) for pre-existing conditions if you lack prior creditable coverage.
Exceptions: If you have a Guaranteed Issue (GI) right (e.g., losing employer/retiree coverage, MA plan ends or you move, 12-month MA “trial right”), you can enroll without underwriting—apply within 63 days.
State rules vary: Some states have birthday/anniversary or continuous enrollment protections.
Tips: Apply promptly after a qualifying event, keep documentation, and compare multiple carriers—rates and underwriting leniency differ.

Medicare Supplement Medical Underwriting

Medicare Supplement (Medigap) underwriting is the health-screening process most insurers use when you apply outside your one-time Open Enrollment Period (the first 6 months you’re 65+ and enrolled in Part B) or outside a Guaranteed-Issue (GI) situation. During underwriting, a carrier can review your medical history, recent conditions and treatments, medications, height/weight, tobacco use, and sometimes doctor or hospital records. Based on that review, the company may approve you, charge a higher premium, add a waiting period for pre-existing conditions (up to 6 months if you lacked recent creditable coverage), or decline the application. In GI situations—like losing qualifying employer coverage or using the “trial right” after trying an MA plan—carriers must accept you with no health questions. Some states add extra protections (e.g., birthday or anniversary rules for switching). Because rules vary by state and carrier, it’s smart to review timing and eligibility before applying.

Underwriting Area	Typical Rule	Common Look-Back	Notes
Eligibility window	If not in Medigap Open Enrollment or no GI right → medical underwriting required	—	OEP/GI generally bypass underwriting.
Phone interview	Short health interview often required	Current	Confirms application answers.
Rx history check	Carriers review prescription fill history	12–24 months	Confirms conditions/ stability.
MIB/records	May check MIB and request medical records	12–24 months	Not all carriers use MIB.
Height/Weight (BMI)	Must fall within carrier build chart	Current	Outside range → decline or rating.
Tobacco use	Smoker rates higher	12 months	Some carriers require smoke-free period for best rate.
Recent hospitalization/ surgery	Recent inpatient stay/major surgery may decline/postpone	3–12 months	Elective or pending surgery often postpones.
Pending tests/referrals	Undiagnosed symptoms or pending work-ups → postpone	Until resolved	Must have diagnosis/treatment plan.
Oxygen use	Current oxygen use usually decline	Current	Includes nocturnal O2 for COPD in many guides.
Mobility/ADLs	Wheelchair, ADL assistance, home health, or nursing facility → often decline	Current	Level of assistance matters.
Cancer (active/recent)	Active treatment or recent diagnosis often decline	2–5 years	In remission beyond window may be OK.
Cardiac events	Recent MI, stent/bypass, heart failure exacerbation → decline/postpone	6–24 moths	Stable CAD with meds may pass.
CHF (heart failure)	Symptomatic or recent hospitalization → usually decline	2 years	Controlled, no recent events may pass with some carriers.
Stroke/TIA	Recent stroke/TIA → decline/postpone	2 years	Older events with full recovery may pass.
Diabetes	Insulin + complications (neuropathy, retinopathy) → decline with many carriers	2 years	Oral meds and A1c control may pass.
CKD/ESRD	Dialysis/ESRD → usually decline	Current	Earlier CKD stages vary by carrier.
Dementia/Alzheimer’s	Usually decline	Current	Cognitive screens may be used.
Substance abuse	Active alcohol/drug abuse → decline	2 years (sustained recovery)	Documentation of recovery may help.
Mental health	Severe, unstable, or recent psych hospitalization → decline/postpone	1–2 years	Stable, well-managed often OK.
Sleep apnea	Untreated, severe → postpone/decline	Current	Treated with CPAP and compliant often OK.
Auto-declines (varies)	Organ transplant, metastatic cancer, ALS, schizophrenia (varies) → often decline	—	Carrier-specific.
State exceptions	Some states have birthday/anniversary rules or continuous access	—	Eases switching without underwriting.
Rate classes/discounts	Household/EFT discounts; tobacco surcharge; gender in some states	Current	Community/issue/attained-age rating affects price.

Important: Rules differ by carrier and state (and by plan letter). Guaranteed Issue or Open Enrollment generally overrides underwriting. If you tell me your state, age, tobacco status, and key conditions, I can summarize likely carriers that are more lenient and where you may qualify.

Medicare Supplement Trial-Right

What it is: A one-time 12-month trial letting you try a Medicare Advantage (MA) plan and still return to Original Medicare with a Medigap policy without medical underwriting.
Who qualifies: 1. You joined an MA plan when first eligible at 65 (no prior Medigap), or

2. You dropped a Medigap policy to try an MA plan for the first time.

Your rights: If you dropped Medigap, you can get the same plan (or a comparable one) from the same insurer, GI.

If you never had Medigap, you can buy certain plans (A, B, D, G, K, L; C/F only if Medicare-eligible before 1/1/2020)—state rules vary.

Timing: You must switch back and apply within 63 days after your MA coverage ends (keep all notices as proof).
Tip: Act early within the 12-month window to avoid gaps and ensure carrier availability.

Frequently Asked Questions (FAQs)

Group Health Insurance

Can I get Part A before 65?

Yes if you have certain disabilities, End-Stage Renal Disease (ESRD), or ALS (special rules apply).

Are blood transfusions covered?

Yes, generally after the first units each calendar year (who pays first can depend on whether the provider gets free blood).

Medicare Supplement Standardized Plans

Medicare Supplement Premium Cost

Medicare Supplement Enrollment

When to Enroll in Medicare Supplement

Medicare Supplement Medical Underwriting

Group Health Insurance

Can I get Part A before 65?

Are blood transfusions covered?

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