Medicare Supplement Plans (known as Medigap plans) work with Original Medicare. Generally, a Medicare beneficiary must have both Part A and Part B to buy a Medigap policy; which covers only one person; therefore, if you and your spouse both want Medigap coverage, each of you has to buy your own policy.

Medigap policies are sold by letter from A to N, excluding E, H, I, J. (This can be confusing since Medicare has four parts: A, B, C and D.) If you have one of these excluded Medigap plans because you purchased it many years ago, you can keep it as long as you pay your premiums.

The coverage of each lettered policy is the same no matter what company sells you the plan. The only difference will be the premium paid each month. Premiums will likely increase every year if you are in a plan, and in most cases they are based on age. People new to Medicare after January 1, 2020 cannot purchase Plans C and F (which covered the Part B deductible.) For an overview of the plans and what each lettered plan covers, see the “Medicare & You” 2025 handbook, page 76.

If you have a Medigap policy and get care, Medicare will pay its share of the Medicare-approved amount for covered health care costs. In most Medigap policies, you agree to have the Medigap insurance company get your claim information directly from Medicare, which is known as a crossover. Medicare will send the claim automatically to your Medigap policy after it pays its share of the claim. Then, your Medigap policy will pay your provider whatever amount you owe under your policy and you are responsible for any costs that remain.

Once you buy a policy, you can keep it as long as you pay your Medigap premiums. All standardized Medigap policies are automatically renewed every year, even if you have health problems. Your Medigap insurance company can only drop you if:

• you stop paying your premiums.
• you were not truthful on the Medigap policy application.
• the insurance company goes bankrupt or goes out of business.

Medigap and Medicare Advantage Plans

A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage. When you are getting started with Medicare, a beneficiary can choose Original Medicare and buy a Medigap plan (and purchase a stand-alone Part D drug plan) or enroll in a Medicare Advantage Plan, but you cannot have both.

You cannot buy a Medigap policy while you are in a Medicare Advantage Plan unless you are switching back to Original Medicare. You cannot use Medigap to pay your Medicare Advantage Plan copayments, deductibles and premiums. If you want to switch to Original Medicare and buy a Medigap policy, you can do so at any time. Remember, when you first secure Medicare Part B, you have a six month ‘guaranteed issue” right to buy a Medigap policy. This means that you cannot be turned down for any reason, even if you have prior or chronic conditions.

If you drop a Medigap policy to join a Medicare Advantage Plan for the first time, you will have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. If it is not available, you can buy a Medigap policy you qualify for that is sold by an insurance company in your state (except for Plans M and N). You may also have an opportunity to enroll in a Medicare drug plan at this time.

If you joined a Medicare Advantage Plan when you were first eligible for Medicare Part A at 65 and you switch back to Original Medicare within the first year, you can choose from any Medigap policy that is sold by an insurance company in your state. You may also have an opportunity to enroll in a Medicare drug plan at this time.

Medigap and Prescription Drug Coverage

Medigap plans sold after 2005 do not include prescription drug coverage. Thus, if you enroll in Medigap for the first time, it will not include drug coverage. If you want prescription drug coverage, you can join a stand-alone Medicare prescription drug plan (Part D).

Charles Clarkson, Esq. is project director of Senior Medicare Patrol of New Jersey