Beginning June 1st, 2010, two new Medigap Plans will be available (Plan M and Plan N.)

These plans will include a copay and a coinsurance similar to a Medicare Advantage Plan, which should help reduce the monthly Medigap premium in some cases.  We can expect to start seeing these plans entering the market starting October 1st, 2010 as a replacement for Private Fee for Service Plans (PFFS). 

Last year Medicare change the rules for Medicare Advantage PFFS Plan will require each plan to for a network. It is not likely Insurance companies will invest in the creation of networks, especially if they can now offer a MediGap Insurance plan that can effectively compete with Medicare Advantage Plans.

These two new plans will be available in addition to the existing 10 standardized Medigap plans, labeled Medigap A – N (except in Massachusetts, Minnesota and Wisconsin) —to view information about plans in these states go to: http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf; page 13). Each standardized Medigap policy must offer the same basic coverage, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter name sold by different insurance companies.

If you purchase your Medicare Part A and Part B through a Medicare Advantage plan rather than Original Medicare, you are not eligible to purchase a Medigap insurance policy. Medigap policies only work with Original Medicare.

Key changes to Medicare Supplement Plans beginning June 1st, 2010:

• Hospice Part A coinsurance (outpatient prescription drug and inpatient respite care coinsurance) will be covered as a basic benefit. Plan K will cover 50% and Plan L will cover 75% of these costs.
• Medigap Plans K, L and N will require you to pay a portion of the Part B coinsurance and copayments. This may result in lower monthly premiums for these plans.
• Medigap Plans D and G have changed. The Plans D and G bought after 6/1/2010 will have different benefits than the plans purchased before 6/1/2010. If you bought a Plan D or Plan G before 6/1/2010 and don’t want to change, your plan will remain the same with its current benefits.
• Terminating Plans – Plans E, H, I, and J will be terminated on May 31st, 2010. If you have one of these plans and purchased it before May 31st, 2010 you will be able to remain on this plan.

Medigap Plans effective after June 1st, 2010:



Medigap plans do not cover long-term care (for example, care provided by a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing.

Medigap Insurance Enrollment

Once you turn 65, you can sign up for any of the currently available Medigap plans (A-N) during a six month open enrollment period. Once you are enrolled, the Medigap insurer must renew your policy for life, as long as you pay your premiums. If you miss a premium payment, you may risk losing your coverage.

Under federal law, once your open enrollment period ends, Medigap insurers can refuse to offer you a Medigap plan because of your age or health status (non guaranteed issue). However, you may have special protections if you want to buy Medigap because of specific enrollment conditions.

Below is a list of the situations that will provide you with the right to receive a guaranteed issue Medigap plan :



Medigap (Medicare Supplement Insurance)

Original Medicare (Medicare Part A and Part B) pays for many, but not all, healthcare services and supplies. A Medigap policy, sold by private insurance companies, can help pay some of the healthcare costs (“gaps”) that Original Medicare doesn’t cover, like copays, coinsurance, and deductibles. Keep in mind, Medigap insurance is supplemental and is not required by Medicare. However, many people who have Original Medicare find Medigap plans helpful to offset gaps in the Original Medicare coverage.

Premium – the Medigap premiums vary based on the plan you select. The plans with the same letter name offer exactly the same benefits but premiums may be different depending on the insurance company. Medigap is a program where it definitely pays to shop around.

One important factor related to the cost of your Medigap premiums is when you enroll. You will have 6 months from the time you turn 65 to enroll in a guarantee issue Medigap plan. Guarantee issue means that as long as you enroll within the 6 month period of receiving Medicare, the Medigap insurance company may not deny your Medigap enrollment based on age or health condition. If you enroll outside the initial enrollment period and you are not eligible for a Medigap Special Enrollment Period, Medigap plans may use medical underwriting to determine your premium based on age and/or health status. In addition, the health plans may choose to deny your application entirely. For this reason, if you are interested in a Medigap plan, it is important to enroll in one when you first become eligible.

About the Author:

My name is Dana Cutter and I am Founder and Editor of Medicare Sherpa. Our staff spends their days searching the Internet for the best content and advice on retirement. On our site you will find articles on Social Security, Medicare Benefits, Prescription Drug Benefits and more. Please feel fee to send me an email with ideas for content, site improvements or general help launching your online persona. I hope you will consider joining and I am looking forward to reading more about you online.

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