2012 

Choosing 

A Medigap 

Policy

Large Print Edition

 Centers for Medicare & Medicaid Services

 Developed jointly by The Centers for Medicare & Medicaid Services (CMS)

 and the National Association of Insurance Companies (NAIC)

This official government guide has important

information about the following:

• What is a Medigap (Medicare 

Supplement Insurance) policy 

• What Medigap policies cover

• Your rights to buy a Medigap policy

• How to buy a Medigap policy

This guide can help if you’re thinking about buying 

a Medigap policy or already have one.

How to use this guide

There are two ways to find the information you need: 

The “Table of Contents” on pages 2 – 4 can help you 

find the sections you need. 

The “List of Topics” on pages 109 – 115 lists topics in 

this guide and the page number of where to find them. 

Who should read this guide?

This guide helps people with Medicare understand 

Medigap (also called “Medicare Supplement Insurance”) 

policies. A Medigap policy is a type of private insurance 

that helps you pay for some of the costs that Original

Medicare doesn’t cover. 

• End of Page

 Underlined words are defined on pages 103 – 107
2 — Table of Contents

Section 1: Medicare Basics

A brief look at Medicare ___ Page 5

What is Medicare? ___ Page 6

The different parts of Medicare ___ Pages 6 – 7

Your Medicare coverage choices at a glance ___ 

Pages 8 – 10

Section 2: Medigap Basics

What is a Medigap policy? ___ Pages 11 – 12

What Medigap policies cover ___ Pages 13 – 16

What Medigap policies don’t cover ___ Page 17

Types of coverage that are NOT Medigap policies ___ 

Page 17

What types of Medigap policies can insurance companies 

sell? ___ Page 18

What do I need to know if I want to buy a Medigap policy? 

___ Pages 19 – 20

When is the best time to buy a Medigap policy? ___ 

Pages 21 – 24

Why is it important to buy a Medigap policy when I'm first 

eligible? ___ Pages 24 – 25

How do insurance companies set prices for Medigap 

policies? ___ Page 26

What this pricing may mean for you ___ Pages 27 – 29
3 — Table of Contents (continued)

Section 2: Medigap Basics (continued)

Comparing Medigap costs ___ Pages 30 – 31

What is Medicare SELECT? ___ Page 32

How does Medigap help pay your Medicare Part B bills? 

___ Pages 32 – 33

Section 3: Your Right to Buy a Medigap Policy

What are guaranteed issue rights? ___ Page 35

When do I have guaranteed issue rights? ___ Page 36

Can I buy a Medigap policy if I lose my health care 

coverage? ___ Pages 46 – 48

Section 4: Steps to Buying a Medigap Policy

Step-by-Step Guide to Buying a Medigap Policy ___ 

Pages 49 – 62

Section 5: For People Who Already Have a Medigap

Policy

Switching Medigap policies ___ Pages 64 – 71

Losing Medigap coverage ___ Page 72

Medigap policies and Medicare prescription drug coverage 

___ Pages 73 – 77
4 — Table of Contents (continued)

Section 6: Medigap Policies for People with a Disability

or ESRD

Information for people under 65 ___ Pages 79 – 82

Section 7: Medigap Coverage in Massachusetts,

Minnesota, and Wisconsin

Massachusetts benefits ___ Pages 84 – 86

Minnesota benefits ___ Pages 87 – 90

Wisconsin benefits ___ Pages 91 – 93

Section 8: For More Information

Where to get more information ___ Page 95

How to get help with Medicare and Medigap questions ___ 

Page 96

State Health Insurance Assistance Program and State 

Insurance Department ___ Pages 97 – 101

Section 9: Definitions

Where Underlined words are defined ___ Pages 103 – 107

Section 10: List of Topics

An alphabetical list of what’s in this guide ___ 

Pages 109 – 115
SECTION 1: MEDICARE BASICS

5

 Underlined words are defined on pages 103 – 107

A brief look at Medicare

This guide helps people with Medicare understand 

Medigap (also called “Medicare Supplement Insurance”) 

policies.

A Medigap policy is health insurance sold by private 

insurance companies to fill gaps in Original Medicare

coverage. Medigap policies can help pay your share 

(coinsurance, copayments, or deductibles) of the costs 

of Medicare-covered services. Some Medigap policies 

also cover certain benefits Original Medicare doesn’t 

cover. Medigap policies don’t cover your share of the 

costs under other types of health coverage, including 

Medicare Advantage Plans, stand-alone Medicare

Prescription Drug Plans, employer/union group health 

coverage, Medicaid, Department of Veterans Affairs (VA) 

benefits, or TRICARE. Insurance companies generally 

can’t sell you a Medigap policy if you have coverage 

through Medicaid or a Medicare Advantage Plan.

Before you learn more about Medigap policies, the 

next few pages provide a brief look at Medicare. If you 

already know the basics about Medicare and only want 

to learn about Medigap, skip to page 11.
6 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What is Medicare?

Medicare is health insurance for the following:

• People 65 or older

• People under 65 with certain disabilities 

• People of any age with End-Stage Renal Disease (ESRD) 

(permanent kidney failure requiring dialysis or a kidney 

transplant) 

The different parts of Medicare

The different parts of Medicare help cover specific 

services: 

Medicare Part A (Hospital Insurance)

• Helps cover inpatient care in hospitals 

• Helps cover skilled nursing facility, hospice, and home 

health care 

Medicare Part B (Medical Insurance)

• Helps cover doctors’ and other health care providers’ 

services, hospital outpatient care, durable medical 

equipment, and home health care 

• Helps cover many preventive services to help maintain 

your health and to keep certain illnesses from getting 

worse 
7 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

The different parts of Medicare (continued)

Medicare Part C (also known as Medicare

Advantage) 

Offers health plan options run by Medicare-approved 

private insurance companies. Medicare Advantage Plans

are a way to get the benefits and services covered under 

Part A and Part B. Most Medicare Advantage Plans 

cover Medicare prescription drug coverage 

(Part D). Some Medicare Advantage Plans may include 

extra benefits for an extra cost. 

Medicare Part D (Medicare Prescription Drug

Coverage) 

• Helps cover the cost of prescription drugs 

• May help lower your prescription drug costs and help 

protect against higher costs

• Run by Medicare-approved private insurance 

companies

• End of Page
8 — Section 2: Medigap Basics

 Your Medicare Coverage Choices at a Glance

There are two main ways to get your Medicare coverage: 

Original Medicare or a Medicare Advantage Plan. Use 

these steps to help you decide which way to get your 

coverage. See page 71 for information about Medicare 

Advantage Plans and Medigap policies.

Start

Step 1: Decide how you want to get your coverage. 

Original Medicare

Part A

Hospital Insurance

Part B

Medical Insurance

Step 2: Decide if you need to add drug coverage.

Part D 

Prescription Drug Coverage
9 — Section 2: Medigap Basics

Your Medicare Coverage Choices at a Glance

(continued)

Step 3: Decide if you need to add supplemental 

coverage.

Medigap 

(Medicare Supplement Insurance) policy

END

 OR

Step 1: Decide how you want to get your coverage.

Medicare Advantage Plan (like an HMO or PPO)

Combines Part A, Part B, and usually Part D

Step 2: Decide if you need to add drug coverage.

Part D 

Prescription Drug Coverage (if not already included)

END

If you join a Medicare Advantage Plan, you don’t need 

and can’t be sold a Medigap policy.
10 — Section 2: Medigap Basics

Your Medicare Coverage Choices at a Glance

(continued)

For more information 

Remember, this guide is about Medigap policies.

To learn more about Medicare, visit

www.medicare.gov/Publications to view the “Medicare & 

You” handbook. You can also call 1 800 633 - 4227. 

TTY users should call 1 877 486 ‐ 2048. 

• End of Page
SECTION 2: MEDIGAP BASICS

11

 Underlined words are defined on pages 103 – 107

What is a Medigap policy?

A Medigap policy (also called “Medicare Supplement 

Insurance”) is private health insurance that’s designed 

to supplement Original Medicare. This means it helps 

pay some of the health care costs (“gaps”) that Original 

Medicare doesn’t cover (like copayments, coinsurance, 

and deductibles). If you have Original Medicare and 

a Medigap policy, Medicare will pay its share of the 

Medicare-approved amounts for covered health care 

costs. Then your Medigap policy pays its share. A 

Medigap policy is different from a Medicare Advantage

Plan (like an HMO or PPO) because those plans are 

ways to get Medicare benefits, while a Medigap policy 

only supplements your Original Medicare benefits. 

Note: Medicare doesn’t pay any of the costs for you to 

get a Medigap policy.
12 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What is a Medigap policy? (continued)

Every Medigap policy must follow Federal and state 

laws designed to protect you, and the policy must be 

clearly identified as “Medicare Supplement Insurance.” 

Medigap insurance companies in most states can only 

sell you a “standardized” Medigap policy identified by 

letters A through N. Each standardized Medigap policy 

must offer the same basic benefits, no matter which 

insurance company sells it. Cost is usually the only 

difference between Medigap policies with the same 

letter sold by different insurance companies.

In Massachusetts, Minnesota, and Wisconsin, Medigap 

policies are standardized in a different way. See pages 

84 – 93. In some states, you may be able to buy another 

type of Medigap policy called Medicare SELECT. SELECT 

plans are standardized plans that may require you to see 

certain providers and may cost less than other plans. 

See page 32.

• End of Page
13 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What Medigap policies cover

The information on the next few pages gives you a quick 

look at the standardized Medigap Plans available.

Note:

• Insurance companies selling Medigap policies are 

required to make Plan A available. If they offer any other 

Medigap plan, they must also offer either Medigap 

Plan C or Plan F. Not all types of Medigap policies may 

be available in your state. See pages 84 – 93 if you live in 

Massachusetts, Minnesota, or Wisconsin. If you need 

more information, call your State Insurance Department

or State Health Insurance Assistance Program. 

See pages 97 – 101 for your state’s phone number.

• Plans D and G —Plans D and G effective on or after 

June 1, 2010, have different benefits than D or G Plans 

bought before June 1, 2010.

• Plans No Longer for Sale —Plans E, H, I, and J are no 

longer sold, but, if you already have one, you can keep it.
14 — Section 2: Medigap Basics

Medigap Plans

How to read the following information:

If the plan letter appears, the Medigap policy covers 

100% of the described benefit. If a percentage is listed 

with the plan letter, the policy covers that percentage 

of the described benefit. If a letter or percentage is not 

listed, the policy doesn’t cover that benefit. 

Note: The Medigap policy covers coinsurance only after 

you have paid the deductible (unless the Medigap policy 

also covers the deductible). 

Medicare Part A Coinsurance hospital costs up to an 

additional 365 days after Medicare benefits are used up

Medigap Plans A, B, C, D, F*, G, K, L, M or N

Out-of-Pocket Limit ** K $4,640 L $2,320

Medicare Part B Coinsurance or Copayment

Medigap Plans A, B, C, D, F*, G, K 50%, L 75%, 

M or N***

Out-of-Pocket Limit** K $4,640 L $2,320

Blood (First 3 Pints)

Medigap Plans A, B, C, D, F*, G, K 50%, L 75%, 

M or N

Out-of-Pocket Limit** K $4,640 L $2,320
15 — Section 2: Medigap Basics

Medigap Plans: (continued)

 Part A Hospice Care Coinsurance or Copayment

Medigap Plans A, B, C, D, F*, G, K 50%, L 75%, 

M or N

Out-of-Pocket Limit** K $4,640 L $2,320

 Skilled Nursing Facility Care Coinsurance

Medigap Plans C, D, F*, G, K 50%, L 75%, M or N

Out-of-Pocket Limit** K $4,640 L $2,320

 Medicare Part A Deductible

Medigap Plans B, C, D, F*, G, K 50%, L 75%, M 50% 

or N

Out-of-Pocket Limit** K $4,640 L $2,320

 Medicare Part B Deductible

Medigap Plans C or F*

 Medicare Part B Excess Charges

Medigap Plans F* or G

Foreign Travel Emergency (Up to Plan Limits)

Medigap Plans C, D, F*, G, M or N
16 — Section 2: Medigap Basics

Medigap Plans: (continued)

*Plan F also offer a high-deductible plan. If you choose 

this option, this means you must pay for Medicarecovered costs up to the deductible amount of $2,070 in 

2012 before your Medigap plan pays anything.

**After you meet your out-of-pocket yearly limit and your 

yearly Part B deductible ($140 in 2012), the Medigap 

plan pays 100% of covered services for the rest of the 

calendar year. 

***Plan N pays 100% of the Part B coinsurance, except 

for a copayment of up to $20 for some office visits and 

up to a $50 copayment for emergency room visits that 

don’t result in an inpatient admission.

• End of Page
17 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What Medigap policies don’t cover

Generally, 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. 

Types of coverage that are NOT Medigap policies

• Medicare Advantage Plans (Part C), like an HMO, PPO, 

or Private Fee-for-Service Plan

• Medicare Prescription Drug Plans (Part D)

• Medicaid

• Employer or union plans, including the Federal 

Employees Health Benefits Program (FEHBP)

• TRICARE 

• Veterans’ benefits 

• Long-term care insurance policies 

• Indian Health Service, Tribal, and Urban Indian Health 

plans
18 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What types of Medigap policies can insurance

companies sell?

In most cases, Medigap insurance companies can sell 

you only a “standardized” Medigap policy. All Medigap 

policies must have specific benefits so you can compare 

them easily. If you live in Massachusetts, Minnesota, or 

Wisconsin, see pages 84 – 93.

Insurance companies that sell Medigap policies don’t have 

to offer every Medigap plan. However, they must offer 

Medigap Plan A if they offer any Medigap policy. 

If they offer any plan in addition to Plan A, they must also 

offer Plan C or Plan F. Each insurance company decides 

which Medigap policies it wants to sell, although state laws 

might affect which ones they offer.

In some cases, an insurance company must sell you a 

Medigap policy, even if you have health problems. Listed 

below are certain times that you’re guaranteed the right to 

buy a Medigap policy: 

• When you’re in your Medigap open enrollment period. 

See pages 21 – 25.

• If you have a guaranteed issue right. See pages 35 – 48.

You may also buy a Medigap policy at other times, but the 

insurance company can deny you a Medigap policy based 

on your health. Also, in some cases it may be illegal for the 

insurance company to sell you a Medigap policy (such as if 

you already have Medicaid or a Medicare Advantage Plan).
19 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What do I need to know if I want to buy a Medigap

policy?

• You must have Medicare Part A and Part B to buy a 

Medigap policy.

• If you have a Medicare Advantage Plan but are 

planning to return to Original Medicare, you can apply 

for a Medigap policy before your coverage ends. The 

Medigap insurer can sell it to you as long as you’re 

leaving the plan. Ask that the new policy start no later 

than when your Medicare Advantage Plan enrollment 

ends, so you will have continuous coverage.

• Plans E, H, I, and J are no longer for sale, but you can 

keep these plans if you already have one.

• You pay the private insurance company a monthly 

premium for your Medigap policy in addition to the 

monthly Part B premium that you pay to Medicare.

• A Medigap policy only covers one person. If you and 

your spouse both want Medigap coverage, you each

will have to buy separate Medigap policies.

• You can buy a Medigap policy from any insurance 

company that’s licensed in your state to sell one.

• If you want to buy a Medigap policy, see page 13 to 

review the benefit choices. Then, follow the “Steps to

Buying a Medigap Policy” on pages 49 – 62.
20 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What do I need to know if I want to buy a Medigap

policy? (continued)

• If you want to drop your Medigap policy, write your 

insurance company to cancel the policy and confirm it’s 

cancelled. Your agent can’t cancel the policy for you.

• 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.

• Cost is usually the only difference between Medigap 

policies with the same letter sold by different insurance 

companies.

• Although some Medigap policies sold in the past 

covered prescription drugs, Medigap policies sold after 

January 1, 2006, aren’t allowed to include prescription 

drug coverage. 

• If you want prescription drug coverage, you can join 

a Medicare Prescription Drug Plan (Part D) offered by 

private companies approved by Medicare. 

See page 7.

To learn about Medicare prescription drug coverage, visit 

www.medicare.gov/publications to view the booklet “Your 

Guide to Medicare Prescription Drug Coverage,” or call 

1 800 633 - 4227. TTY users should call 1 877 486 - 2048. 
21 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

When is the best time to buy a Medigap policy?

The best time to buy a Medigap policy is during your 

Medigap open enrollment period. This period lasts for 6 

months and begins on the first day of the month in which 

you’re both 65 or older and enrolled in Medicare Part B. 

Some states have additional open enrollment periods 

including those for people under 65. During this period, 

an insurance company can’t use medical underwriting. 

This means the insurance company can’t do any of the 

following because of your health problems:

• Refuse to sell you any Medigap policy it offers 

• Charge you more for a Medigap policy than they charge 

someone with no health problems

• Make you wait for coverage to start (except as explained 

on the next page) 

• End of Page
22 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

When is the best time to buy a Medigap policy?

(continued)

While the insurance company can’t make you wait for 

your coverage to start, it may be able to make you wait 

for coverage related to a pre-existing condition. A preexisting condition is a health problem you have before 

the date a new insurance policy starts. In some cases, 

the Medigap insurance company can refuse to cover 

your out-of-pocket costs for these pre-existing health 

problems for up to 6 months. This is called a “pre-existing 

condition waiting period.” After 6 months, the Medigap 

policy will cover the pre-existing condition. Coverage 

for a pre-existing condition can only be excluded in a 

Medigap policy if the condition was treated or diagnosed 

within 6 months before the date the coverage starts 

under the Medigap policy. This is called the “look-back 

period.” After the 6-month pre-existing waiting period, the 

Medigap policy will cover the condition that was excluded. 

Remember, for Medicare‐covered services, Original

Medicare will still cover the condition, even if the Medigap 

policy won’t cover your out‐of‐pocket costs, but you’re 

responsible for the coinsurance or copayment.
23 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

When is the best time to buy a Medigap policy?

(continued)

If you have a pre-existing condition and you buy a 

Medigap policy during your Medigap open enrollment

period and you’re replacing certain kinds of health 

coverage that count as “creditable coverage,” it’s 

possible to avoid or shorten waiting periods for preexisting conditions. Prior creditable coverage is 

generally any other health coverage you recently had 

before applying for a Medigap policy. If you have had at 

least 6 months of continuous prior creditable coverage, 

the Medigap insurance company can’t make you wait 

before it covers your pre-existing conditions.

There are many types of health care coverage that may 

count as creditable coverage for Medigap policies, 

but they will only count if you didn’t have a break in 

coverage for more than 63 days.

Talk to your Medigap insurance company. It will be 

able to tell you if your previous coverage will count as 

creditable coverage for this purpose. You can also call 

your State Health Insurance Assistance Program. See 

pages 97 – 101.

If you buy a Medigap policy when you have a 

guaranteed issue right (also called “Medigap 

protection”), the insurance company can’t use a 

pre‐existing condition waiting period. See pages 35 – 48 

for more information about guaranteed issue rights.
24 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

When is the best time to buy a Medigap policy?

(continued)

Note: If you’re under 65 and have Medicare, generally 

because of a disability or ESRD, you might not be able 

to buy the Medigap policy you want, or any Medigap 

policy, until you turn 65. Federal law doesn’t require 

insurance companies to sell Medigap policies to people 

under 65. However, some states require Medigap 

insurance companies to sell you a Medigap policy, even 

if you’re under 65. See page 79 for more information. 

Why is it important to buy a Medigap policy when

I'm first eligible?

It’s very important to understand your Medigap open

enrollment period. Medigap insurance companies are 

generally allowed to use medical underwriting to decide 

whether to accept your application and how much to 

charge you for the Medigap policy. However, if you apply 

during your Medigap open enrollment period, you can 

buy any Medigap policy the company sells, even if you 

have health problems, for the same price as people with 

good health. If you apply for Medigap coverage after

your open enrollment period, there is no guarantee that 

an insurance company will sell you a Medigap policy if 

you don’t meet the medical underwriting requirements, 

unless you’re eligible because of one of the limited 

situations listed on pages 37 – 45.
25 — Section 2: Medigap Basics

Why is it important to buy a Medigap policy when

I'm first eligible? (continued)

It’s also important to understand that your Medigap 

rights may depend on when you choose to enroll in 

Medicare Part B. If you’re 65 or older, your Medigap 

open enrollment period begins when you enroll in 

Part B and can’t be changed or repeated. In most cases, 

it makes sense to enroll in Part B when you’re first 

eligible, because you might otherwise have to pay a 

Part B late enrollment penalty.

However, if you have group health coverage through 

an employer or union, because either you or your 

spouse is currently working, you may want to wait to 

enroll in Part B. This is because employer plans often 

provide coverage similar to Medigap, so you don’t 

need a Medigap policy. When your employer coverage 

ends, you will get a chance to enroll in Part B without 

a late enrollment penalty which means your Medigap 

open enrollment period will start when you’re ready to 

take advantage of it. If you enrolled in Part B while you 

still had the employer coverage, your Medigap open 

enrollment period would start, and unless you bought a 

Medigap policy before you needed it, you would miss 

your open enrollment period entirely. If you or your 

spouse is still working and you have coverage through 

an employer, contact your employer or union benefits 

administrator to find out how your insurance works with 

Medicare. See page 35 for more information. 
26 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

How do insurance companies set prices for Medigap

policies?

Each insurance company decides how it will set the 

price, or premium, for its Medigap policies. It’s important 

to ask how an insurance company prices its policies. 

The way they set the price affects how much you pay 

now and in the future. Medigap policies can be priced or 

“rated” in three ways: 

1. Community-rated (also called “no-age-rated”) 

2. Issue-age-rated (also called “entry-age-rated”) 

3. Attained-age-rated 

Each of these ways of pricing Medigap policies is 

described on pages 27 – 29. The examples show how 

your age affects your premiums, and why it’s important 

to look at how much the Medigap policy will cost you 

now and in the future. The amounts in the examples 

aren’t actual costs. Other factors such as geographical 

rating, medical underwriting, and discounts can also 

affect the amount of your premiums.
27 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

How do insurance companies set prices for Medigap

policies? (continued)

Type of pricing 

Community-rated (also called “no-age-rated”) 

How it’s priced

Generally the same monthly premium is charged to 

everyone who has the Medigap policy, regardless of age.

What this pricing may mean for you

Your premium isn’t based on your age. Premiums may go 

up because of inflation and other factors but not because 

of your age. 

Examples

Mr. Smith is 65. He buys a Medigap policy and pays a 

$165 monthly premium.

Mrs. Perez is 72. She buys the same Medigap policy 

as Mr. Smith. She also pays a $165 monthly premium 

because, with this type of Medigap policy, everyone pays 

the same price regardless of age.
28 — Section 2: Medigap Basics

How do insurance companies set prices for Medigap

policies? (continued)

Type of pricing

Issue-age-rated (also called “entry age-rated”) 

How it’s priced

The premium is based on the age you are when you buy 

(are “issued”) the Medigap policy. 

What this pricing may mean for you

Premiums are lower for people who buy at a younger age 

and won’t change as you get older. Premiums may go up 

because of inflation and other factors but not because of 

your age. 

Examples

Mr. Han is 65. He buys a Medigap policy and pays a 

$145 monthly premium. 

Mrs. Wright is 72. She buys the same Medigap policy 

as Mr. Han. Since she is older when she buys it, her 

monthly premium is $175. 

Type of pricing

Attained-age-rated

How it’s priced

The premium is based on your current age (the age you 

have “attained”), so your premium goes up as you get 

older. 
29 — Section 2: Medigap Basics

How do insurance companies set prices for Medigap

policies? (continued)

What this pricing may mean for you

Premiums are low for younger buyers but go up as 

you get older. They may be the least expensive at first, 

but they can eventually become the most expensive. 

Premiums may also go up because of inflation and other 

factors. 

Examples 

Mrs. Anderson is 65. She buys a Medigap policy and 

pays a $120 monthly premium. 

• At 66, her premium goes up to $126. 

• At 67, her premium goes up to $132. 

• At 72, her premium goes up to $165.

Mr. Dodd is 72. He buys the same Medigap policy as 

Mrs. Anderson. He pays a $165 monthly premium. His 

premium is higher than Mrs. Anderson’s because it’s 

based on his current age. Mr. Dodd’s premium will go up 

every year. 

• At 73, his premium goes up to $171. 

• At 74, his premium goes up to $177. 
30 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

Comparing Medigap costs

As discussed on the previous pages, the cost of 

Medigap policies can vary widely. There can be big

differences in the premiums that different insurance

companies charge for exactly the same coverage. As 

you shop for a Medigap policy, be sure to compare the 

same type of Medigap policy, and consider the type of 

pricing used. See pages 26 – 29. For example, compare 

a Medigap Plan C from one insurance company with 

a Medigap Plan C from another insurance company. 

Although this guide can’t give actual costs of Medigap 

policies, you can get this information by calling 

insurance companies or your State Health Insurance

Assistance Program. See pages 97 – 101.

You can also find out which insurance companies sell 

Medigap policies in your area by visiting 

www.medicare.gov/medigap.

The cost of your Medigap policy may also depend 

on whether the insurance company does any of the 

following: 

• Offers discounts (such as discounts for women, nonsmokers, or people who are married; discounts for 

paying yearly; discounts for paying your premiums 

using electronic funds transfer; or discounts for multiple 

policies). 
31 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

Comparing Medigap costs (continued)

• Uses medical underwriting, or applies a different 

premium when you don’t have a guaranteed issue right, 

or aren’t in a Medigap open enrollment period.

• Sells Medicare SELECT policies that may require you to 

use certain providers. If you buy this type of Medigap 

policy, your premium may be less. See page 32. 

• Offers a “high-deductible option” for Medigap 

Plan F. If you buy Medigap Plan F with a 

high-deductible option, you must pay the first $2,070 

(in 2012) of deductibles, copayments, and coinsurance

not paid by Medicare before the Medigap policy pays 

anything. You must also pay a separate deductible 

($250 per year) for foreign travel emergency services. 

• If you bought your Medigap Plan J before 

January 1, 2006, and it still covers prescription drugs, 

you would also pay a separate deductible ($250 per 

year) for prescription drugs covered by the Medigap 

policy. And, if you have a Plan J with a high deductible 

option, you must pay a $2,070 deductible before the 

policy pays anything.
32 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

What is Medicare SELECT?

Medicare SELECT is a type of Medigap policy sold in 

some states that requires you to use hospitals and, in 

some cases, doctors within its network to be eligible 

for full insurance benefits (except in an emergency). 

Medicare SELECT can be any of the standardized 

Medigap Plans. See pages 13 – 16. These policies 

generally cost less than other Medigap policies. However, 

if you don’t use a Medicare SELECT hospital or doctor for 

non-emergency services, you will have to pay some or all 

of what Medicare doesn’t pay. Medicare will pay its share 

of approved charges no matter which hospital or doctor 

you choose. 

How does Medigap help pay your Medicare Part B bills?

In most Medigap policies, when you sign the Medigap 

insurance contract you agree to have the Medigap 

insurance company get your Medicare Part B claim 

information directly from Medicare, and then they pay 

the doctor directly. Some Medigap insurance companies 

also provide this service for Medicare Part A claims.
33 — Section 2: Medigap Basics

 Underlined words are defined on pages 103 – 107

How does Medigap help pay your Medicare Part B

bills? (continued)

If your Medigap insurance company doesn’t provide 

this service, ask your doctors if they “participate” in 

Medicare. This means that they “accept assignment” 

for all Medicare patients. If your doctor participates, 

the Medigap insurance company is required to pay the 

doctor directly if you request.

If you have any questions about Medigap claim filing, call 

1 800 633 - 4227. TTY users should call 1 877 486 - 2048. 

• End of Page
34 — Section 2: Medigap Basics

Notes
 

SECTION 3: YOUR RIGHT TO BUY 

A MEDIGAP POLICY

35

 Underlined words are defined on pages 103 – 107

What are guaranteed issue rights?

As explained on pages 21 – 24, the best time to buy a 

Medigap policy is during your Medigap open enrollment

period, when you have the right to buy any Medigap 

policy offered in your state. However, even if you aren’t in 

your Medigap open enrollment period, there are several 

situations in which you may still have a guaranteed right to 

buy a Medigap policy if you’re 65 or older. 

See pages 35 – 36 for more information.

Guaranteed issue rights (also called “Medigap protections”) 

are rights you have in certain situations when insurance 

companies must offer you certain Medigap policies. In 

these situations, an insurance company must do the 

following: 

• Sell you a Medigap policy 

• Cover all your pre-existing health conditions 

• Can’t charge you more for a Medigap policy regardless of 

past or present health problems 

If you live in Massachusetts, Minnesota, or Wisconsin, you 

have guaranteed issue rights to buy a Medigap policy, but 

the Medigap policies are different. See pages 84 – 93 for 

your Medigap policy choices. 
36 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

When do I have guaranteed issue rights?

In most cases, you have a guaranteed issue right when 

you have other health care coverage that changes in 

some way, such as when you lose the other health care 

coverage. In other cases, you have a “trial right” to try a 

Medicare Advantage Plan and still buy a Medigap policy 

if you change your mind. For trial rights, see page 41.

• End of Page
37 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

An insurance company can’t refuse to sell you a 

Medigap policy in the following situations: 

You have a guaranteed issue right if... 

Situation 1: You are in a Medicare Advantage Plan, and 

your plan is leaving Medicare or stops giving care in your 

area, or you move out of the plan’s service area. 

You have the right to buy... 

Medigap Plan A, B, C, F, K, or L that is sold in your state 

by any insurance company. 

You only have this right if you switch to Original Medicare

rather than join another Medicare Advantage Plan. 

You can/must apply for a Medigap policy... 

As early as 60 calendar days before the date your health 

care coverage will end, but no later than 63 calendar days 

after your health care coverage ends. Medigap coverage 

can’t start until your Medicare Advantage Plan coverage 

ends.
38 — Section 3: Your Right to Buy a Medigap Policy

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 2: You have Original Medicare and an 

employer group health plan (including retiree or COBRA 

coverage) or union coverage that pays after Medicare 

pays and that plan is ending. 

Note: In this situation, you may have additional rights under 

state law. 

You have the right to buy... 

Medigap Plan A, B, C, F, K, or L that is sold in your state 

by any insurance company. 

If you have COBRA coverage, you can either buy a 

Medigap policy right away or wait until the COBRA 

coverage ends. 
39 — Section 3: Your Right to Buy a Medigap Policy

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You can/must apply for a Medigap policy... 

No later than 63 calendar days after the latest of these

3 dates: 

1. Date the coverage ends.

2. Date on the notice you get telling you that coverage is 

ending (if you get one).

3. Date on a claim denial, if this is the only way you know 

that your coverage ended.

• End of Page
40 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 3: You have Original Medicare and a Medicare

SELECT policy. You move out of the Medicare SELECT 

policy’s service area. 

Call the Medicare SELECT insurer for more information 

about your options. 

You have the right to buy... 

Medigap Plan A, B, C, F, K, or L that's sold by any 

insurance company in your state or the state you're 

moving to. 

You can/must apply for a Medigap policy...

As early as 60 calendar days before the date your 

Medicare SELECT coverage will end, but no later than 

63 calendar days after your Medicare SELECT coverage 

ends. 
41 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 4: (Trial Right) You joined a Medicare

Advantage Plan or Programs of All-Inclusive Care for the 

Elderly (PACE) when you were first eligible for Medicare 

Part A at 65, and within the first year of joining, you decide 

you want to switch to Original Medicare. 

You have the right to buy... 

Any Medigap policy that's sold in your state by any 

insurance company. 

You can/must apply for a Medigap policy...

As early as 60 calendar days before the date your 

coverage will end, but no later than 63 calendar days after 

your coverage ends. 

Note: Your rights may last for an extra 12 months under 

certain circumstances. 
42 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 5: (Trial Right) You dropped a Medigap policy 

to join a Medicare Advantage Plan (or to switch to a 

Medicare SELECT policy) for the first time, you have 

been in the plan less than a year, and you want to switch 

back. 

You have the right to buy... 

The Medigap policy you had before you joined the 

Medicare Advantage Plan or Medicare SELECT policy, if 

the same insurance company you had before still sells it. 

If your former Medigap policy isn’t available, you can 

buy a Medigap Plan A, B, C, F, K, or L that is sold in your 

state by any insurance company. 
43 — Section 3: Your Right to Buy a Medigap Policy

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You can/must apply for a Medigap policy...

As early as 60 calendar days before the date your 

coverage will end, but no later than 63 calendar days 

after your coverage ends. 

Note: Your rights may last for an extra 12 months under 

certain circumstances. 

• End of Page
44 — Section 3: Your Right to Buy a Medigap Policy

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 6: Your Medigap insurance company goes 

bankrupt and you lose your coverage, or your Medigap 

policy coverage otherwise ends through no fault of your 

own. 

You have the right to buy... 

Medigap Plan A, B, C, F, K, or L that is sold in your state 

by any insurance company. 

You can/must apply for a Medigap policy...

No later than 63 calendar days from the date your 

coverage ends.

• End of Page
45 — Section 3: Your Right to Buy a Medigap Policy

An insurance company can’t refuse to sell you a

Medigap policy in the following situations: (continued)

You have a guaranteed issue right if... 

Situation 7: You leave a Medicare Advantage Plan or 

drop a Medigap policy because the company hasn’t 

followed the rules, or it misled you. 

You have the right to buy... 

Medigap Plan A, B, C, F, K, or L that's sold in your state 

by any insurance company. 

You can/must apply for a Medigap policy... 

No later than 63 calendar days from the date your 

coverage ends.

• End of Page
46 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

Can I buy a Medigap policy if I lose my health care

coverage? 

Because you may have a guaranteed issue right to buy a 

Medigap policy, make sure you keep the following: 

• A copy of any letters, notices, emails, and/or claim 

denials that have your name on them as proof of your 

coverage being terminated 

• The postmarked envelope these papers come in as 

proof of when it was mailed 

You may need to send a copy of some or all of these 

papers with your Medigap application to prove you have 

a guaranteed issue right. 

If you have a Medicare Advantage Plan but you’re 

planning to return to Original Medicare, you can apply 

for a Medigap policy before your coverage ends. The 

Medigap insurer can sell it to you as long as you’re 

leaving the plan. Ask that the new policy take effect no 

later than when your Medicare Advantage enrollment 

ends, so you will have continuous coverage.
47 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

Can I buy a Medigap policy if I lose my health care

coverage? (continued)

 For more information 

If you have any questions or want to learn about any 

additional Medigap rights in your state, you can do the 

following: 

• Call your State Health Insurance Assistance Program to 

make sure that you qualify for these guaranteed issue 

rights. See pages 97 – 101. 

• Call your State Insurance Department if you’re denied 

Medigap coverage in any of these situations. See pages 

97 – 101. 

• End of Page
48 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 103 – 107

Can I buy a Medigap policy if I lose my health care

coverage? (continued)

Important: The guaranteed issue rights in this section 

are from Federal law. These rights are for both Medigap 

and Medicare SELECT policies. Many states provide 

additional Medigap rights. 

There may be times when more than one of the 

situations on pages 37 – 45, applies to you. When this 

happens, you can choose the guaranteed issue right that 

gives you the best choice. 

Some of the situations listed on pages 37 – 45 include 

loss of coverage under Programs of All-Inclusive Care for 

the Elderly (PACE). PACE combines medical, social, and 

long-term care services, and prescription drug coverage 

for frail people. To be eligible for PACE, you must meet 

certain conditions. PACE may be available in states 

that have chosen it as an optional Medicaid benefit. If 

you have Medicaid, an insurance company can sell you 

a Medigap policy only in certain situations. For more 

information about PACE, call 1 800 633 ‐ 4227. TTY 

users should call 1 877 486 ‐ 2048. 
 

SECTION 4: STEPS TO BUYING 

A MEDIGAP POLICY

49

 Underlined words are defined on pages 103 – 107

Step-by-Step Guide to Buying a Medigap Policy

Buying a Medigap policy is an important decision. Only 

you can decide if a Medigap policy is the way for you 

to supplement Original Medicare coverage and which 

Medigap policy to choose. Shop carefully. Compare 

available Medigap policies to see which one meets your 

needs. As you shop for a Medigap policy, keep in mind 

that different insurance companies may charge different 

amounts for exactly the same Medigap policy, and not all 

insurance companies offer all of the Medigap policies. 

Below is a step‐by‐step guide to help you buy a Medigap 

policy. If you live in Massachusetts, Minnesota, or 

Wisconsin, see pages 84 – 93. 

STEP 1: Decide which benefits you want, then decide 

which of the Medigap Plans A through N meet your 

needs. 

STEP 2: Find out which insurance companies sell 

Medigap policies in your state. 

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare costs. 

STEP 4: Buy the Medigap policy.
50 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 1: Decide which benefits you want, then decide 

which of the Medigap Plans A through N meet your 

needs. 

You should think about your current and future health care 

needs when deciding which benefits you want because 

you might not be able to switch Medigap policies later. 

Decide which benefits you need, and select the Medigap 

policy that will work best for you. The information on pages 

13 – 16 provide an overview of Medigap benefits. 

STEP 2: Find out which insurance companies sell 

Medigap policies in your state. 

To find out which insurance companies sell Medigap 

policies in your state, you can do any of the following: 

• Call your State Health Insurance Assistance Program. 

See pages 97 – 101. Ask if they have a “Medigap rate 

comparison shopping guide” for your state. This guide 

usually lists companies that sell Medigap policies in your 

state and their costs. 

• Call your State Insurance Department. See pages

97 – 101. 
51 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 2: Find out which insurance companies sell

Medigap policies in your state. (continued)

• Visit www.medicare.gov/medigap.

This web site will help you find information on all your 

health plan options, including the Medigap policies in 

your area. You can also get information on the following: 

How to contact the insurance companies that sell 

Medigap policies in your state 

What each Medigap policy covers 

How insurance companies decide what to charge 

you for a Medigap policy premium

If you don’t have a computer, your local library or senior 

center may be able to help you look at this information. 

You can also call 1 800 633 - 4227. A customer service 

representative will help you get information on all your 

health plan options including the Medigap policies in your 

area. TTY users should call 1 877 486 ‐ 2048.
52 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 2: Find out which insurance companies sell

Medigap policies in your state. (continued)

Since costs can vary between companies, you should 

plan to call more than one insurance company that sells 

Medigap policies in your state. Before you call, check 

the companies to be sure they are honest and reliable by 

using one of the resources listed below. 

• Call your State Insurance Department. Ask if they keep a 

record of complaints against insurance companies that 

can be shared with you. When deciding which Medigap 

policy is right for you, consider any complaints against 

the insurance company.

• Call your State Health Insurance Assistance Program. 

These programs can give you free help with choosing a 

Medigap policy. 

• Go to your local public library for help with the following: 

Get information on an insurance company’s 

financial strength from independent rating services 

such as The Street.com Ratings, A.M. Best, and 

Standard & Poor’s. 

Look at information about the insurance company 

online. 

• Talk to someone you trust, like a family member, your 

insurance agent, or a friend who has a Medigap policy 

from the same Medigap insurance company.
53 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare 

costs. 

Before you call any insurance companies, figure out if 

you're in your Medigap open enrollment period or if you 

have a guaranteed issue right. Read pages 21 – 24 and 

37 – 42 carefully. If you have questions, call your State

Health Insurance Assistance Program. See pages

97 – 101. Keep track of the information you get on the 

lines that follow each question.

 Ask each insurance company... 

“Are you licensed in ___?” [Say the name of your state]

Note: If the answer is NO, stop right here, and try 

another company. 

Insurance Company #1

Insurance Company #2

• End of Page
54 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare 

costs. (continued)

 Ask each insurance company... 

“Do you sell Medigap Plan ___?” [Say the letter of the 

Medigap plan you’re interested in.] 

Note: Insurance companies usually offer some, but not 

all, Medigap policies. Make sure the company sells the 

plan you want. Also, if you’re interested in a Medicare

SELECT or high deductible Medigap policy, say so. 

Insurance Company #1

Insurance Company #2

“Do you use medical underwriting for this Medigap 

policy?” 

Note: If the answer is NO, go to step 4. If the answer 

is YES, but you know you’re in your Medigap open

enrollment period or have a guaranteed issue right to 

buy that Medigap policy, go to step 4. Otherwise, you can 

ask, “Can you tell me whether I am likely to qualify for the 

Medigap policy?” 

Insurance Company #1

Insurance Company #2
55 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare 

costs. (continued)

 Ask each insurance company... 

“Do you have a waiting period for pre-existing

conditions?”

Note: If the answer is YES, ask how long the waiting 

period is, and write it below.

Insurance Company #1

Insurance Company #2

“Do you price this Medigap policy by using 

community-rating, issue-age-rating, or attained-agerating?” See pages 27 – 29.

Note: Circle the one that applies for that insurance 

company. 

Insurance Company #1- Community rating

Issue-age rating

Attained-age rating

Insurance Company #2 - Community rating

Issue-age rating

Attained-age rating
56 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare 

costs. (continued)

 Ask each insurance company... 

“I am ___ years old. What would my premium be 

under this Medigap policy?” 

Note: If it's attained-age, ask, “How frequently does the 

premium increase due to my age?” 

Insurance Company #1

Insurance Company #2 

“Has the premium for this Medigap policy increased 

in the last 3 years due to inflation or other reasons?” 

Note: If the answer is YES, ask how much it has 

increased, and write it below. 

Insurance Company #1

Insurance Company #2 
57 — Section 4: Steps to Buying a Medigap Policy

STEP 3: Call the insurance companies that sell the 

Medigap policies you’re interested in and compare 

costs. (continued)

 Ask each insurance company... 

“Do you offer any discounts or additional 

(innovative) benefits?” See pages 30 – 31.

Insurance Company #1

Insurance Company #2

“Is there any extra charge to process my claims 

automatically?” 

Insurance Company #1

Insurance Company #2

• End of Page
58 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the

Medigap policies you’re interested in and compare

costs. (continued)

Watch out for illegal insurance practices.

It’s illegal for anyone to do the following: 

• Pressure you into buying a Medigap policy, or lie to or 

mislead you to switch from one company or policy to 

another. 

• Sell you a second Medigap policy when they know that 

you already have one, unless you tell the insurance 

company in writing that you plan to cancel your existing 

Medigap policy. 

• Sell you a Medigap policy if they know you have 

Medicaid, except in certain situations. 

• Sell you a Medigap policy if they know you are in a 

Medicare Advantage Plan (like an HMO, PPO, or Private 

Fee‐for‐Service Plan) unless your coverage under the 

Medicare Advantage Plan will end before the effective 

date of the Medigap policy. 

• Claim that a Medigap policy is part of the Medicare 

Program or any other Federal program. Medigap is 

private health insurance. 

• Claim that a Medicare Advantage Plan is a Medigap 

policy. 
59 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

STEP 3: Call the insurance companies that sell the

Medigap policies you’re interested in and compare

costs. (continued)

• Sell you a Medigap policy that can’t legally be sold in your 

state. Check with your State Insurance Department (see 

pages 97 – 101) to make sure that the Medigap policy 

you’re interested in can be sold in your state. 

• Misuse the names, letters, or symbols of the U.S. 

Department of Health & Human Services (HHS), Social 

Security Administration (SSA), Centers for Medicare 

& Medicaid Services (CMS), or any of their various 

programs like Medicare. (For example, they can’t 

suggest the Medigap policy has been approved or 

recommended by the Federal government.) 

• Claim to be a Medicare representative if they work for a 

Medigap insurance company.

• Sell you a Medicare Advantage Plan when you say you 

want to stay in Original Medicare and buy a Medigap 

policy. A Medicare Advantage Plan isn’t the same as 

Original Medicare. See page 5. If you enroll in a Medicare 

Advantage Plan, you can’t use a Medigap policy. 

If you believe that a Federal law has been broken, call 

the Inspector General’s hotline at 1 800 447 - 8477. TTY 

users should call 1 800 377 - 4950. Your State Insurance 

Department can help you with other insurance-related 

problems.
60 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

 STEP 4: Buy the Medigap policy. 

Once you decide on the insurance company and 

the Medigap policy you want, you should apply. The 

insurance company must give you a clearly worded 

summary of your Medigap policy. Read it carefully. If 

you don’t understand it, ask questions. Remember the 

following when you buy your Medigap policy: 

• Filling out your application. Fill out the application 

carefully and completely, including medical questions. 

The answers you give will determine your eligibility 

for open enrollment or guaranteed issue rights. If the 

insurance agent fills out the application, make sure it’s 

correct. If you buy a Medigap policy during your Medigap

open enrollment period or provide evidence that you’re 

entitled to a guaranteed issue right, the insurance 

company can’t use any medical answers you give to 

deny you a Medigap policy or change the price. The 

insurance company can’t ask you any questions about 

your family history or require you to take a genetic test. 
61 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

 STEP 4: Buy the Medigap policy. (continued)

• Paying for your Medigap policy. It’s best to pay for 

your Medigap policy by check, money order, or bank 

draft. Make it payable to the insurance company, not 

the agent. If buying from an agent, get a receipt with 

the insurance company’s name, address, and phone 

number for your records. Some companies may offer 

electronic funds transfer.

• Starting your Medigap policy. Ask for your Medigap 

policy to become effective when you want coverage to 

start. Generally, Medigap policies begin the first of the 

month after you apply. If, for any reason, the insurance 

company won’t give you the effective date for the 

month you want, call your State Insurance Department. 

See pages 97 – 101. 

Note: If you already have a Medigap policy, ask for your 

new Medigap policy to become effective when your old 

Medigap policy coverage ends. 

• Getting your Medigap policy. If you don’t get your 

Medigap policy in 30 days, call your insurance company. 

If you don’t get your Medigap policy in 60 days, call your 

State Insurance Department. See pages 97 – 101.
62 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 103 – 107

 STEP 4: Buy the Medigap policy. (continued)

If you already have a Medigap policy, it’s illegal for an 

insurance company to sell you a second policy unless 

you tell them in writing that you will cancel the first 

Medigap policy. However, don’t cancel your old Medigap 

policy until the new one is in place, and you decide to 

keep it. See page 64. Once you get the new Medigap 

policy, you have 30 days to decide if you want to keep 

the new policy. This is called your “free look” period. The 

30-day free look period begins on the day you get your 

Medigap policy. You will need to pay both premiums for 

one month.

• End of Page
 

SECTION 5: FOR PEOPLE WHO 

ALREADY HAVE A MEDIGAP POLICY

63

You should read this section if any of these situations 

apply to you: 

• You’re thinking about switching to a different Medigap 

policy. See pages 64 – 71. 

• You’re losing your Medigap coverage. See page 72. 

• You have a Medigap policy with Medicare prescription 

drug coverage. See pages 73 – 77. 

If you just want a refresher about Medigap insurance, 

turn to pages 14 – 16.

• End of Page
64 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

 Switching Medigap policies 

If you’re satisfied with your current Medigap policy’s 

cost, coverage, and customer service, you don’t need 

to do anything. If you’re thinking about switching to a 

new Medigap policy, see pages 64 – 71 to answer some 

common questions about switching Medigap policies. 

 Can I switch to a different Medigap policy? 

In most cases, you won’t have a right under Federal 

law to switch Medigap policies, unless you're within 

your 6‐month Medigap open enrollment period or are 

eligible under a specific circumstance for guaranteed

issue rights. But, if your state has more generous 

requirements, or the insurance company is willing to sell 

you a Medigap policy, make sure you compare benefits 

and premiums before switching. If you bought your 

Medigap policy before 2010, it may offer coverage that 

isn’t available in a newer Medigap policy. On the other 

hand, Medigap policies bought before 1992 might not be 

guaranteed renewable and might have bigger premium 

increases than newer, standardized Medigap policies 

currently being sold. 
65 — Section 5: For People Who Already Have a 

Medigap Policy

 Switching Medigap policies (continued)

 Can I switch to a different Medigap policy? (continued)

If you decide to switch, don’t cancel your first Medigap 

policy until you have decided to keep the second 

Medigap policy. On the application for the new Medigap 

policy, you will have to promise that you will cancel your 

first Medigap policy. You have 30 days to decide if you 

want to keep the new Medigap policy. This is called your 

“free look period”. The 30‐day free look period starts 

when you get your new Medigap policy. You will need to 

pay both premiums for one month. 

Do I have to switch Medigap policies if I have an older

Medigap policy? 

No. But if you buy a new Medigap policy, you have to 

give up your old policy (except for your 30-day “free look 

period,” see page 68). Once you cancel the policy, you 

can’t get it back, and it can no longer be sold because it 

isn’t a standardized policy. 
66 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

 Switching Medigap policies (continued)

Do I have to wait a certain length of time after I buy my

first Medigap policy before I can switch to a different 

Medigap policy? 

No. You should be aware that if you’ve had your old 

Medigap policy for less than 6 months, the Medigap 

insurance company may be able to make you wait up 

to 6 months for coverage of a pre‐existing condition. 

However, if your old Medigap policy had the same 

benefits, and you had it for 6 months or more, the new 

insurance company can’t exclude your pre-existing 

condition. If you’ve had your Medigap policy less than

6 months, the number of months you’ve had your current 

Medigap policy must be subtracted from the time you 

must wait before your new Medigap policy covers your 

pre‐existing condition. 

If the new Medigap policy has a benefit that isn’t in your 

current Medigap policy, you may still have to wait up to 6 

months before that benefit will be covered, regardless of 

how long you have had your current Medigap policy. 
67 — Section 5: For People Who Already Have a 

Medigap Policy

 Switching Medigap policies (continued)

Do I have to wait a certain length of time after I buy my

first Medigap policy before I can switch to a different 

Medigap policy? (continued)

If you’ve had your current Medigap policy longer than 

6 months and want to replace it with a new one with 

the same benefits and the insurance company agrees 

to issue the new policy, they can’t write pre-existing 

conditions, waiting periods, elimination periods, or 

probationary periods into the replacement policy. 

Why would I want to switch to a different Medigap

policy? 

Some reasons for switching may include the following: 

• You’re paying for benefits you don’t need. 

• You need more benefits than you needed before. 

• Your current Medigap policy has the right benefits, but 

you want to change your insurance company. 

• Your current Medigap policy has the right benefits, but 

you want to find a policy that's less expensive. 
68 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Switching Medigap policies (continued)

Why would I want to switch to a different Medigap

policy? (continued)

It’s important to compare the benefits in your current 

Medigap policy to the benefits listed on pages

13 – 16. If you live in Massachusetts, Minnesota, or 

Wisconsin, see pages 84 – 93. To help you compare 

benefits and decide which Medigap policy you want, 

follow the “Steps to Buying a Medigap Policy” in 

Section 4. If you decide to change insurance companies, 

you can call the new insurance company and arrange to 

apply for your new Medigap policy. If your application is 

accepted, call your current insurance company, and ask 

to have your coverage end. The insurance company can 

tell you how to submit a request to end your coverage.

As discussed on pages 64 – 65, you should have your 

old Medigap policy coverage end after you have the new 

Medigap policy for 30 days. Remember, this is your 

30 - day free look period. You will need to pay both 

premiums for one month.
69 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Switching Medigap policies (continued)

Can I keep my current Medigap policy (or Medicare 

SELECT policy) or switch to a different Medigap policy 

if I move out-of-state? 

You can keep your current Medigap policy regardless 

of where you live as long as you still have Original

Medicare. If you want to switch to a different Medigap 

policy, you will have to check with your current or the 

new insurance company to see if they will offer you a 

different Medigap policy.

You may have to pay more for your new Medigap policy 

and answer some medical questions if you’re buying a 

Medigap policy outside of your Medigap open enrollment

period. See pages 21 – 25.

• End of Page
70 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Switching Medigap policies (continued)

Can I keep my current Medigap policy (or Medicare

SELECT policy) or switch to a different Medigap policy

if I move out-of-state? (continued)

If you have a Medicare SELECT policy and you move out 

of the policy’s area, you have the following choices:

• Buy a standardized Medigap policy from your current 

Medigap policy insurance company that offers the same 

or fewer benefits than your current Medicare SELECT 

policy. If you’ve had your Medicare SELECT policy for 

more than 6 months, you won’t have to answer any 

medical questions. 

• You have a guaranteed issue right to buy a Medigap 

Plan A, B, C, F, K, or L that's sold in most states by any 

insurance company.

• End of Page
71 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Switching Medigap policies (continued)

What happens to my Medigap policy if I join a Medicare 

Advantage Plan? 

Medigap policies can’t work with Medicare Advantage

Plans. If you decide to keep your Medigap policy, you 

will have to pay your Medigap policy premium, but the 

Medigap policy can’t pay any deductibles, copayments, 

coinsurance, or premiums under a Medicare Advantage 

Plan. So, if you want to join a Medicare Advantage Plan, 

you may want to drop your Medigap policy. Contact your 

Medigap Plan insurance company to find out how to 

disenroll. However, if you leave the Medicare Advantage 

Plan you might not be able to get the same Medigap 

policy back, or in some cases, any Medigap policy unless 

you have a “trial right.” See page 41. Your rights to buy 

a Medigap policy may vary by state. You always have 

a legal right to keep the Medigap policy after you join a 

Medicare Advantage Plan. However, because you have a 

Medicare Advantage Plan, the Medigap policy would no 

longer provide benefits that supplement Medicare. 
72 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

 Losing Medigap coverage 

Can my Medigap insurance company drop me?

If you bought your Medigap policy after 1992, in most 

cases the Medigap insurance company can’t drop you 

because the Medigap policy is guaranteed renewable. 

This means your insurance company can’t drop you 

unless one of the following happens: 

• You stop paying your premium. 

• You weren’t truthful on the Medigap policy application. 

• The insurance company becomes bankrupt or insolvent. 

However, if you bought your Medigap policy before 

1992, it might not be guaranteed renewable. This means 

the Medigap insurance company can refuse to renew the 

Medigap policy, as long as it gets the state’s approval 

to cancel your Medigap policy. However, if this does 

happen, you have the right to buy another Medigap 

policy. See the guaranteed issue right, on page 44. 
73 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Medigap policies and Medicare prescription drug

coverage 

If you bought a Medigap policy before January 1, 2006 

and it has coverage for prescription drugs, see below 

and page 20. 

Medicare offers prescription drug coverage (Part D) for 

everyone with Medicare. If you have a Medigap policy 

with prescription drug coverage, that means you chose 

not to join a Medicare Prescription Drug Plan when you 

were first eligible. However, you can still join a Medicare 

Prescription Drug Plan. Your situation may have changed 

in ways that make a Medicare Prescription Drug Plan fit 

your needs better than the prescription drug coverage 

in your Medigap policy. It’s a good idea to review your 

coverage each fall, because you can join a Medicare 

Prescription Drug Plan between

October 15 — December 7. Your new coverage will begin 

on January 1. 

• End of Page
74 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Medigap policies and Medicare prescription drug

coverage (continued)

Why would I change my mind and join a Medicare

Prescription Drug Plan?

In a Medicare Prescription Drug Plan, you may have 

to pay a monthly premium, but Medicare pays a large 

part of the cost. There’s no maximum yearly amount 

as with Medigap prescription drug benefits in old Plans 

H, I and J (these plans are no longer sold). However, 

a Medicare Prescription Drug Plan might only cover 

certain prescription drugs (on its “formulary” or “drug 

list”). It’s important that you check whether your current 

prescription drugs are on the Medicare Prescription Drug 

Plan’s list of covered prescription drugs before you join. 

If your Medigap premium or your prescription drug 

needs were very low when you had your first chance to 

join a Medicare Prescription Drug Plan, your Medigap 

prescription drug coverage may have met your needs. 

However, if your Medigap premium or the amount of 

prescription drugs you use has increased recently, a 

Medicare Prescription Drug Plan might now be a better 

choice for you. 
75 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Medigap policies and Medicare prescription drug

coverage (continued)

Will I have to pay a late enrollment penalty if I join a 

Medicare Prescription Drug Plan now?

This will depend on whether your Medigap policy 

includes “creditable prescription drug coverage.” This 

means that the Medigap policy’s drug coverage pays, 

on average, at least as much as Medicare’s standard 

prescription drug coverage. 

If it isn’t creditable coverage, and you join a Medicare

Prescription Drug Plan now, you’ll probably pay a higher 

premium (a penalty added to your monthly premium) 

than if you had joined when you were first eligible. You 

should also consider that your prescription drug needs 

could increase as you get older. Each month that you 

wait to join a Medicare Prescription Drug Plan will make 

your late enrollment penalty higher. Your Medigap carrier 

must send you a notice every year telling you if the 

prescription drug coverage in your Medigap policy is 

creditable. You should keep these notices in case you 

decide later to join a Medicare Prescription Drug Plan.
76 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Medigap policies and Medicare prescription drug

coverage (continued)

Will I have to pay a late enrollment penalty if I join a 

Medicare Prescription Drug Plan now? (continued)

If your Medigap policy includes creditable coverage and 

if you decide to join a Medicare Prescription Drug Plan, 

you won’t have to pay a late enrollment penalty as long 

as you don’t drop your Medigap policy before you join 

the Medicare Prescription Drug Plan. You can only join a 

Medicare Prescription Drug Plan between

October 15 — December 7 unless you lose your Medigap 

policy (for example, if it isn’t guaranteed renewable, and 

your company cancels it). In that case, you may be able to 

join a Medicare Prescription Drug Plan at the time you lose 

your Medigap policy. 

• End of Page
77 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 103 – 107

Medigap policies and Medicare prescription drug

coverage (continued)

Can I join a Medicare Prescription Drug Plan and have

a Medigap policy with prescription drug coverage?

No. If your Medigap policy covers prescription drugs, 

you must tell your Medigap insurance company if you 

join a Medicare Prescription Drug Plan so it can remove 

the prescription drug coverage from your Medigap policy 

and adjust your premium. Once the drug coverage is 

removed, you can’t get that coverage back even though 

you didn’t change Medigap policies.

What if I decide to drop my entire Medigap policy (not

just the Medigap prescription drug coverage) and join a

Medicare Advantage Plan that offers prescription drug

coverage?

You need to be careful about the timing because you can 

only join a Medicare Prescription Drug Plan or Medicare

Advantage Plan during the open enrollment period 

between October 15 — December 7. Your coverage 

will begin on January 1 as long as the plan gets your 

enrollment request by December 7.
78 — Section 5: For People Who Already Have a 

Medigap Policy

Notes
 

SECTION 6: MEDIGAP POLICIES FOR 

PEOPLE WITH A DISABILITY OR ESRD

79

 Underlined words are defined on pages 103 – 107

 Information for people under 65

Medigap policies for people under 65 and eligible for 

Medicare because of a disability or End-Stage Renal 

Disease (ESRD)

You may have Medicare before 65 due to a disability or 

ESRD (permanent kidney failure requiring dialysis or a 

kidney transplant). 

If you’re a person with Medicare under 65 and have a 

disability or ESRD, you might not be able to buy the 

Medigap policy you want, or any Medigap policy, until 

you turn 65. Federal law doesn’t require insurance 

companies to sell Medigap policies to people under 

65. However, some states require Medigap insurance 

companies to sell you a Medigap policy, even if you’re 

under 65. These states are listed on the next page.

Important: These are the minimum Federal standards. 

For your state requirements, call your State Health

Insurance Assistance Program. See pages 97 – 101.
80 — Section 6: Medigap policies for people with a 

Disability or ESRD

Medigap policies for people under 65 and eligible for

Medicare because of a disability or End-Stage Renal 

Disease (ESRD) (continued)

At the time of printing this guide, the following states 

required insurance companies to offer at least one kind 

of Medigap policy to people with Medicare under 65: 

• California*

• Colorado 

• Connecticut 

• Delaware**

• Florida

• Georgia

• Hawaii 

• Illinois 

• Kansas 

• Louisiana 

• Maine 

• Maryland 

• Massachusetts* 

• Michigan 

• Minnesota 

• Mississippi 

• Missouri

• New Hampshire 

• New Jersey 

• New York 

• North Carolina 

• Oklahoma 

• Oregon 

• Pennsylvania 

• South Dakota 

• Tennessee

• Texas 

• Vermont* 

• Wisconsin
81 — Section 6: Medigap policies for people with a 

Disability or ESRD

 Underlined words are defined on pages 103 – 107

Medigap policies for people under 65 and eligible for

Medicare because of a disability or End-Stage Renal 

Disease (ESRD) (continued)

* A Medigap policy isn’t available to people with ESRD 

under 65.

** A Medigap policy is only available to people with 

ESRD. 

Even if your state isn’t listed on the page before, some 

insurance companies may voluntarily sell Medigap 

policies to people under 65, although they will probably 

cost you more than Medigap policies sold to people over 

65, and they can use medical underwriting. Check with 

your state about what rights you might have under state 

law.

Remember, if you’re already enrolled in Medicare 

Part B, you will get a Medigap open enrollment period

when you turn 65. You will probably have a wider choice 

of Medigap policies and be able to get a lower premium

at that time. During the Medigap open enrollment 

period, insurance companies can’t refuse to sell you 

any Medigap policy due to a disability or other health 

problem, or charge you a higher premium (based on 

health status) than they charge other people who are 65. 
82 — Section 6: Medigap policies for people with a 

Disability or ESRD

 Underlined words are defined on pages 103 – 107

Medigap policies for people under 65 and eligible for 

Medicare because of a disability or End-Stage Renal 

Disease (ESRD) (continued)

Because Medicare (Part A and/or Part B) is creditable 

coverage, if you had Medicare for more than 6 months 

before you turned 65, you may not have a pre-existing

condition waiting period. For more information about 

the Medigap open enrollment period and pre-existing 

conditions, see pages 21 – 25. If you have questions, 

call your State Health Insurance Assistance Program. 

See pages 97 – 101

• End of Page
83

 

SECTION 7: MEDIGAP COVERAGE IN 

MASSACHUSETTS, MINNESOTA, AND 

WISCONSIN

Massachusetts benefits ___ Pages 84 – 86

Minnesota benefits ___ Pages 87 – 90

Wisconsin benefits ___ Pages 91 – 93

• End of Page
84 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Massachusetts — Chart of standardized Medigap

policies 

 Massachusetts benefits

• Inpatient Hospital Care: Covers the Medicare Part A 

coinsurance plus coverage for 365 additional days after 

Medicare coverage ends 

• Medical Costs: Covers the Medicare Part B 

coinsurance (generally 20% of the Medicare‐approved

amount) 

• Blood: Covers the first 3 pints of blood each year

• Part A Hospice coinsurance or copayment

Note: The check marks in the chart on the next page 

mean the benefit is covered. 

• End of Page
85 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Massachusetts — Chart of standardized Medigap 

policies (continued)

89 —Section 7: Massachusetts, Minnesota, and 

Wisconsin Medigap Plans

Massachusetts—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Core Plan Supplement 1 

Plan

Basic Benefits ✔ ✔

Medicare Part A: Inpatient 

Hospital Deductible ✔

Medicare Part A: 

Skilled Nursing Facility 

Coinsurance

✔

Medicare Part B: 

Deductible ✔

Foreign Travel Emergency ✔

Inpatient Days in Mental 

Health Hospitals

60 days per 

calendar 

year

120 days per 

benefit year

State‐Mandated Benefits 

(Annual Pap tests and 

mammograms. Check 

your plan for other state‐

mandated benefits.)

✔ ✔
86 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Massachusetts — Chart of standardized Medigap 

policies (continued)

For more information on these Medigap policies, visit 

www.medicare.gov/medigap, or call your State Insurance 

Department. See pages 97 – 101. 

• End of Page
87 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Minnesota — Chart of standardized Medigap policies

 Minnesota benefits

• Inpatient Hospital Care: Covers the Medicare Part A 

coinsurance

• Medical Costs: Covers the Medicare Part B coinsurance 

(generally 20% of the Medicare-approved amount)

• Blood: Covers the first 3 pints of blood each year

• Part A hospice and respite cost sharing

• Parts A and B home health services and supplies cost 

sharing

Note: The check marks in the chart on the next page 

mean the benefit is covered. 
88 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Minnesota — Chart of standardized Medigap policies 

(continued)

91 —Section 7: Massachusetts, Minnesota, and 

Wisconsin Medigap Plans

Minnesota—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Basic Plan Extended Basic 

Plan

Basic Benefits ✔ ✔

Medicare Part A: 

Inpatient Hospital 

Deductible

✔

Medicare Part A: Skilled 

Nursing Facility (SNF) 

Coinsurance 

✔ ✔

Medicare Part B: 

Deductible ✔

Foreign Travel 

Emergency 80% 80%

Outpatient Mental Health 50% 50%

Usual and Customary 

Fees 80%*

91 —Section 7: Massachusetts, Minnesota, and 

Wisconsin Medigap Plans

Minnesota—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Basic Plan Extended 

Plan

Basic Benefits ✔ ✔

Medicare Part A: 

Inpatient Hospital 

Deductible

✔

Medicare Part A: Skilled 

Nursing Facility (SNF) 

Coinsurance 

✔ ✔

Medicare Part B: 

Deductible ✔

Foreign Travel 

Emergency 80% 80%

Outpatient Mental Health 50% 50%

Usual and Customary 

Fees 80%

91 —Section 7: Massachusetts, Minnesota, and 

Wisconsin Medigap Plans

Minnesota—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Basic Plan Extended Basic 

Plan

Basic Benefits ✔ ✔

Medicare Part A: 

Inpatient Hospital 

Deductible

✔

Medicare Part A: Skilled 

Nursing Facility (SNF) 

Coinsurance 

✔ ✔

Medicare Part B: 

Deductible ✔

Foreign Travel 

Emergency 80% 80%

Outpatient Mental Health 50% 50%

Usual and Customary 

Fees 80%*

(Provides 100 days

 of SNF care)

(Provides 120 days

 of SNF care)

80%*

*Pays 100% after you spend $1,000 in out-of-pocket 

costs for a calendar year.
89 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

Minnesota — Chart of standardized Medigap policies 

(continued)

92 —Section 7: Massachusetts, Minnesota, and 

Wisconsin Medigap Plans

Medigap Benefits Basic Plan Extended Basic 

Plan

Medicare-covered 

Preventive Care ✔ ✔

Physical Therapy 20% 20%

Coverage while in a 

Foreign Country 80%

State-mandated Benefits 

(Diabetic equipment 

and supplies, routine 

cancer screening, 

reconstructive surgery, 

and immunizations) 

✔ ✔

* Pays 100% after you spend $1,000 in out-of-pocket costs for 

a calendar year. 

Note: The check marks in this chart mean the benefit is covered. 

Minnesota—Chart of standardized Medigap policies 

(continued)

80%*

*Pays 100% after you spend $1,000 in out-of-pocket 

costs for a calendar year.
90 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Minnesota — Chart of standardized Medigap policies

(continued)

Mandatory Riders: Insurance companies can offer 

four additional riders that can be added to a Basic Plan. 

You may choose any one or all of the following riders to 

design a Medigap policy that meets your needs:

• Medicare Part A: Inpatient Hospital Deductible 

• Medicare Part B: Deductible 

• Usual and Customary Fees 

• Non-Medicare Preventive Care 

Minnesota version of Medigap Plans K, L, M, N, and 

high deductible F are available. 

Important: The Basic and Extended Basic benefits are 

available when you enroll in Part B, regardless of age or 

health problems. If you return to work and drop Part B to 

elect your employer’s health plan, you will get another 

6‐month Medigap open enrollment period after you retire 

from that employer when you can elect Part B again. 
91 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

 Wisconsin — Chart of standardized Medigap policies

 Wisconsin Basic benefits

• Inpatient Hospital Care: Covers the Part A coinsurance

• Medical Costs: Covers the Part B coinsurance 

(generally 20% of the Medicare-approved amount) 

• Blood: Covers the first 3 pints of blood each year

• Part A Hospice coinsurance or copayment

Note: The check marks in the chart on the next page 

mean the benefit is covered.

• End of Page
92 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Wisconsin — Chart of standardized Medigap policies

Basic Benefits ✔

Medicare Part A: Skilled 

Nursing Facility Coinsurance ✔

Inpatient Mental Health 

Coverage

175 days per lifetime in

addition to Medicare's benefit

Home Health Care 40 visits in addition to those 

paid by Medicare

State Mandated Benefits ✔

For more information on these Medigap policies, call your State

Insurance Department. See pages 99 – 103. You can also visit 

www.medicare.gov, and select “Compare Health Plans and 

Medigap Policies in Your Area.” 

Note: The check marks in this chart mean the benefit is 

covered.

• End of Page

Medigap Benefits Basic Plan

Optional Riders 

Insurance companies are allowed to offer the following 

additional riders to a Medigap policy.

• Part A Deductible

• Additional Home Health Care (365 visits including those 

paid by Medicare) 

• Part B Deductible 

• Part B Excess Charges

• Foreign Travel Emergency

• 50% Part A Deductible

• Part B Copayment or Coinsurance
93 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 103 – 107

Wisconsin — Chart of standardized Medigap policies 

(continued)

For more information on these Medigap policies, visit 

www.medicare.gov/medigap, or call your State Insurance 

Department. See pages 97 – 101. 

Plans known as “50% and 25% Cost-sharing Plans” are 

available. These plans are similar to standardized Plans 

K (50%) and L (25%). A high deductible plan ($2,070 in 

2012) is also available.

• End of Page
94 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

Notes
SECTION 8: FOR MORE INFORMATION

95

 Underlined words are defined on pages 103 – 107

 Where to get more information 

On pages 97 – 101, you will find telephone numbers for 

your State Health Insurance Assistance Program and 

State Insurance Department.

• Call your State Health Insurance Assistance Program for 

help with any of the following: 

Buying a Medigap policy or long-term care 

insurance 

 Dealing with payment denials or appeals 

 Medicare rights and protections 

 Choosing a Medicare plan 

 Deciding whether to suspend your Medigap policy

 Questions about Medicare bills 

• Call your State Insurance Department if you have 

questions about the Medigap policies sold in your area 

or any insurance‐related problems. 
96 — Section 8: For More Information

How to get help with Medicare and Medigap questions 

If you have questions about Medicare, Medigap, or need 

updated telephone numbers for the contacts listed on 

pages 97 – 101, you can do the following: 

Visit www.medicare.gov: 

• For Medigap policies in your area, 

visit www.medicare.gov/medigap

• For updated telephone numbers, visit 

www.medicare.gov/contacts

Call 1 800 633 ‐ 4227:

• Customer service representatives are available 24 hours 

a day, 7 days a week. TTY users should call

1 877 486 ‐ 2048. If you need help in a language other 

than English or Spanish, let the customer service 

representative know the language.

• End of Page
97 — Section 8: For More Information

Telephone Numbers for State Health Insurance 

Assistance Programs (SHIPS) and State Insurance 

Departments - States A though G

State State Health

Insurance

Assistance

Program

State Insurance

Department

Alabama 1 800 243 - 5463 1 800 433 - 3966

Alaska 1 800 478 - 6065 1 800 467 - 8725

American Samoa Not Available 1 684 633 - 4116 

Arizona 1 800 432 - 4040 1 800 325 - 2548 

Arkansas 1 800 224 - 6330 1 800 224 - 6330 

California 1 800 434 - 0222 1 800 927 - 4357 

Colorado 1 888 696 - 7213 1 800 930 - 3745 

Connecticut 1 800 994 - 9422 1 800 203 - 3447 

Delaware 1 800 336 - 9500 1 800 282 - 8611 

Florida 1 800 963 - 5337 1 877 693 - 5236 

Georgia 1 800 669 - 8387 1 800 656 - 2298 

Guam 1 671 735 - 7388 1 671 635 - 1835 

 Underlined words are defined on pages 103 – 107
98 — Section 8: For More Information

Telephone Numbers for State Health Insurance 

Assistance Programs (SHIPS) and State Insurance 

Departments - States H though M

State State Health

Insurance

Assistance

Program

State Insurance

Department

Hawaii 1 888 875 - 9229 1 808 586 - 2790 

Idaho 1 800 247 - 4422 1 800 721 - 3272 

Illinois 1 800 548 - 9034 1 866 445 - 5364 

Indiana 1 800 452 - 4800 1 800 622 - 4461 

Iowa 1 800 351 - 4664 1 877 955 - 1212

Kansas 1 800 860 - 5260 1 800 432 - 2484 

Kentucky 1 877 293 - 7447 1 800 595 - 6053 

Louisiana 1 800 259 - 5301 1 800 259 - 5300 

Maine 1 877 353 - 3771 1 800 300 - 5000 

Maryland 1 800 243 - 3425 1 800 492 - 6116 

Massachusetts 1 800 243 - 4636 1 617 521 - 7794 

Michigan 1 800 803 - 7174 1 877 999 - 6442 

Minnesota 1 800 333 - 2433 1 800 657 - 3602 

 Underlined words are defined on pages 103 – 107
99 — Section 8: For More Information

Telephone Numbers for State Health Insurance 

Assistance Programs (SHIPS) and State Insurance 

Departments - States M (continued) though N

State State Health

Insurance

Assistance

Program

State Insurance

Department

Mississippi 1 800 948 - 3090 1 800 562 - 2957 

Missouri 1 800 390 - 3330 1 800 726 - 7390 

Montana 1 800 551 - 3191 1 800 332 - 6148 

Nebraska 1 800 234 - 7119 1 800 234 - 7119 

Nevada 1 800 307 - 4444 1 800 992 - 0900 

New Hampshire 1 866 634 - 9412 1 800 852 - 3416 

New Jersey 1 800 792 - 8820 1 800 446 - 7467 

New Mexico 1 800 432 - 2080 1 800 947 - 4722 

New York 1 800 701 - 0501 1 800 342 - 3736 

North Carolina 1 800 443 - 9354 1 800 546 - 5664 

North Dakota 1 800 247 - 0560 1 800 247 - 0560 

Northern Mariana 

Islands Not Available 1 670 664 - 3064

 Underlined words are defined on pages 103 – 107
100 — Section 8: For More Information

Telephone Numbers for State Health Insurance 

Assistance Programs (SHIPS) and State Insurance 

Departments - States O though U

State State Health

Insurance

Assistance

Program

State Insurance

Department

Ohio 1 800 686 - 1578 1 800 686 - 1526 

Oklahoma 1 800 763 - 2828 1 800 522 - 0071 

Oregon 1 800 722 - 4134 1 888 877 - 4894 

Pennsylvania 1 800 783 - 7067 1 877 881 - 6388 

Puerto Rico 1 877 725 - 4300 1 888 722 - 8686 

Rhode Island 1 401 462 - 4444 1 401 462 - 9520 

South Carolina 1 800 868 - 9095 1 803 737 - 6160 

South Dakota 1 800 536 - 8197 1 800 310 - 6560 

Tennessee 1 877 801 - 0044 1 800 342 - 4029 

Texas 1 800 252 - 9240 1 800 252 - 3439 

Utah 1 877 424 - 4640 1 866 439 - 3805 

 Underlined words are defined on pages 103 – 107
101 — Section 8: For More Information

Telephone Numbers for State Health Insurance 

Assistance Programs (SHIPS) and State Insurance 

Departments - States V though W

State State Health

Insurance

Assistance

Program

State Insurance

Department

Vermont 1 800 642 - 5119 1 800 631 - 7788 

Virgin Islands 1 340 772 - 7368 1 340 774 - 7166 

1 340 714 - 4354 

(St.Thomas) 

Virginia 1 800 552 - 3402 1 877 310 - 6560

Washington 1 800 562 - 6900 1 800 562 - 6900

Washington D.C. 1 202 994 - 6272 1 202 727 - 8000

West Virginia 1 877 987 - 4463 1 888 879 - 9842

Wisconsin 1 800 242 - 1060 1 800 236 - 8517 

Wyoming 1 800 856 - 4398 1 800 438 - 5768 

 Underlined words are defined on pages 103 – 107
102 — Section 8: For More Information

Notes
SECTION 9: DEFINITIONS

103

 Where underlined words are defined

 Letters A through D

Assignment — An agreement by your doctor or other 

supplier to be paid directly by Medicare, to accept the 

payment amount Medicare approves for the service, and 

not to bill you for any more than the Medicare deductible 

and coinsurance.

Coinsurance — An amount you may be required to pay 

as your share of the costs for services after you pay any 

deductibles. Coinsurance is usually a percentage (for 

example, 20%).

Copayment — An amount you may be required to 

pay as your share of the cost for a medical service or 

supply, like a doctor’s visit, hospital outpatient stay, or a 

prescription. A copayment is usually a set amount, rather 

than a percentage. For example, you might pay $10 or 

$20 for a doctor’s visit or prescription.

Deductible — The amount you must pay for health 

care or prescriptions, before Original Medicare, your 

prescription drug plan, or your other insurance begins to 

pay.
104 — Section 9: Definitions

 Letters E through M

Excess Charge — If you have Original Medicare, and the 

amount a doctor or other health care provider is legally 

permitted to charge is higher than the Medicare-approved 

amount, the difference is called the excess charge. 

Guaranteed Issue Rights (also called “Medigap 

Protections”) — Rights you have in certain situations 

when insurance companies are required by law to sell 

or offer you a Medigap policy. In these situations, an 

insurance company can’t deny you a Medigap policy, or 

place conditions on a Medigap policy, such as exclusions 

for pre-existing conditions, and can’t charge you more 

for a Medigap policy because of a past or present health 

problem.

Guaranteed Renewable Policy — A Medigap policy that 

can’t be terminated by the insurance company unless you 

make untrue statements to the insurance company, commit 

fraud, or don’t pay your premiums. All Medigap policies 

issued since 1992 are guaranteed renewable.

Medicaid — A joint Federal and state program that helps 

with medical costs for some people with limited income 

and resources. Medicaid programs vary from state to 

state, but most health care costs are covered if you qualify 

for both Medicare and Medicaid.
105 — Section 9: Definitions

Letter M (continued)

Medical Underwriting — The process that an insurance 

company uses to decide, based on your medical history, 

whether or not to take your application for insurance, 

whether or not to add a waiting period for pre‐existing 

conditions (if your state law allows it), and how much to 

charge you for that insurance.

Medicare Advantage Plan (Part C) — A type of 

Medicare health plan offered by a private company that 

contracts with Medicare to provide you with all your 

Medicare Part A and Part B benefits. Medicare Advantage 

Plans include Health Maintenance Organizations, 

Preferred Provider Organizations, Private Fee-for-Service 

Plans, Special Needs Plans, and Medicare Medical 

Savings Account Plans. If you are enrolled in a Medicare 

Advantage Plan, Medicare services are covered through 

the plan and aren’t paid for under Original Medicare. 

Most Medicare Advantage Plans offer prescription drug 

coverage.

Medicare-approved Amount — In Original Medicare, 

this is the amount a doctor or supplier that accepts 

assignment can be paid. It may be less than the actual 

amount a doctor or supplier charges. Medicare pays part of 

this amount and you are responsible for the difference.
106 — Section 9: Definitions

 Letters M (continued) through O

Medicare Prescription Drug Plan (Part D) — 

A stand-alone drug plan that adds prescription drug 

coverage to Original Medicare, some Medicare Cost 

Plans, some Medicare Private-Fee-for-Service Plans, 

and Medicare Medical Savings Account Plans. If 

you have a Medigap policy without prescription drug 

coverage, you can also add a Medicare Prescription 

Drug Plan. These plans are offered by insurance 

companies and other private companies approved by 

Medicare. Medicare Advantage Plans may also offer 

prescription drug coverage that follows the same rules 

as Medicare Prescription Drug Plans.

Medicare SELECT — A type of Medigap policy that may 

require you to use hospitals and, in some cases, doctors 

within its network to be eligible for full benefits.

Open Enrollment Period (Medigap) — A one‐timeonly, 6-month period when Federal law allows you to buy 

any Medigap policy you want that is sold in your state. 

It starts in the first month that you are covered under 

Medicare Part B, and you’re 65 or older. During this 

period, you can’t be denied a Medigap policy or charged 

more due to past or present health problems. Some 

states may have additional open enrollment rights under 

state law.

Original Medicare — Original Medicare is fee-forservice coverage under which the government pays your 

health care providers directly for your Part A and/or

Part B benefits.
107 — Section 9: Definitions

 Letters P through S

Pre-existing Condition — A health problem you had 

before the date that a new insurance policy starts. 

Premium — The periodic payment to Medicare, an 

insurance company, or a health care plan for health care or 

prescription drug coverage.

State Health Insurance Assistance Program 

(SHIP) — A state program that gets money from the 

Federal government to give free local health insurance 

counseling to people with Medicare.

State Insurance Department — A state agency that 

regulates insurance and can provide information about 

Medigap policies and other private health insurance. 

• End of Page
108 — Section 9: Definitions

Notes
SECTION 10: LIST OF TOPICS

109

 An alphabetical list of what’s in this guide

 A

Attained-age-rated Policies 26 – 29, 55

 B

Blood 14, 84, 87, 91 

 C

Changing (Switching) Medigap Policies 64 – 71 

Claim Filing 32 

COBRA (Consolidated Omnibus Budget Reconciliation 

Act) 38 

Coinsurance 5, 11, 14 – 16, 22, 71, 84, 85, 87, 91

Comparing Cost 30

Copayment 5, 11, 14 – 16, 22, 71, 84, 91

Creditable Coverage 75, 76, 82
110 — Section 10: List of Topics

 D

Deductible 5, 11, 14 – 16, 31, 54, 71, 85, 88, 90

Disability 24, 79 – 82

 E

Employer Group Health Plan 38

End-Stage Renal Disease (ESRD) 6, 79 – 82 

Excess Charges 15, 92

 F

Finding Reliable Insurance Companies 53

Foreign Travel Emergency 31, 85, 88, 92

 G

Guaranteed Issue Rights 23, 35 – 48, 64, 104 

Guaranteed Renewable 20, 64, 72, 76, 104
111 — Section 10: List of Topics

 H

High-deductible Option 16, 31, 54, 90, 93

Hospice Care 6, 15, 84, 87, 91

 I

Illegal Insurance Practices 58 

Inspector General’s Office 59 

Issue-age-rated Policies 26, 28, 55 

 L

Long-term Care Insurance 17, 48, 97 

 M

Medicaid 5, 17, 18, 48, 58, 104 

Medical Savings Account Plan 106

Medical Underwriting 21, 24, 26, 31, 54, 81, 105

Medicare Advantage Plan 5, 7, 8, 11, 17 – 19, 36 – 37, 

41 – 42, 45, 58 – 59, 71, 77, 105
112 — Section 10: List of Topics

M (continued)

Medicare-approved Amount 87, 91, 105

Medicare Cost Plan 106

Medicare Part A (Hospital Insurance) 6, 8, 13 – 15, 41, 

84 – 85, 88, 90, 92

Medicare Part B (Medical Insurance) 6, 13 – 14, 21, 25, 

32 – 33, 81, 84 – 85, 87 – 88, 90 

Medicare Prescription Drug Plan 5, 7, 8, 17, 20, 73 – 78, 

106

Medicare SELECT 12, 31, 32, 40, 42, 48, 54, 69 - 70, 

106

Medicare Supplement Insurance (see Medigap) 

Medigap 

Best Time To Buy 21 – 24

Claim Filing 32

Steps To Buying 49 – 62

Under 65 79 – 82 

What It Is 11 – 12 

What’s Covered and What’s Not Covered 13 – 17
113 — Section 10: List of Topics

M (continued)

Medigap Benefits Chart 

Plans A through N 13 – 16

Massachusetts 84 – 86 

Minnesota 87 – 90 

Wisconsin 91 – 93 

Medigap Policies and Medicare Prescription Drug 

Coverage 73 – 77 

Medigap Protections (Guaranteed Issue Rights) 46, 60, 

64, 104 

Moving 69 – 70

 N

No-age-rated Policies 26 – 27

 O

Open Enrollment Period (Medigap) 21 – 25, 31, 35, 53 – 

54, 60, 64, 69, 73, 81, 90, 106

Original Medicare 5 – 8, 11, 22, 37 – 38, 40, 41, 49, 59, 

69, 106
114 — Section 10: List of Topics

 P

PACE (Programs of All-Inclusive Care for the Elderly) 41, 

48

Pre-existing Condition 21 – 24, 35, 55, 66 – 67, 82, 107

Premium 19, 20, 26 – 31, 56, 62, 64, 68, 71, 72, 74, 75, 

77, 81, 107

Prescription Drug Coverage (Medicare) 5, 7, 9, 16, 20, 

73 – 77

Preventive Care 6, 89

Pricing Policies 26 – 29

 R

Right to Buy a Medigap Policy 35 – 47

 S

Skilled Nursing Facility (Care) 6, 15, 85, 88, 92

State Health Insurance Assistance Program 23, 49,

50, 52, 95, 97 – 101, 107

State Insurance Department 13, 50, 52, 59, 97 – 101, 

107

Switching Medigap Policies 64 – 71 
115 — Section 10: List of Topics

 T 

TRICARE 5, 17 

 U 

Union Coverage 38

 V 

Veterans’ Benefits 17

 W 

Waiting Period 22 – 23, 55, 67, 82, 105

www.medicare.gov 30, 51, 86, 93, 96

• End of Page
116 — Section 10: List of Topics

Notes
Important Information about this guide

The information, phone numbers, and web addresses in 

this guide were correct at the time of printing. Changes 

may occur after printing. To get the most up-to-date 

information and Medicare phone numbers, visit 

www.medicare.gov, or call 1 800 633 ‐ 4227. 

TTY users should call 1 877 486 ‐ 2048.

The “2012 Choosing a Medigap Policy: A Guide to 

Health Insurance for People with Medicare” isn’t a legal 

document. Official Medicare Program legal guidance 

is contained in the relevant statutes, regulations, and 

rulings.
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Centers for Medicare & Medicaid Services 

7500 Security Boulevard 

Baltimore, Maryland 21244 - 1850

Official Business 

Penalty for Private Use, $300 

CMS Publication No. 02110 - LE 

Revised December 2011 

To get this publication on CD, in Braille, or 

Spanish, visit www.medicare.gov on the web, or call 

1 800 633 - 4227. TTY users should call 1 877 486 - 2048. 

¿Necesita una copia en español? Visite www.medicare.gov 

en el sitio Web. Para saber si esta publicación esta impresa 

y disponible (en espanol), llame GRATIS al 1 800 633 - 4227. 

Los usarios de TTY deben llamar al 1 877 486 - 2048.