Large Print Edition

Centers for Medicare & Medicaid Services

2014

Choosing A Medigap Policy: 

A Guide to Health Insurance 

for People with Medicare

This official government guide has important 

information about:

• Medicare Supplement Insurance 

(Medigap) policies 

• 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.

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

and the national association of insurance companies (NAIC)

Who should read this guide? 

This guide helps people with Medicare understand 

“Medicare Supplement Insurance” policies (also called 

Medigap 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. 

Medicare & the Health Insurance Marketplace

The Health Insurance Marketplace, a key part of the 

Affordable Care Act, is a new way for individuals, 

families, and employees of small businesses to get 

health insurance.

If I have Medicare, do I need to do anything?

No. Medicare isn’t part of the Marketplace, so you 

don’t need to do anything. If you have Medicare, you’re 

considered covered. The Marketplace won’t affect your 

Medicare choices, and your benefits won’t change. No 

matter how you get Medicare, whether through Original 

Medicare or a Medicare Advantage Plan (like an HMO or 

PPO), you’ll still have the same benefits and security you 

have now. You won’t have to make any changes.

Note: The Marketplace doesn’t offer Medicare 

Supplement Insurance (Medigap) policies or Part D drug 

plans. For more information about the Marketplace, visit 

HealthCare.gov.
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 Medicare.gov, or call 1 800 633 4227. TTY users 

should call 1 877 486 2048.

The “2014 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.

• End of Page
1 — Table of Contents

Section 1: Medicare Basics

A brief look at Medicare ___ Page 5

What is Medicare? ___ Page 6

The different parts of Medicare ___ Page 6

Your Medicare coverage choices at a 

glance ___ Pages 8 – 10

Section 2: Medigap Basics

What’s 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?___Pages 18 – 19

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

policy?___Pages 19 – 21

When’s the best time to buy a Medigap 

policy? ___Pages 22 – 25

Why is it important to buy a Medigap policy when 

I’m first eligible? ___Pages 26 – 27
2 — Table of Contents (continued)

Section 2: Medigap Basics (continued)

How do insurance companies set prices for Medigap 

policies? ___ Page 28

What this pricing may mean for you ___Pages 29 – 30

Comparing Medigap costs ___Pages 32 – 33

What’s Medicare SELECT? ___Page 34

How does Medigap help pay my Medicare Part B 

bills? ___Pages 34 – 35

Section 3: Your Right to Buy a Medigap Policy

What are guaranteed issue rights? ___Page 37

When do I have guaranteed issue rights? ___Page 38

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

coverage? ___Page 44

Section 4: Steps to Buying a Medigap Policy

Step-by-step guide to buying a Medigap 

policy___Page 47
3 — Table of Contents (continued)

Section 5: For People Who Already Have a 

Medigap Policy

Switching Medigap policies___Pages 60 – 66

Losing Medigap coverage___Page 67

Medigap policies and Medicare prescription drug 

coverage___Pages 68 – 72

Section 6: Medigap Policies for People with a Disability 

or ESRD

Information for people under 65___Page 73

Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

Massachusetts benefits___Page 78

Minnesota benefits___Page 79

Wisconsin benefits___Page 84
4 — Table of Contents (continued)

Section 8: For More Information

Where to get more information___Page 87

How to get help with Medicare and Medigap 

questions___Page 88

State Health Insurance Assistance Program and State 

Insurance Department___Pages 89 – 93

Section 9: Definitions

Where underlined words are defined___Page 95

• End of Page
5

 

Section 1: Medicare Basics

 Underlined words are defined on pages 95 – 99

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 like emergency foreign travel expenses. 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 1: Medicare Basics

What’s Medicare? 

Medicare is health insurance for:

• 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 

• 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 

• Preventive services to help maintain your health and 

to keep certain illnesses from getting worse 
7 — Section 1: Medicare Basics

The different parts of Medicare (continued)

Medicare Part C (Medicare Advantage) 

• Includes all benefits and services covered under 

Part A and Part B

• Run by Medicare-approved private insurance 

companies 

• Usually includes Medicare prescription drug coverage 

(Part D) as part of the plan 

• May include extra benefits and services for an extra 

cost

Medicare Part D (Medicare Prescription Drug 

Coverage) 

• Helps cover the cost of outpatient prescription drugs 

• Run by Medicare-approved private insurance 

companies

• May help lower your prescription drug costs and help 

protect against higher costs in the future
8 — Section 1: Medicare Basics

 Underlined words are defined on pages 95 – 99

Your Medicare coverage choices at a glance 

There are 2 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 66 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 1: Medicare Basics

Your Medicare coverage choices at a glance 

(continued)

STEP 3: Decide if you need to add supplemental 

coverage.

Medicare Supplement Insurance 

(Medigap) policy

END

OR

Medicare Advantage Plan

Part C (like an HMO or PPO)

Part C

Combines Part A, Part B, and usually Part D

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

Part D 

Prescription Drug Coverage (Most Medicare Advantage 

Plans cover prescription drugs. You may be able to 

add drug coverage in some plan types if not already 

included.) 

END
10 — Section 1: Medicare Basics

Your Medicare coverage choices at a glance 

(continued)

If you join a Medicare Advantage Plan, you can’t use 

and can’t be sold a Medicare Supplement Insurance 

(Medigap) policy. 

For more information 

Remember, this guide is about Medigap policies. 

To learn more about Medicare, visit Medicare.gov, 

look at your “Medicare & You” handbook, or call 

1 800 633 - 4227. TTY users should call 

1 877 486 - 2048.

• End of Page
11

 

Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

What’s a Medigap policy? 

A “Medicare Supplement Insurance” policy (also called 

Medigap) is private health insurance that’s designed to 

supplement Original Medicare. This means it helps pay 

some of the health care costs that Original Medicare 

doesn’t cover (like copayments, coinsurance, and 

deductibles). These are “gaps” in Medicare coverage. 

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 the 

costs of 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 95 – 99

What’s 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 

78 – 86. In some states, you may be able to buy another 

type of Medigap policy called Medicare SELECT. 

Medicare SELECT plans are standardized plans that may 

require you to see certain providers and may cost less 

than other plans. See page 34.

• End of Page
13 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

What Medigap policies cover

The information on the next few pages gives you a quick 

look at the standardized Medigap Plans available.

Notes: 

• 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 

78 – 86 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 89 – 93 

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 

generally keep it.
14 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

What Medigap policies cover (continued)

Below is basic information about the different benefits that 

Medigap policies cover. If a plan letter and percentage 

appears, the Medigap plan covers that percentage of the 

benefit, and you’re responsible to pay the rest. 

Note: You’ll need more details than this chart provides 

to compare and choose a policy. Call your State Health 

Insurance Assistance Program for help. See pages 89 –

93 for your state’s phone number.

Medicare Part A coinsurance and hospital costs (up 

to an additional 365 days after Medicare benefits are 

used) 

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

Out-of-Pocket Limit** K $4,940 L $2,470

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 $4,940 L $2,470
15 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

Blood (first 3 pints) 

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

M or N

Out-of-Pocket Limit** K $4,940 L $2,470

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 $4,940 L $2,470

Skilled nursing facility care coinsurance

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

Out-of-Pocket Limit** K $4,940 L $2,470

Medicare Part A deductible

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

or N

Out-of-Pocket Limit** K $4,940 L $2,470
16 — Section 2: Medigap Basics

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

* Plan F also offers a high-deductible plan in some 

states. If you choose this option, this means you 

must pay for Medicare-covered costs (coinsurance, 

copayments, deductibles) up to the deductible amount 

of $2,140 in 2014 before your policy pays anything. 

** For Plans K and L, after you meet your out-of-pocket 

yearly limit and your yearly Part B deductible ($147 in 

2014), 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.
17 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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

• Qualified Health Plans sold in the Health Insurance 

Marketplace
18 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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 78 – 86.

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 22 – 25.

• If you have a guaranteed issue right. See pages 37 – 

43.
19 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

What types of Medigap policies can insurance 

companies sell? (continued)

You may be able to 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 (like if you already have Medicaid or a 

Medicare Advantage Plan).

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’ll have continuous coverage.

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

generally 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.
20 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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

Medigap policy? (continued)

• 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.

• When you have your Open Enrollment Period you can 

buy a Medigap policy from any insurance company 

that’s licensed in your state.

• If you want to buy a Medigap policy, see pages 14 – 16 

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

Buying a Medigap Policy” on pages 47 – 58.

• 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.

• Different insurance companies may charge different 

premiums for the same exact policy. As you shop for 

a policy, be sure you’re comparing the same policy 

(for example, compare Plan A from one company with 

Plan A from another company).
21 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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

Medigap policy? (continued)

• Some states may have laws that may give you 

additional protections.

• 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 pages 6 – 9.

To learn about Medicare prescription drug coverage, visit 

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. 

• End of Page
22 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

When’s 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 (Medical Insurance). 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 these 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
23 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

When’s 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 pre-existing 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 “preexisting 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 preexisting condition 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 Medicare coinsurance or copayment.
24 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

When’s the best time to buy a Medigap policy? 

(continued) 

Creditable coverage

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.

Your Medigap insurance company can 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 89 – 93.
25 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

When’s the best time to buy a Medigap policy? 

(continued) 

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 37 – 43 for more information 

about guaranteed issue rights.

Note: If you’re under 65 and have Medicare because of a 

disability or End-Stage Renal Disease (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 73 for more information. 

• End of Page
26 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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’s 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 38 – 43.

It’s also important to understand that your Medigap 

rights may depend on when you choose to enroll in 

Medicare Part B (Medical Insurance). If you’re 65 or 

older, your Medigap Open Enrollment Period begins 

when you enroll in Part B and it can’t be changed or 

repeated. In most cases, it makes sense to enroll in 

Part B and purchase a Medigap policy when you’re first 

eligible for Medicare, because you might otherwise have 

to pay a Part B late enrollment penalty and you might 

miss your Medigap Open Enrollment Period. However, 

there are exceptions if you have employer coverage.
27 — Section 2: Medigap Basics

Why is it important to buy a Medigap policy when 

I’m first eligible? (continued)

Employer coverage

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 benefits based on current employment often 

provide coverage similar to Part B, and you would be 

paying for Part B before you need it, and your Medigap 

Open Enrollment might expire before a Medigap policy 

would be useful. When the employer coverage ends, 

you’ll 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 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 39 for more information. 
28 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

How do insurance companies set prices for Medigap 

policies? 

Each insurance company decides how it’ll 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 3 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 in the chart on the next page. 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 

where you live, medical underwriting, and discounts can 

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

 Underlined words are defined on pages 95 – 99

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. 

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. 
30 — Section 2: Medigap Basics

How do insurance companies set prices for Medigap 

policies? (continued)

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. 

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.
31 — Section 2: Medigap Basics

How do insurance companies set prices for Medigap 

policies? (continued)

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 

each year. 

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

• At 74, his premium goes up to $177. 

• End of Page
32 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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 28 – 30. 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 89 – 93.

You can also find out which insurance companies sell 

Medigap policies in your area by visiting Medicare.gov.

The cost of your Medigap policy may also depend 

on whether the insurance company does any of the 

following: 

• Offers discounts (like 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). 
33 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

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 34. 

• Offers a “high-deductible option” for Medigap 

Plan F. If you buy Medigap Plan F with a highdeductible option, you must pay the first $2,140 (in 

2014) 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 $2,140 (in 2014) 

deductible before the policy pays anything. 
34 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

What’s 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 page 14. These policies generally 

cost less than other Medigap policies. However, if you 

don’t use a Medicare SELECT hospital or doctor for nonemergency services, you’ll 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 my 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 whatever amount is owed under your 

policy. Some Medigap insurance companies also provide 

this service for Medicare Part A (Hospital Insurance) 

claims.
35 — Section 2: Medigap Basics

 Underlined words are defined on pages 95 – 99

How does Medigap help pay my 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
NOTES
37

Section 3: Your Right to Buy a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

What are guaranteed issue rights? 

As explained on pages 22 – 27, 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. See pages 38 – 43 for more 

information.

Guaranteed issue rights are rights you have in certain 

situations when insurance companies must offer you 

certain Medigap policies. In these situations, an insurance 

company must: 

• 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 

78 – 86 for your Medigap policy choices. 
38 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 95 – 99

When do I have guaranteed issue rights? 

In most cases, you have a guaranteed issue right when 

you have certain types of other health care coverage 

that changes in some way, like 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 pages 41 – 42.

The following information describes the situations that 

give you a right to buy a policy, the kind of policy you 

can buy, and when you can or must apply for it. 

Situation1: 

You have a guaranteed issue right if... 

You’re 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’s 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. 
39 — Section 3: Your Right to Buy a Medigap Policy

The following information describes the situations 

that give you a right to buy a policy, the kind of policy 

you can buy, and when you can or must apply for it. 

(continued)

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.

Situation 2: 

You have a guaranteed issue right if... 

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’s 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. 
40 — Section 3: Your Right to Buy a Medigap Policy

 Underlined words are defined on pages 95 – 99

The following information describes the situations 

that give you a right to buy a policy, the kind of policy 

you can buy, and when you can or must apply for it. 

(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 

Situation 3:

You have a guaranteed issue right if... 

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

 Underlined words are defined on pages 95 – 99

The following information describes the situations 

that give you a right to buy a policy, the kind of policy 

you can buy, and when you can or must apply for it. 

(continued)

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. 

Situation 4: 

You have a guaranteed issue right if... 

(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 95 – 99

The following information describes the situations 

that give you a right to buy a policy, the kind of policy 

you can buy, and when you can or must apply for it. 

(continued)

Situation 5: 

You have a guaranteed issue right if... 

(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 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... 

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

The following information describes the situations 

that give you a right to buy a policy, the kind of policy 

you can buy, and when you can or must apply for it. 

(continued)

Situation 6: 

You have a guaranteed issue right if... 

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’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. 

Situation 7: 

You have a guaranteed issue right if... 

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

 Underlined words are defined on pages 95 – 99

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 these: 

• 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’ll have continuous coverage. 

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

 Underlined words are defined on pages 95 – 99

For more information 

If you have any questions or want to learn about any 

additional Medigap rights in your state, you can: 

• Call your State Health Insurance Assistance Program to 

make sure that you qualify for these guaranteed issue 

rights. See pages 89 – 93. 

• Call your State Insurance Department if you’re denied 

Medigap coverage in any of these situations. See pages 

89 – 93. 

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 in the chart on pages 38 – 43 applies to you. 

When this happens, you can choose the guaranteed 

issue right that gives you the best choice. 

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

 Underlined words are defined on pages 95 – 99

For more information (continued) 

Some of the situations listed include loss of coverage 

under Programs of All-inclusive Care for the Elderly 

(PACE). PACE combines medical, social, and longterm 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, visit Medicare.gov, or call 

1 800 633 - 4227. TTY users should 

call 1 877 486 - 2048. 

• End of Page
47

Section 4: Steps to Buying a 

Medigap Policy

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 78 – 86. 

STEP 1: Decide which benefits you want, then decide 

which of the standardized Medigap Plans 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. 
48 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

STEP 1: Decide which benefits you want, then decide 

which of the Medigap Plans meets 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 provides 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: 

• Call your State Health Insurance Assistance Program. 

See pages 89 – 93. 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 

89 – 93. 
49 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

STEP 2: Find out which insurance companies sell 

Medigap policies in your state. (continued)

• Visit Medicare.gov/find-a-plan/questions/Medigaphome.aspx. 

This website will help you find information on all your 

health plan options, including the Medigap policies in 

your area. You can also get information on: 

 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.
50 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

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’re honest and reliable by using 

one of these resources: 

• 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 these complaints, if any.

• 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: 

Getting information on an insurance company’s 

financial strength from independent rating services 

like The Street.com Ratings, A.M. Best, and 

Standard & Poor’s. 

Looking 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.
51 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

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 22 – 25 and 

38 – 43 carefully. If you have questions, call your State

Health Insurance Assistance Program. See pages 89 –

93. 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 
52 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

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 
53 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

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 in the line below.

Insurance Company #1 

Insurance Company #2 

“Do you price this Medigap policy by using 

community-rating, issue-age-rating, or attained-agerating?” See page 29. 

Note: Circle the one that applies for that insurance 

company.

Insurance Company #1- Community

Issue-age

Attained-age

Insurance Company #2 - Community

Issue-age

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

 Underlined words are defined on pages 95 – 99

STEP 3: Call the insurance companies that sell the

Medigap policies you’re interested in and 

compare costs. (Continued)

Ask each insurance company... 

“I’m ___ 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 in the line below.

Insurance Company #1 

Insurance Company #2 

“Do you offer any discounts or additional (innovative) 

benefits?” See page 32.

Insurance Company #1 

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

 Underlined words are defined on pages 95 – 99

STEP 3: (continued) 

Watch out for illegal practices. 

It’s illegal for anyone to: 

• 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’re in 

a Medicare Advantage Plan (like an HMO or PPO) 

unless your coverage under the Medicare Advantage 

Plan will end before the effective date of the Medigap 

policy.

• Claim that a Medigap policy is a part of Medicare or 

any other federal program. Medigap is private health 

insurance.

• Claim that a Medicare Advantage Plan is a Medigap 

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

 Underlined words are defined on pages 95 – 99

STEP 3: (continued) 

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

in your state. Check with your State Insurance

Department (see pages 89 – 93) 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.
57 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

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 these 

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. 

• Paying for your Medigap policy. You can 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.
58 — Section 4: Steps to Buying a Medigap Policy

 Underlined words are defined on pages 95 – 99

STEP 4: Buy the Medigap policy. (continued)

• 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 89 – 93. 

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. 

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’ll 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 55. 

• End of Page
59

 

Section 5: For People Who Already 

Have a Medigap Policy

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 60 – 66. 

• You’re losing your Medigap coverage. See page 67. 

• You have a Medigap policy with Medicare prescription 

drug coverage. See pages 68 – 72. 

If you just want a refresher about Medigap insurance, turn 

to page 13.

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

Medigap Policy

 Underlined words are defined on pages 95 – 99

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 below and pages 61 – 66 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.
61 — Section 5: For People Who Already Have a 

Medigap Policy

Switching Medigap policies (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’ll have to promise that you’ll 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’ll need to pay 

both premiums for one month. 

Do I have to switch Medigap policies if I have a 

Medigap policy that is no longer sold? 

No. But you can’t have more than one Medigap policy, 

so if you buy a new Medigap policy, you have to give 

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

period,” described above). Once you cancel the policy, 

you can’t get it back. 

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

Medigap Policy

 Underlined words are defined on pages 95 – 99

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’ve had your current Medigap policy.

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. 
63 — Section 5: For People Who Already Have a 

Medigap Policy

Switching Medigap policies (continued)

Why would I want to switch to a different Medigap 

policy?

Some reasons for switching may include: 

• 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. 

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 78 – 86. 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.
64 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

Switching Medigap policies (continued)

As discussed on page 60, 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’ll need to pay both 

premiums for one month.

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’ll have to check with your current or the new 

insurance company to see if they’ll 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 22 – 25.
65 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

Switching Medigap policies (continued)

If you have a Medicare SELECT policy and you move out 

of the policy’s area, you have these:

• 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 any 

Medigap Plan A, B, C, F, K, or L that’s available for 

sale in most states by any insurance company.

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

Medigap Policy

 Underlined words are defined on pages 95 – 99

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’ll 

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 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 pages 41 – 42. 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. 
67 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

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 these 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 43. 
68 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

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 37. 

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
69 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

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. 
70 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

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 you qualify for Extra Help, 

you won’t pay a late enrollment penalty. 

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 each 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. 
71 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

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 

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. 

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.
72 — Section 5: For People Who Already Have a 

Medigap Policy

 Underlined words are defined on pages 95 – 99

Medigap policies and Medicare prescription drug 

coverage (continued)

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.

• End of Page
73

Section 6: Medigap Policies for People 

With a Disability or ESRD

 Underlined words are defined on pages 95 – 99

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 89 – 93.
74 — Section 6: Medigap policies for people with a 

Disability or ESRD

Information for people under 65 (continued)

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

• Montana

• New Hampshire 

• New Jersey 
75 — Section 6: Medigap policies for people with a 

Disability or ESRD

 Underlined words are defined on pages 95 – 99

Information for people under 65 (continued)

• New York 

• North Carolina 

• Oklahoma 

• Oregon 

• Pennsylvania 

• South Dakota

• Tennessee 

• Texas 

• Vermont 

• Wisconsin 

Note: Some states provide these rights to all people 

with Medicare under age 65, while others only extend 

them to those who are eligible for Medicare by reason of 

disability or only to those with ESRD. Check with your 

State Insurance Department about what rights you might 

have under state law.

Even if your state isn’t listed on this page or the page 

before, some insurance companies may voluntarily sell 

Medigap policies to people under 65, although they’ll 

probably cost you more than Medigap policies sold to 

people over 65, and they can use medical underwriting. 

Check with your State Insurance Department about what 

rights you might have under state law.
76 — Section 6: Medigap policies for people with a 

Disability or ESRD

 Underlined words are defined on pages 95 – 99

Information for people under 65 (continued)

Remember, if you’re already enrolled in Medicare Part B, 

you’ll get a Medigap Open Enrollment Period when you 

turn 65. You’ll 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.

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 26 – 28. If you have questions, 

call your State Health Insurance Assistance Program. 

See pages 89 – 93.

• End of Page
77

Section 7: Medigap Coverage 

in Massachusetts, Minnesota, 

and Wisconsin

Massachusetts benefits ___ pages 78 – 80

Minnesota benefits ___ pages 80 – 83

Wisconsin benefits ___ pages 84 – 86

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

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

Massachusetts—Chart of standardized 

Medigap policies

Massachusetts benefits 

Inpatient hospital care: covers the Medicare Part A 

(Hospital insurance) coinsurance plus coverage for 365 

additional days after Medicare coverage ends 

• Medical costs: covers the Medicare Part B (Medical 

Insurance) coinsurance (generally 20% of the 

Medicare-approved amount) 

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

• Part A hospice coinsurance or copayment

The check marks in this chart mean the benefit is 

covered. 

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

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

3 3

3 3

3

3

3

3

Medigap Benefits Core Plan Supplement 1

Plan

Basic Benefits

Part A: Inpatient hospital

deductible

Part A: skilled nursing

facility (SNF) coinsurance

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 statemandated benefits.)

Massachusetts—Chart of standardized 

Medigap policies (continued)
80 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

Massachusetts—Chart of standardized 

Medigap policies (continued)

For more information on these Medigap policies, visit 

Medicare.gov/find-a-plan, or call your State Insurance

Department. See pages 89 – 93. 

Minnesota—Chart of standardized Medigap policies

Minnesota 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 and respite cost sharing

• Parts A and B home health services and supplies cost 

sharing

The check marks in this chart mean the benefit is 

covered. 
81 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

3 3

3

3 3

3

Minnesota—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Core Plan Extended 

Basic Plan

Basic Benefits

Part A: inpatient 

hospital deductible

Part A: skilled nursing 

facility (SNF) coinsurance (Provides 100 

days of SNF care)

(Provides 120 

days of SNF care)

Part B: deductible 

Foreign travel emergency 80% 80%*

Outpatient mental 

health 20% 20%

Usual and customary 

fees 80%*

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

costs for a calendar year. Minnesota versions of 

Medigap Plans K, L, M, N, and high deductible F are 

available. 
82 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

3

3

3

3

Minnesota—Chart of standardized Medigap policies 

(continued)

Medigap Benefits Core 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. Minnesota versions of 

Medigap Plans K, L, M, N, and high deductible F are 

available. 
83 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

Minnesota—Chart of standardized Medigap policies 

(continued)

Mandatory Riders

Insurance companies can offer 4 additional riders that 

can be added to a Basic Plan. You may choose any one 

or all of these riders to design a Medigap policy that 

meets your needs:

1. Part A: inpatient hospital deductible

2. Part B: deductible

3. Usual and customary fees

4. Non-medicare preventive care

Minnesota versions 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’ll get another 

6-month Medigap Open Enrollment Period after you 

retire from that employer when you can elect Part B 

again.
84 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

Wisconsin—Chart of standardized Medigap policies

Wisconsin 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

The check marks in this chart mean the benefit is 

covered. 

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

Minnesota, and Wisconsin

3

3

3

Wisconsin—Chart of standardized Medigap policies

(continued)

• End of Page

Medigap Benefits Basic Plan

Basic Benefits

Part A: skilled nursing 

facility (SNF)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
86 — Section 7: Medigap Coverage in Massachusetts, 

Minnesota, and Wisconsin

 Underlined words are defined on pages 95 – 99

Wisconsin—Chart of standardized Medigap policies 

(continued)

Optional Riders 

Insurance companies are allowed to offer these 7 

additional riders to a Medigap policy:

1. Part A deductible

2. Additional home health care (365 visits including 

those paid by Medicare) 

3. Part B deductible

4. Part B excess charges

5. Foreign travel emergency

6. 50% Part A deductible

7. Part B copayment or coinsurance

For more information on these Medigap policies, visit 

Medicare.gov/find-a-plan or call your State Insurance

Department. See pages 89 – 93.

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 ($2,140 

deductible for 2014) is also available.
87

Section 8: For More Information

 Underlined words are defined on pages 95 – 99

Where to get more information 

On pages 89 – 93, you’ll find phone numbers for your 

State Health Insurance Assistance Program and State

Insurance Department. 

• Call your State Health Insurance Assistance Program for 

help with: 

 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. 
88 — Section 8: For More Information

How to get help with Medicare and Medigap questions 

If you have questions about Medicare, Medigap, or 

need updated phone numbers for the contacts listed on 

pages 89 – 93, you can: 

Visit Medicare.gov: 

• For Medigap policies in your area, visit 

Medicare.gov/find-a-plan.

• For updated phone numbers, visit 

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
89 — Section 8: For More Information

 Underlined words are defined on pages 95 – 99

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 1 866 552 - 4464 1 800 656 - 2298 

Guam 1 671 735 - 7421 1 671 635 - 1835 
90 — Section 8: For More Information

 Underlined words are defined on pages 95 – 99

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 1 888 473 - 4858 

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 - 5300 1 800 259 - 5301 

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 
91 — Section 8: For More Information

 Underlined words are defined on pages 95 – 99

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 1 888 727 - 5772 

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
92 — Section 8: For More Information

 Underlined words are defined on pages 95 – 99

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 - 0510 1 401 462 - 9520 

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

South Dakota 1 800 536 - 8197 1 605 773 - 3563 

Tennessee 1 877 801 - 0044 1 800 342 - 4029 

Texas 1 800 252 - 9240 1 800 578 - 4677 

Utah 1 800 541 - 7735 1 800 439 - 3805 
93 — Section 8: For More Information

 Underlined words are defined on pages 95 – 99

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 1 800 964 - 1784 

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 

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

1 340 714 - 4354 

(St.Thomas) 
NOTES
95

Section 9: Definitions

Where underlined words are defined

Letters A through D

Assignment—An agreement by your doctor, provider, or 

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 visit, 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.
96 — 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 Medicareapproved amount, the difference is called the excess 

charge. 

Guaranteed issue rights—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—An insurance policy 

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. 
97 — 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’re 

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. 
98 — 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-time-only, 

6-month period when Federal law allows you to buy 

any Medigap policy you want that’s sold in your state. 

It starts in the first month that you’re 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. 
99 — Section 9: Definitions

Letters P through S

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
NOTES

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 Product No. 02110 - LE

Revised February 2014 

To get this publication on CD, in Braille or Spanish, visit 

www.medicare.gov, 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.