Medicare open enrollment: Can you buy supplemental insurance?

Medicare supplemental insurance or “Medigap,” which you buy in the individual market, picks up a lot of the coinsurance costs and deductibles that people with traditional Medicare would otherwise have to pay. With it, you can sleep at night without worrying about out-of-pocket costs if you need hospital or medical care. You have the right to buy Medigap insurance during the six months after you first enroll in Medicare Part B.

There are a series of standardized Medigap plans labeled A through N. They all cover the basic coinsurance costs for medical services. But, some also cover coinsurance for nursing home care and others pick up some of the hospital deductible as well. Some Medigap plans have lower premiums because they require you to pay a high deductible before coverage kicks in. Premiums differ depending upon the type of plan and insurance company offering it you choose.

If you are in a Medicare Advantage plan and want to move to traditional Medicare, it is sometimes not possible to buy Medigap insurance. A lot depends on the state you live in. Some states guarantee you the right to buy Medigap coverage, no matter your age or health status–New York, Massachusetts, Connecticut and Maine. And, eight states, including those four, do not allow Medigap insurers to charge you more based on your health status or age.

In most states, the Medigap premium charged and whether you can even buy Medigap coverage at all, depends on your health status. Medigap insurers are not likely to sell you insurance if they don’t have to and the insurance company believes you will incur large health care costs.

There are a few other situations in which you can buy Medigap insurance, some under federal law and some under state laws. For example, you always have the right to buy a Medigap plan if you sign up for Medicare Advantage when you first enroll in Medicare and then decide you want to switch to traditional Medicare within 12 months. Many states also guarantee you the right to buy a Medigap plan if you lose your retiree supplemental coverage.

Medigap premiums can easily be $1,500 or more a year and, if you are able to buy a policy after your initial enrollment period, the insurer can charge you more in most states, depending upon your health status. But, if you see a doctor or go to the hospital during the course of the year, you might spend less for the Medigap policy than you would for deductibles and copays in Medicare Advantage.

Medicare Advantage plans, unlike Medigap plans in most states, cost the same for everyone, no matter their health status or age. That said, Medicare Advantage plans can charge you up to $7,550 a year out of pocket for in-network care alone, excluding prescription drugs.

If you qualify for Medicare because of a disability, you have no right to buy Medigap coverage under federal law. Most states do require insurers to sell you a Medigap policy. But, 19 states do not. And, if you have end state renal disease–kidney failure–only 14 states give you the right to buy a Medigap plan.

Contact your state health insurance assistance program or SHIP for guidance on buying a Medigap policy in your state. You can call 1-800-677-1116 for the phone number of your local SHIP.

Here’s more from Just Care:

• Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan
• Open Enrollment: You could save big money on drugs
• Enrolling in Medicare? Here’s a checklist
• People with serious health needs more likely to disenroll from Medicare Advantage plans