Do You Need a Medigap Policy? Your Ability to Get One May Depend on Where You Live.

Americans who receive their health insurance through Medicare may want to purchase Medigapextra coverage through a Medigap Policy.  However, one’s ability to purchase a Medigap policy may depend on where they live.

Medicare is a government funded and run health insurance program for eligible individuals. To be eligible for Medicare, you must be:

  • 65+ years old;
  • have collected SSDI more than 24 months; or
  • have been diagnosed with end stage renal disease (ESRD) or ALS.

Medicare coverage is divided into four parts:

  • Part A: Hospital Insurance. Includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance. Includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare-approved private insurance company. Make sure to select a plan that covers your health care providers.
  • Part D: Prescription Drug Coverage. You have different plans to choose from depending on where you live, with different premiums and formularies. Make sure to select a plan that covers the drugs you take.

For more information about Medicare, you can read our Quick Guide on Medicare, or watch this webinar.

Parts A and B of Medicare are often called “original Medicare,” because that is the coverage that originally existed. Part B of Medicare has an 80/20 cost share, meaning that Medicare covers 80% and you are responsible for 20% of your medical expenses covered under Part B.  In order to help people pay for the 20% and for other things that Medicare does not cover, Medicare created an option to buy supplemental health insurance coverage, called Medigap. There are different Medigap plans, which are named by letters, which are offered by private health insurance companies. You must have Medicare Parts A and B to buy a Medigap plan.

Medicare’s website allows you to type in your zip code and whether or not you already own a Medigap policy, and it shows you the different Medigap policies available to you. . Medicare also provides a chart comparing Medigap plans A-N and their benefits. For example, Medigap plan A does not cover skilled nursing facility care coinsurance, while Medigap plan F does. Medigap plans K and L have an out-of-pocket limit, while the other 12 plans do not. It is important to note that three states – Massachusetts, Minnesota, and Wisconsin – offer different Medigap plans not available in other states. There are separate pages for the Medigap plans on Medicare’s website for these exceptions.

Medigap policies, however, are only available in certain states. According to Medicare, “each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer.”

While Medigap policies seem like they would be welcomed and encouraged in each state, there are 22 states that are allowed to not sell Medigap policies to those under 65 years of age who qualify for Medicare because of a disability. Those states are: Alabama, Alaska, Arizona, Arkansas, Idaho, Indiana, Iowa, Kansas, Kentucky, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Utah, Virginia, Washington, West Virginia, and Wyoming. Simply put, if you live in one of these and are on Medicare but under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65.

The remaining 28 states require insurance companies to offer people under 65 at least one Medigap plan: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin.

Click here for more information about Medigap plans and coverage.