Medigap Supplement Plans - California

What is Medigap?
Medigap, also known as Medicare Supplement Insurance, helps cover some healthcare costs that Original Medicare (Parts A and B) doesn’t cover, such as copayments, coinsurance, and deductibles. It’s sold by private insurance companies and provides additional financial protection.

About Medigap Plans

• Private Companies: Medigap plans are offered by private companies such as United Healthcare, Anthem, and Blue Shield of California, among others.

• Additional Premium: The premium for your Medigap plan is in addition to your Medicare Part B premium, which is $240 in 2024.

• Eligibility: You must be enrolled in Medicare Part A and Part B to be eligible for a Medigap plan.

• Standardized and Renewable: Medigap plans are standardized and guaranteed renewable, meaning they cannot be canceled as long as you continue paying your premium, regardless of changes in your health condition.

• No Prescription Coverage: Since January 1, 2006, Medigap plans do not include prescription drug coverage. You will need to enroll in a separate Part D plan for prescription drugs.

• Individual Coverage: Medigap plans only cover one individual. Spouses must enroll in their own separate Medigap plans.

• Exclusive Enrollment: It is illegal to be enrolled in both a Medigap plan and a Medicare Advantage plan simultaneously.

• Exclusions: Medigap plans do not cover services not included in Original Medicare, such as Long-Term Care, dental care, hearing aids, eyeglasses, or private-duty nursing.

 

Enrollment Periods for Medigap in California

Initial Enrollment Period (IEP)
When it Happens: Starts the month you turn 65 and are enrolled in Medicare Part B.
Duration: Lasts for 6 months.
Why It’s Important: You have a guaranteed right to buy any Medigap policy offered in your state without medical underwriting. Insurance companies cannot deny you coverage or charge you higher premiums due to your health.

Open Enrollment Period in California (Birthday Rule)

The Birthday Rule in California is a special provision that allows Medigap policyholders to switch to another Medigap plan with the same or lesser benefits without medical underwriting. This means you can change plans without answering health questions or undergoing a medical examination.
 

Eligibility Period: The Birthday Rule applies every year during a 60-day period that starts on your birthday.
Duration: You have 60 days from your birthday to take advantage of this opportunity.
Why It’s Important: During this time, you can switch to another Medigap plan with the same or lesser benefits without having to answer health questions or undergo medical underwriting.

63-Day Guaranteed Issue Period
When it Happens: Occurs if you lose certain types of health coverage, such as employer-based health insurance.
Duration: 63 days from the date your previous health coverage ends.
Why It’s Important: During this period, you can buy certain Medigap plans without medical underwriting. This means you can’t be denied coverage or charged higher premiums based on your health.

8-Month Special Enrollment Period
When it Happens: Applies if you delay enrolling in Medicare Part B because you have employer or union health coverage.
Duration: Begins the month after your employment ends or the month after your group health coverage ends, whichever happens first, and lasts for 8 months.
Why It’s Important: You have the opportunity to sign up for Medicare Part B and Medigap without late enrollment penalties. However, this period does not offer the same guaranteed issue rights as the Initial Enrollment Period or the 63-Day Guaranteed Issue Period.
 

One-Year Trial Period
Switching from Medicare Advantage to Medigap
When it Happens: If you are enrolled in a Medicare Advantage (MA) plan for the first time and you decide within the first year that you want to switch back to Original Medicare.
Duration: You have a one-year trial period from the date you first enrolled in the Medicare Advantage plan.
Why It’s Important: During this one-year trial period, you have the guaranteed right to switch to a Medigap plan without medical underwriting. This means you can return to Original Medicare and purchase a Medigap policy regardless of your health status.

 

Steps to Switch During the Trial Period:
Disenroll from Medicare Advantage: Contact your Medicare Advantage plan to disenroll.
Enroll in Original Medicare: Ensure you are enrolled in both Medicare Part A and Part B.
Purchase a Medigap Plan: Apply for a Medigap plan within the one-year trial period to take advantage of the guaranteed issue rights.
 

Switching Outside the One-Year Trial Period
If you are outside the one-year trial period, switching from a Medicare Advantage plan to a Medigap plan can be more challenging.

Annual Election Period (AEP): You can disenroll from your Medicare Advantage plan during the AEP (October 15th to December 7th) and return to Original Medicare.
 

Special Enrollment Period (SEP): You might qualify for an SEP if you meet specific criteria, such as moving out of your plan’s service area or your plan leaving Medicare.
 

Medical Underwriting: Outside of guaranteed issue periods, you may need to go through medical underwriting to get a Medigap plan. This means the insurance company can consider your health status and potentially deny you coverage or charge higher premiums.
 

Steps to Switch Outside the Trial Period:

• Disenroll from Medicare Advantage: Disenroll during the AEP or an SEP.

• Enroll in Original Medicare: Ensure you are enrolled in both Medicare Part A and Part B.

• Purchase a Medigap Plan: Apply for a Medigap plan. Be prepared for medical underwriting unless you qualify for another guaranteed issue period.

 

Additional Features and Benefits
Standardized Plans
Consistency: Medigap plans are standardized. For example, Plan G offers the same benefits regardless of the insurance company, though premiums can vary between companies.
 

No Networks or Referrals
Flexibility: Medigap keeps you within the Original Medicare network, allowing you to see any provider that accepts Medicare nationwide without worrying about networks or needing referrals. Over 95% of providers nationwide accept Medicare, which is convenient for frequent travelers or those with multiple residences.
 

Guaranteed Renewable
Continuous Coverage: Your Medigap plan is guaranteed renewable, meaning your coverage cannot be canceled as long as you pay your premiums. This ensures continuous coverage regardless of your medical expenses. It’s recommended to set up automatic bank withdrawals to avoid missing payments and risking the loss of coverage.
 

Easy Claims Processing
Seamless: The claims process is simple. Providers first file a claim with Original Medicare. Once Medicare pays its share, the remaining amount is forwarded to your Medigap plan, which automatically covers its portion without further questioning.
 

 

FAQs
Why Do Supplement Rates Go Up?
Rates typically increase due to medical inflation and the rising costs of healthcare services.

What Makes One Company Better Than Another?
Factors include the company’s rate increase history, financial stability, and customer service reputation.

Are There Any Drawbacks to Choosing Medigap?
One potential drawback is the cost of premiums, which can be higher compared to other Medicare options. Additionally, Medigap plans do not cover prescription drugs, so you might need a separate Part D plan.


Understanding Medigap plans and their enrollment periods ensures you get the right coverage without the risk of being denied due to health issues. If you have questions or need help choosing a plan, our team is here to assist you.​​​​​