What is medigap insurance and who's eligible?

A medigap insurance policy covers many medical costs that Medicare insurance may not pay for. If somone is nearing or already at age 65, she probably knows that Medicare ends up paying for only about half of all medical costs. Part of this slack is taken up by Medicare Part D prescription drug plans, which pay some of the high cost of medicines. And some people fill coverage gaps by leaving traditional Medicare and joining a Medicare Part C Medicare Advantage managed care plan.

The person you're caring for may be part of the majority, though, that stays in traditional Medicare Part A and Part B. If so, you may want to investigate her eligibility to buy a medigap supplemental insurance policy, with a dozen types of plans to choose from.

More about medigap insurance

The problem is that not everyone is allowed to buy any medigap policy, any time. Whether a person can buy a particular policy, and under what terms, depends on when she applies and what other coverage she's had. Understanding these restrictions can help her take full advantage of the medigap policies available to her.

Medigap insurance policies fill part of the gaps in medical costs that Medicare Part A and Medicare Part B don't pay. The types of medigap policies that can be sold are regulated by the federal government, but the policies themselves are sold by private insurance companies. If a person is enrolled in Medicare Part A and Part B, she'll find that both have deductibles, copayments, and uncovered expenses that she's personally responsible for. A medigap policy pays some or all of these costs.

If she's enrolled in a Medicare Part C "Medicare Advantage" managed care plan and wants to keep that plan, she does not need a medigap insurance policy.

What medigap insurance policies is someone eligible for at age 65?

Most people enroll in Medicare at age 65. Within six months of first signing up for Medicare Part B, a person has "guaranteed enrollment" in a medigap policy. This means that she may buy any medigap policy offered in the state where she lives, in any of 12 plan categories.

An insurance company must sell her the policy of her choice without any medical screening, regardless of her medical history. The company isn't permitted to place any extra limits on the coverage offered. And she must be offered the policy for the same monthly premium as everyone else buying the same policy when first eligible for Medicare.