Learn How Medigap Works

Generally, you must have Original Medicare Part A and Part B to buy a Medigap policy. A Medigap policy only covers one person, so if you and your spouse both want Medigap coverage, you each have to buy your own policy.

If you have a Medigap policy and get care, Medicare will pay its share of the Medicare-approved amount for covered health care costs. In most Medigap policies, you agree to have the Medigap insurance company get your Part B claim information directly from Medicare. Then, your Medigap policy will pay your doctor whatever amount you owe under your policy and you’re responsible for any costs that are left. Some Medigap insurance companies also provide this service for Part A claims.

If your Medigap insurance company doesn't get your claims information directly from Medicare, ask your doctors if they "participate" in Medicare. This means that they "accept assignment" for all Medicare patients. If your doctor participates, your Medigap insurance company is required to pay your doctor directly, if you ask them to.

Once you buy a policy, you'll keep it as long as you pay your Medigap premiums. All standardized Medigap policies are automatically renewed every year, even if you have health problems. Your Medigap insurance company can only drop you if:

  • You stop paying your premiums
  • You weren't truthful on the Medigap policy application
  • The insurance company goes bankrupt or goes out of business

Medigap & other Medicare coverage

Medigap & Medicare Advantage Plans

A Medigap policy is different from a Medicare Advantage Plan (Part C). A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. A Medigap policy is a supplement to Original Medicare coverage. When you’re getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage Plan, but you can’t have both.

  • If you have a Medicare Advantage Plan, you can’t buy a Medigap policy. It's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. If you want to switch to Original Medicare and buy a Medigap policy, contact your Medicare Advantage Plan to see if you're able to disenroll.
  • If you have a Medigap policy and join a Medicare Advantage Plan for the first time, you may want to drop your Medigap policy because you’ll be paying for coverage you can’t use. If after you join a Medicare Advantage Plan for the first time and you’re not happy with your plan, you’ll have a single 12-month period (your trial right period) to get your Medigap policy back if the same insurance company still sells it once you return to Original Medicare. After that period, you might have to wait to drop your Medicare Advantage Plan, and you might not be able to buy a Medigap policy, or it may cost more.

Medigap & prescription drug coverage

Medigap plans sold after 2005 don’t include prescription drug coverage. So, if you enroll in Medigap for the first time, it won’t include drug coverage. If you want prescription drug coverage, you can join a separate Medicare drug plan (Part D). What if I have a Medigap policy that already has prescription drug coverage?

Tip: If you join a Medigap policy and a Medicare drug plan offered by the same company, you may need to make 2 separate premium payments for your coverage. Contact your insurance company for more details.

Next steps: Get Medigap costs