Medigap

I have Medigap and I’m finding it difficult to afford. What are my other options for supplemental coverage?

You may want to find out if you qualify for Medicaid, if your income and assets are low enough. Medicaid helps many low-income people on Medicare with their Medicare premiums and cost-sharing requirements, and may also cover some benefits that are not covered by Medicare, such as dental services and long-term services and supports. To find out if you qualify, you can contact the State Medical Assistance Office or the State Health Insurance Assistance Program (SHIP) in your state. SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.

If you do not qualify for Medicaid and you want to stay in traditional Medicare, you could try to switch to a less expensive Medigap policy. However, if you are applying for a Medigap policy outside your initial open enrollment period, then in most circumstances, insurance companies are allowed to deny your application based on medical underwriting or can charge you higher premiums. You can find more information about the Medigap plans available in your state by contacting your state’s health insurance department or your SHIP.

Another option could be to enroll in a Medicare Advantage plan. Medicare Advantage plans provide all benefits covered under Medicare Part A and Part B, but often have lower cost-sharing requirements than traditional Medicare. They also have limits on out-of-pocket spending, but include physician networks, which means that you will pay more if you see a provider out-of-network. Medicare Advantage plans may charge a premium in addition to the Part B monthly premium. For free assistance with understanding your options for supplemental coverage, contact your local SHIP.

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While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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