Medigap Plans and Illegal Practices

If you’re new to Medicare and just getting started, we want to remind you to know your rights as a Medicare beneficiary. Unfortunately, fraud or illegal practices are not unheard of in this industry and Medigap plans can be confusing. What are they, exactly? A Medigap plan, also called a Supplement Plan, can help pay your extra out-of-pocket costs. Because traditional Medicare does not cover all of your medical expenses, you’ll be responsible for deductibles, co-payments, and other expenses. This is why it truly pays to buy a private Medigap policy to fill in those gaps. However, we want to remind you to do your research and know your rights. 

According to Medicare.gov, it is illegal for anyone to do the *following: 

1. Pressure you to buy a Medigap policy or lie to get you to switch to a new company or policy.
2. Sell you a second Medigap policy when they know you already have one. (They can sell you a policy if you state, in writing, that you plan to cancel your existing policy.)
3. Sell you a Medigap policy if they know you have Medicaid, except in certain situations.
4. Sell you a Medigap policy if they know you’re in a Medicare Advantage (MA) Plan. (They can sell you a policy if your MA plan coverage will end before the Medigap policy’s effective date.)
5. Claim that a Medigap policy is part of the Medicare program or any other federal program. Medigap is private health insurance.
6. Claim that a Medicare Advantage Plan is a Medigap policy.
7. Sell you a Medigap policy that can’t legally be sold in your state. Check with your State Insurance Department to make sure the policy you’re interested in can be sold in your state.
8. Misuse the names, letters, or symbols of these:
   • U.S. Department of Health & Human Services (HHS)
   • Social Security
   • Centers for Medicare & Medicaid Services (CMS)
   • Any of their programs, like Medicare.
   For example, they can’t suggest the Medigap policy has been approved or recommended by the federal government
9. Claim to be a Medicare representative if they work for a Medigap insurance company.
10. Sell you a Medicare Advantage Plan when you say you want to keep Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the same as Original Medicare. If you enroll in a Medicare Advantage Plan, you’ll be disenrolled from Original Medicare and can’t use a Medigap policy.

If you have any questions about a Medigap policy, or any other Medicare plan, please contact us today. 

*list from Medicare.gov