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Medicare’s Healthcare Coverage

The basics on your benefits.

What is Original Medicare?

All U.S. citizens aged 65 and older are eligible to receive Original Medicare Parts A and B,  which are administered by the federal government's Centers for Medicare and Medicaid Services.

Original Medicare includes three parts:

Part A

Hospital Insurance

Part B

Medical Insurance

Part D

Prescription Drug

A hospital
An Ambulance
Prescription bottle

Your out-of-pocket expenses:

Original Medicare provides good coverage, but  Medicare beneficiaries still have to pay out of pocket  for many costs related to their health care:  

• Monthly premiums

• Annual deductibles

• Coinsurance

• Co-payments  

• Services or supplies not approved by Medicare

• Charges above the Medicare-approved amount

• Dental care  

• Vision care and eyeglasses

• Long-term care  

• Ongoing home health care

Your Medigap Open Enrollment Period

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Under federal law, you get a 6 month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can: 

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  • Enroll in any Medigap policy. An insurance company can’t refuse to sell you any medical policy it offers. They also can’t use medical underwriting to decide whether to accept your application or deny you coverage due to pre-existing health problems.

  • Generally get better prices and more choices among policies. Insurance companies can’t charge you more because of pre-existing health problems.  

  • Have your coverage start right away. An insurance company can’t make you wait, except for coverage related to a pre-existing condition. 

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After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment period. It doesn’t repeat every year, like the Medicare Open Enrollment Period.

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Generally, your Medigap policy will begin the first of the month after you apply, unless you ask for a different effective date.

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What if I miss my Medigap Open Enrollment Period?

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Outside of your Medigap Open Enrollment Period:

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  • You may have to pay more for a policy.

  • Fewer policy options may be available to you.

  • The insurance company is allowed to deny you a policy if you don’t meet their medical underwriting requirements.

 

There are certain situations where you may be able to buy a Medigap policy outside of your Medigap Open Enrollment Period. Situations where an insurance company can’t deny you a Medigap policy are called “guaranteed issue rights” or “Medigap protections.”

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