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Frequently Asked Questions About Medigap Policies

Terminology Used in this Section

Agent/Producer: An agent or producer is an insurance salesperson working for one particular insurance carrier and is licensed to do business in Utah.

Broker: A broker is an independent insurance salesperson and is licensed to do business in Utah.

Cost Share: A share of the cost of paying for your medical care under any Part or Plan can include:

  • Premium: A periodic payment you make to be able to have insurance.
  • Deductible: An amount you must pay before any other coverage is paid.
  • Coinsurance/Copay: An amount you pay (generally after the deductible) which is a set amount or percent of an acceptable claim.

Enrollee: An individual shopping to choose a Medicare Supplement (Medigap) plan.

Insurance Carrier: For the purposes of this website, an insurance carrier (or insurer) is an insurance company that is offering a particular Medigap Plan.

Medigap: Medigap is another name for Medicare Supplement coverage. It fills in many of the “gaps” of traditional Medicare Parts A and B. It includes standardized “Plans”, which are separate and distinct from the “Parts” of Medicare.

Medigap Plans: Medigap Plan letters include A, B, C*, D, E, F*, G, K, L, M, and N. These describe types of plans that seek to fill in unpaid portions of Medicare coverage.

Medicare Part A: Part A (federally funded) covers inpatient hospital costs, hospice, and skilled nursing care. There is no cost for this coverage.

Medicare Part B: Part B (federally funded) covers other types of care like doctor visits, home health care, and medical equipment. Your premium is based on your income.

Medicare Part C: Part C is also called a Medicare Advantage plan. It is administered by an insurance carrier. It will include the same type of coverage in Parts A and B, and sometimes D.

Medicare Part D: Part D covers medication. It may be purchased from an insurance carrier (not federally funded).

Medicare Parts: Parts A, B, C, and D describe portions of Medicare coverage that may or may not be federally funded. See the definition of each part to see what it is.

Medicare Supplement Plan: See definition for Medigap.

Penalty: Amount charged for late enrollment if you have not previously enrolled. The amount is added to your monthly premium and is based on how long you waited to enroll.

Tricare: A type of federally funded coverage that covers Uniformed Service members and their families, National Guard, Survivors, Former Spouses. You can visit the Tricare.mil website if you think you are eligible.

Underwriting: Underwriting is a practice of determining what risk is involved in insuring a single individual and adjusting for that risk. That adjustment means you might pay more.

*Plans C and F are unavailable to purchase if you were new to Medicare on or after January 1, 2020.

Question/Answer Table of Contents

Question/Answer Section

Q: What is this website?

A: The State of Utah Rate Transparency website is designed to help you make smart decisions about purchasing a Medicare Supplement (Medigap) Plan. It is also intended to provide additional transparency in the area of Medicare Supplement rating practices. This website is not intended to be utilized as an exhaustive resource.
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Q: Why can’t I just sign up for Medicare? Why do I need a Medicare Supplement (Medigap) plan?

A: If you are fine with only the services in Parts A and B, you can choose to pay only for those parts. However, Parts A and B of Medicare don’t include drug coverage (Part D). They don’t include coverage for the things in Medigap Plans. You can view a comparison of the types of coverage offered by these plans and decide what is right for you. If you wait to elect drug coverage, your premium may be higher — this is called a penalty.
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Q: What is the difference between a Medicare “Part” and a Medigap “Plan”?

A: While both a Medicare “Part” and a Medigap “Plan” use letters to describe what they do, they are distinctly different types of coverage. Medicare Parts describe different portions of Medicare, which pay different things. A Medigap Plan describes coverage for things not covered by Medicare. This coverage is provided through third-party insurance carriers and is not federally funded.
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Q: What is a Medigap “Plan”?

A: Medigap is also known as Medicare Supplement coverage. Different from a “Part” of Medicare, Medigap “Plans” attempt to fill in the gaps that are not paid by federally funded Medicare Parts A and B. You can choose Medigap instead of Medicare Advantage.
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Q: Which Medigap “Plan” is best?

A: Everyone has different coverage needs so you get to choose which plan is best for you. We suggest using the side-by-side comparison table or “Benefit Chart”.
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Q: What is a Medicare Advantage plan (Part C)?

A: Medicare Advantage plans (Part C) are not part of the “Plan” choices on this website. When you have a Medicare Advantage plan, you still have to pay for regular Medicare premiums. However, the coverage is managed by a private insurance carrier that administers benefits for Medicare. This means they pay your doctor when you get care.

The plans might have a low or no additional premium. The premium you do pay may cover some small additional benefit. Part D drug coverage may NOT be included in Medicare Advantage plans. There may be gaps in coverage that will not be paid by your Medicare Advantage plan. You may have additional plan restrictions that aren’t on traditional Medicare. You may have to select a Primary Care Physician (PCP). You might have to get referrals when you get specialty care.
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Q: Can I switch between Medigap and Medicare Advantage?

A: There are special rules that determine if you can change your plan after the enrollment period. Consult the ‘Medicare and You’ resource available through Medicare.gov.
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Q: Can I have both Medigap and Medicare Advantage?

A: No. You can only choose one. Anyone who tries to sell you both is breaking the law. You can report fraudulent activity to the Utah Insurance Department.
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Q: Will I have to pay more than just the premium for Medigap?

A: Yes, when you sign up for Medigap coverage, it might have additional cost share like a premium, deductible, and copay or coinsurance to pay for more services. You will already be paying some costs directly to the Social Security Administration for your Medicare. You may refer to the following website for a list of Medicare costs, by part: https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance.
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Q: What about Part D coverage? Which Medigap Plan has it?

A: Medigap Plans can no longer be sold with drug coverage, but if you already have a Medigap Plan with drug coverage, you can keep your plan.

Part D coverage can be obtained when you are first eligible for Medicare. Keep in mind that if you choose not to enroll in either Part D or another type of supplemental or advantage plan covering drugs, you may pay a penalty. You can find out more about Part D coverage on the Medicare.gov website: https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage.
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Q: What if I can’t afford to pay for any coverage?

A: Based on your income you might get extra help paying for Medicare, or you might not have to pay a late enrollment penalty. The program is called “Extra Help”. There is also a Medicare Savings Program that may be partially funded by your state. You can call Medicare to ask about these programs.
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Q: Why can’t I sign up for Medigap Plans C* or F*?

A: Starting in January 2020, Medicare changed the cost-sharing rules. It disallows Medigap Plans from paying for your traditional Medicare Part B deductible. If you were eligible for Medicare before that date, you can still have one of those plans. If not, you can choose another plan.
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Q: Will Medigap cover e-visits with my provider?

A: Medicare covers e-visits to allow you to talk with your doctor using an online patient portal without going to the doctor’s office. Practitioners who can provide these services include doctors, nurse practitioners, physician assistants, physical therapists, occupational therapists, and speech-language pathologists. Licensed clinical social workers and clinical psychologists may provide these services in specific circumstances. Medigap plans will cover 20% coinsurance for these visits.
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Q: I have heard the terms Preferred and Non-Preferred for these plans. What do these names mean?

A: An insurance carrier may use these terms for any reason. Because there is no standardized naming system (other than Plan letters A-N), it may be up to the enrollee to seek an answer on any particular plan name.
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Q: I have been working since the age of 65 and I don’t have Medicare yet. How does this impact my enrollment in Medicare and a supplement plan?

A: Per the “Medicare and You” resource available through Medicare.gov, you may defer enrollment in Medicare if you have employer or union coverage and are actively employed. Certain types of medical coverage would not fulfill this requirement such as:

  • Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage,
  • Health Insurance Marketplace coverage,
  • Retiree coverage, and
  • VA coverage, etc.

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Q: I am eligible due to disability. Why are my rates higher than those available to older enrollees?

A: Disabled individual enrollees eligible for Medicare may be subject to additional costs for care. These costs may be deferred by an insurance carrier back to the enrollee. When you turn 65 you may be eligible to enroll in lower-cost coverage.
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Q: I am outside my enrollment period but I want a Medigap Plan. What happens now?

A: Selection of a Medigap Plan outside of an enrollment period may subject an enrollee to underwriting of their policy.
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Q: The chicken or the egg: Do I sign up for Medicare first before getting a Medigap or Medicare Advantage plan?

A: Yes, you must enroll in Medicare Parts A and B first. You have to go to the Social Security Administration website to sign up. If you are signing up for the first time, you may wish to read the steps below:

  • Go to SSA.gov and click on the Medicare Enrollment button (or icon).
  • Decide whether you want to sign up for BOTH Social Security benefits AND Medicare or just Medicare.
  • If just Medicare, click the “Apply for Medicare Only” button halfway down the page.
  • You will get a card in the mail. This is when you can sign up for Medigap coverage.
  • You will then get a bill after your Medicare coverage starts. If you signed up for Social Security benefits, your premiums may be deducted from your monthly check.

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Q: I pay a premium for my Medicare already. What will I pay for Medigap or Medicare Advantage?

A: If you sign up for Medigap:

  • You will still pay a Medicare Part B premium directly to Medicare.
  • You will have an additional premium for Medigap coverage based on your Plan choice (A-N).
  • You will pay for that Plan directly to the insurance carrier.

If you sign up for Medicare Advantage (Part C):

  • You will still pay a Medicare Part B premium directly to Medicare.
  • You may or may not have an additional premium for Medicare advantage.
  • The insurer that sells your Medicare Advantage plan will get money from the government to pay for your benefits. They will pay your doctor.
  • You might have some plan restrictions that don’t apply to regular Medicare.

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Q: I am 65 today. What do I do?

A: Happy birthday! Generally, when you are about to turn 65, you should look at the available options. Medicare should start the first day of the month in which you turn 65. Your enrollment period spans three months before through four months after the first day of your birth month. So, if you turn 65 on June 7, your enrollment period will start on March 1 and end on October 31. Refer to the “chicken or the egg” question above for the steps to help you sign up.
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Q: I am employed and 65. I have medical coverage through my employer. How does that impact my choice?

A: You may need to speak to the person in charge of your benefits and find out if it is best to start Medicare or continue your employee coverage. If you have family covered under your employee coverage, it may impact your decision. Unless they independently qualify for Medicare, dependents are not eligible to enroll in Medicare.
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Q: What if I signed up for Medicare late?

A: You may have to pay a penalty based on how long you were eligible without paying for benefits.
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Q: I qualify for Medicare and Medigap because of End State Renal Disease (ESRD). How do I sign up?

A: The sign-up process is no different. The main difference is that the order of payment from insurance might be different based on how long you have had coverage. For the first 30 months on Medicare, Medicare pays second. After 30 months of coverage, Medicare will pay first. Starting in 2021, people with ESRD can sign up for Medicare Advantage plans.
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Q: How does Medigap work with Railroad Retirement Board (RRB) benefits?

A: Those eligible for RRB benefits still have to sign up for Medicare.

If you are eligible for U.S. Railroad Retirement Board benefits, you will get your Medicare card from them. Your benefits will be deducted from your RRB benefits. You can qualify for Medigap.
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Q: How does Medigap work with Tricare?

A: Those eligible for Tricare benefits still have to sign up for Medicare. Tricare has two types: Tricare or Tricare For Life.

  • Tricare For Life pays secondary to Medicare. So you will need to sign up for Medicare Parts A and B, but you wouldn’t need any Medigap.
  • Regular Tricare pays INSTEAD of Medicare. This means you can have both Medicare AND Tricare, but only one or the other can pay. If you seek care at a VA facility, Tricare will pay. If you go to a non-VA facility, Medicare will pay. You can have Medigap. This means you might have three types of coverage: Medicare, Tricare, and a Medigap Plan.

However, if you are an active-duty service member or have an active-duty family member, you don’t have to enroll in Part B to keep Tricare. Contact Tricare for more information.
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Q: Are there other government benefits that can impact my choice?

A: Federal Employee Health Benefits Program, Veterans benefits, CHAMPVA, and Indian Health Services all impact how Medicare works. For more information contact the government program and speak with them directly.
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Q: I might get care at a religious hospital or facility. How does this impact my coverage?

A: If the facility isn’t run by medical staff, Medicare may only pay for room and board or some items that don’t need a doctor’s prescription. The religious portion of care is not covered.
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Q: How do insurance companies set prices for Medigap Policies?

A: Each insurance company decides how it will set the price, or premium, for its Medigap policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced or “rated” in 3 ways:

  • Community-rated (also called “no-age-rated”). Your premium isn’t based on your age. Premiums may go up because of inflation and other factors but not because of your age.
  • Issue-age-rated (also called “entry-age-rated”). Premiums are lower for people who buy at a younger age and won’t change just because you get older. Premiums may go up because of inflation and other factors but not because of your age.
  • Attained-age-rated. Premiums are low for younger buyers but go up as you get older. They may be the least expensive at first, but they can eventually become the most expensive. Premiums may also go up because of inflation and other factors.

Most companies in Utah offer Attained-age-rated products. Other factors like where you live, medical underwriting, and discounts can also affect the amount of your premium.
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Q: What is a SELECT Medigap plan?

A: Medicare SELECT is a type of Medigap policy that requires you to use hospitals and, in some cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). They offer the same coverage benefits as the standard Medigap policies. Because SELECT policies restrict the network they are generally less expensive than standard plans. However, if you don’t use a Medicare SELECT hospital or doctor for non-emergency services, you’ll have to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
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Q: Do I have to choose a gender to get my rates?

A: Some people may not identify with a binary gender. However, insurance companies do still use binary genders to make rating decisions. This is currently a legal rating practice in Utah. To assist you further, you may speak with an agent, broker, or directly to an insurance carrier. A list of licensed agents and brokers is located on the Utah Insurance Department website. The department does not sponsor or recommend any particular licensed agent or broker.
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Q: What can affect my rates?

A: Many things can impact the rates of an individual Medigap Plan including age, gender, weight, the type of coverage chosen (i.e. how comprehensive), etc.
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Q: What if I smoke?

A: The term “smoking” can mean many things to different insurance carriers. In some cases, “smoking” might mean any recreational use of tobacco, nicotine, or THC regardless of the method (including chewing tobacco, vaping, etc.). The rates of a smoker might be increased up to 20% due to an additional risk of illness.
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Q: What is a household discount? Am I eligible for one?

A: Some insurance carriers offer discounts if more than one individual is enrolled. This is sometimes called a “household discount”. A particular insurance carrier will have more information about possible discounts.
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Q: How do I protect myself from Medicare-related scams?

A: If you are looking for a government, military, or other reference website for more information, you will want to make sure you are in the right place. Most government sites will usually end in .gov, .edu, .org, or .mil for the military. When in doubt, find a trusted source for a telephone number, call the department or organization you are trying to reach, and ask if you are in the right place.

NEVER give your personal information to someone you don’t trust. A trusted source will not charge you money for answers. Phone and email scams are common. You can call the Center for Medicare and Medicaid Services for answers on how to spot these scams and how to protect yourself.
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Q: These answers don’t address all my questions about the plans available. What if I have more questions about my plan choice?

A: If you have already selected a possible insurer, you may contact that insurer through an agent, broker, or directly via the insurance carrier. However, there are many resources to utilize for more information. You may call:

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