Medigap FAQs

What is a Medicare supplement policy? How does it work?

Also called a Medigap or Medsupp plan, these plans offer coverage above and beyond what Medicare covers. For example, Medicare often covers about 80 percent of the cost for healthcare services. Supplemental policies may cover all or part of the 20 percent you’re responsible for paying. Medicare doesn’t cover any emergency or urgent care you may need in a foreign country, but some supplements cover a portion of that care. These policies are different than Medicare Advantage plans, which replace your Original Medicare coverage. Supplements are in addition to your Original Medicare coverage.

Can I get a Medicare supplement policy if I already have some other Medicare coverage?

There are several combinations of coverage you can have, and several you cannot. Here’s a few of the most common combinations you can have:

  • Original Medicare + nothing else
  • Original Medicare + stand-alone Part D Prescription Drug Plan (PDP)
  • Original Medicare + supplement policy
  • Original Medicare + supplement policy + stand-alone Part D Prescription Drug Plan (PDP)
  • a Medicare Advantage (MA) plan (without Part D prescription drug coverage) + nothing else
  • a Medicare Advantage (MA) plan (without Part D prescription drug coverage) + prescription drug coverage provided through your employer or union
  • a Medicare Advantage Prescription Drug (MA-PD) plan (with Part D prescription drug coverage) + nothing else

You cannot have:

  • a supplement policy + an MA or MA-PD plan
  • an MA-PD plan + a stand-alone PDP

If you have other coverage not listed (for example TriCare, VA, or union benefits), please contact your plan or customer service for more information.

Who is eligible to apply?

There are only a few requirements you must meet to enroll in our plans:

  • You must have Medicare Part A and B.
  • You must permanently live in Florida.

Being disabled or having End Stage Renal Disease does not disqualify you from coverage in a Medicare supplement policy.

When can I apply?

Usually the best times enroll in a supplemental policy are during your “Medigap open enrollment period” or when you qualify for “guaranteed issue rights.”

During these periods, insurance companies cannot deny your coverage, make you wait for coverage to start, or charge a higher premium due to health problems. If you have not had creditable coverage, its possible there may be a waiting period of up to 6 months for coverage to begin for pre-existing conditions.

Your Medigap open enrollment period is the 6-month period that begins on the first day of the month when you’re both 65 or older and enrolled in Medicare Part B. Or if you’re under 65, it begins the first day of the month you become disabled and qualify for Medicare. If you have employer coverage and don’t want to enroll in Medicare Part B when you turn 65, your Medigap open enrollment period would begin at the time you choose to enroll in Part B.

You could qualify for guaranteed issue rights:

  • if you you have a Medicare Advantage plan or supplement policy and they go out of business
  • if your employer, union, or retiree coverage ends

There are other reasons you could qualify, so contact us for more information.

You can still apply outside of your Medigap open enrollment period, but your premiums may be higher, pre-existing conditions may not be covered right away, and depending on your medical history you may be denied coverage.

What is creditable coverage?

In general, it’s coverage you had before beginning a new policy. When you apply for a new policy, the insurance company usually asks what kind of coverage you had with your old policy, how long you had that policy, and if there was any lapse of coverage between your old policy and the new one. This helps determine whether there will be a waiting period before care related to a pre-existing condition is covered.

What is a pre-existing condition?

It’s a health condition that was diagnosed and/or treated within six months before your new policy begins. If you had less than six months of creditable coverage or more than 63 days without coverage before your new policy begins, supplemental policies can require a waiting period of up to six months before covering care related to a pre-existing condition. This is called a “pre-existing condition waiting period.”

Do I have to get a health screening? Can my application be denied because of my medical history?

If you apply for coverage during your Medigap open enrollment period or when you qualify for guaranteed issue rights (and you meet the other eligibility requirements), you cannot be denied coverage because of your medical history. The only questions we ask to determine your premium are your age, gender, and whether you use tobacco.

If you apply for coverage outside your Medigap open enrollment period, you are not “guaranteed issue”—we will ask you to answer a complete health questionnaire, but we don’t require a physical health screening. Depending on your medical history, it’s possible you could be denied coverage. Your medical history does not affect your premiums, only whether or not you qualify for coverage.

How do I apply for coverage?

You can apply in person at our office, through your insurance agent, or by mail. More information  

If my application is approved, when does my coverage begin?

Your coverage begins first day of the month after we receive and approve your application.

How much do these plans cost?

Premiums are listed in the Outline of Coverage:

Can I get a supplemental policy through my employer?

This option is not currently available through Health First Insurance.

Do I have to use providers in your network?

No, our supplemental policies don’t have a provider network, so you can see any provider who accepts Medicare.

Do these plans include prescription drug coverage? Do I need to have a stand-alone Part D plan (PDP)?

You are not required to have PDP coverage to go with your supplemental policy. However, since these plans do not include Part D prescription drug coverage, we recommend you enroll in a PDP plan if you need prescription drug coverage. Also, if you enroll in Part D coverage when you become eligible, you can avoid Medicare’s late enrollment penalty.

Where can I get more detailed information about my policy?

Refer to your Medicare supplement insurance policy for the most detailed information about your plan.

Will I need prior authorization for any services?

No, we don’t require any prior authorizations. We follow Medicare’s guidelines to determine if a procedure is medically necessary and eligible for coverage. 

How do I pay my premium?

When you apply, you can choose to pay with:

  • automatic credit card payments
  • automatic debits from your checking account (electronic funds transfer)
  • a check (we’ll send you monthly invoices)

Mailing address

Health First Insurance
6450 US Highway 1
Rockledge, FL 32955

You can also pay by credit card over the phone. You cannot have your premium deducted from your Social Security check.

To pay by electronic funds transfer (EFT), please complete the Automatic Payment Form and mail it to us.

If you’re mailing a check, please be sure to make it payable to Health First Insurance.

What happens if my premium payment is late?

If your payment is more than 31 days late, your policy will be canceled. We cannot set up payment plans for past due balances.

Are there deductibles, out-of-pocket limits, or lifetime limits?

Deductibles and limits depend on which policy you choose. Plan F covers the Medicare Part B deductible, and Plans F and N cover the Part A deductible. Plans F and N also include a Foreign Travel Emergency benefit, which has a$250 deductible and $50,000 lifetime maximum. 

Does Health First offer any services that Original Medicare does not cover?

Yes, as an additional service not covered by Medicare, we're proud to offer subscribers a free fitness center membership

Can Health First Insurance cancel my policy for any reason?

We can cancel your coverage if you haven’t paid your premium for more than 31 days or if we discover material representation. Examples of material representation would be if you included any misleading or incorrect information on your application, or file false claims.

*Not covered by Medicare

HFI-www-faq (3/2012)