Your Medigap Protections and the PFFS Plan

Medigap policies are bought as supplemental insurance for Original Medicare plans. When you join a Medicare private-fee-for-service (PFFS) plan, your Medigap policy under Original Medicare does not apply to your medical expenses. Although you are entitled to drop your Medigap policy, you can also keep it should you want to return to your Original Medicare plan. If you drop your Medigap policy, you may be able to regain it under two conditions:

  • Your Medicare PFFS plan ends due to the choice of the plan itself
  • You join a PFFS plan and leave before the end of the first year's membership

Medigap Protections After the Expiration of the PFFS Plan

Medicare private-fee-for-service (PFFS) plans often choose to end their plan coverage due to federal regulations. In this year alone, some PFFS plans chose to end their coverage. Unlike years past, this year's regulations required PFFS plans to give a prescribed network of doctors, hospitals, and insurance providers so patients can know who would and would not accept their PFFS plans. Should your PFFS plan be canceled due to the decision of the plan itself, you will be allowed to regain your Medigap policy. You can apply for your Medigap coverage anywhere from about 60 days before your PFFS coverage ends until 63 days after your PFFS coverage ends.

Medigap Protections After Leaving the PFFS Plan

In order to enroll in private-fee-for-service (PFFS) plans, a patient must already have been enrolled under Original Medicare and, consequently had parts A (hospital) and B (outpatient and medical) insurance. If a patient joins a PFFS plan and leaves within the same year he or she joined, the patient can regain their old Medigap policy. If you were new to Medicare when you joined the PFFS plan, you will be able to choose which of the twelve standard Medigap policies (labeled "A" through "L") you would like to have. If you had an old Medigap policy before the PFFS plan and you depart from the plan, you may be able to regain your old Medigap policy.

Even though you may join a PFFS plan, this does not signal the end of your Medigap policy. Under certain circumstances, you can purchase a new Medigap policy or return to your original policy. In any case, you can fee l confident knowing that Original Medicare plans and Medigap policies are there to aid you if you cannot find the a PFFS plan that you like.