Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a health care professional for more than 30 years, with experience working as a bedside nurse and as a clinical manager. She has a passion for educating, assisting, and advising seniors throughout the health care process.
A Medicare Supplement Insurance plan, also called a Medigap plan, is offered by a Medicare-approved private insurance company to help bridge the gap between the charges you pay and what is covered by the federal Medicare program.
While Medicare pays for a large percentage of the health care services and supplies you may need, you are still responsible for a portion of the costs in the form of deductibles, copays, and coinsurance. A Medigap policy helps with these costs and sometimes offers more coverage for excess charges and travel health emergencies. A separate Medicare prescription drug plan will still be required. For anyone who wants to buy Medigap policies, here is a guide to how they work.
Who Should Get a Medicare Supplement Insurance Plan?
A Medicare Supplement Insurance plan may be a good choice for you if you:
- Turn 65 and want to cover as much of your health care costs as possible while on Original Medicare.
- Are already on Original Medicare but want help paying for your portion of costs for services received moving forward.
- Want peace of mind that your health insurance policies will pay for the majority of your Medicare-covered health care costs without constraints of networks or need for referrals.
- Don’t mind purchasing a standalone Medicare Part D plan for prescription drug coverage.
What Is a Medicare Supplement Insurance Plan?
Medicare Supplement Insurance plans provide additional coverage to supplement Original Medicare. Here is a breakdown of Medicare supplement policies:
|Plan structure||A Medigap policy is a standardized plan regulated by the federal government and administered by a private insurance company that covers cost-sharing requirements of Medicare Part A and Part B services. Part D prescription drug coverage is separate.|
|Benefits available||Varies by plan, but can include Part A deductible, Part A and B copays and coinsurance, the first three pints of blood, skilled nursing home coinsurance, Part B excess charges, and foreign travel emergency services. Out-of-pocket limits may apply.|
|Cost sharing||Monthly plan premium, which varies by plan, insurer, and state of residence. There are high-deductible plans available in some areas.|
How Medicare Supplement Insurance plans work
When you purchase a Medicare Supplement Insurance plan, your Medigap supplement plan will serve as a secondary source of insurance. Medicare will be used first to pay for any Medicare-approved costs for health care supplies and services, then your Medigap policy will be charged.
In most cases, there is nothing additional you need to do to submit a claim to your Medigap supplement plan as most doctors and health care facilities will bill for you automatically.
Medigap policies are guaranteed renewable. That is, as long as you pay your premiums on time, your policy will remain in effect.
Benefits available with a Medicare Supplement Insurance plan
A Medigap policy may include the following benefits:
- Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Medicare Part B coinsurance or copayment
- The first three pints of blood
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible (only certain plans for people eligible for Medicare before January 1, 2020)
- Part B excess charges
- Travel emergency services when abroad
- Out-of-pocket limit
Medigap policies are standardized differently in Wisconsin, Massachusetts, or Minnesota and may include coverage for basic and extended care.
|Advantages of a Medicare Supplement Insurance Plan||Disadvantages of a Medicare Supplement Insurance Plan|
Compare your Medicare Supplement options
Compare benefits of standardized Medigap supplement plans:
|Medigap Benefits||Plan A||Plan B||Plan C||Plan D||Plan F*||Plan G*||Plan
|Plan M||Plan N|
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes***|
|Blood (first 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charge||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange (up to plan limits)||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out-of-pocket limit**||N/A||N/A||N/A||N/A||N/A||N/A||$6,940 in 2023||$3,470 in 2023||N/A||N/A|
* Plans F and G also offer a high-deductible plan in some states. With this Medigap policy option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of$2,700 in 2023 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible Medicare beneficiaries on or after January 1, 2020.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap policy pays 100% of covered health care services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
Who is Eligible for a Medigap Plan?
Anyone who is eligible for Medicare and enrolled in Part A and Part B (Original Medicare) may be eligible to purchase a Medigap policy. If you miss your Medigap Open Enrollment period, you may not be able to purchase a policy depending on your health condition. You cannot have a Medigap policy and a Medicare Advantage Plan at the same time.
How Much Does a Medigap Plan Cost?
You pay a premium each month for your Medigap policy on top of what Original Medicare costs. This premium varies depending on benefits offered, when you purchase your policy, how it is priced, and in which zip code and state you reside. Because Medigap plans are offered through private insurers, the companies set their premiums. Premium costs may increase each year based on age, inflation, or other factors. You should also compare the health care costs of medicare advantage vs. a medigap policy to figure out which route is best.
With high-deductible supplement Medigap plans, you will pay the full amount of any Medicare-covered costs, including coinsurance, copayments and deductibles, up to the set deductible amount for that year. In 2023, the high deductible amount for Medigap supplement plans is $2,700.
See how pricing and availability compare for three different Medigap Medicare supplement coverage plans for a 65 year old female in Chicago, Illinois who doesn’t use tobacco in 2023:
|Plan||Premium range||Number of Plans available|
|Plan A||$85 to $1,013||65 total
*68 (attained age)
~4 (issue age)
|Plan G||$98 to $849||68 total
*60 (attained age)
~5 (issue age)
|Plan N||$79 to $669||62 total:
*57 (attained age)
~2 (issue age)
*Attained age pricing: Premiums are low for younger buyers but go up as you get older and can eventually become the most expensive.
^Community pricing: Premiums are the same no matter how old you are. Premiums may go up because of inflation and other factors.
~Issue age pricing: Premiums are low for younger buyers and won’t change as you get older.
How Do I Enroll in a Medigap Plan?
According to the Centers for Medicaid and Medicare’s Guide to Choosing a Medigap Policy, in general, you will get the best price for Medicare Supplemental Insurance policies if you purchase a plan during the Initial Enrollment Period as soon as you are age 65 or eligible for a Medicare plan. If you don’t choose to enroll in Original Medicare (Parts A and B), your other main option is to get an all-inclusive Medicare Advantage plan, but you should explore the key differences to help you make that decision.
There are certain situations which may give you guaranteed issue rights to purchase a Medigap policy, regardless of your health conditions or any preexisting health conditions.
- Moving out of the coverage area while in a Medicare Advantage Plan or Medicare SELECT Plan
- Your existing Medicare Advantage Plan leaving Medicare coverage
- Your other insurance plan outside of Medicare is ending
- You are within your trial right period
- Your plan coverage ends through no fault of your own
To enroll in a Medigap Plan, contact the insurer to make sure you are in your Open Enrollment Period or have guaranteed issue rights. Complete the application and determine when you want your policy to start.
Who Should Get a Medigap Plan?
If you rely on Original Medicare for your health insurance coverage, you should consider supplement Medigap plans to offset the portion of health care costs that Medicare doesn’t pay. Remember, if you have Medicare Advantage, then you can’t also get Medigap. As with Original Medicare, you have freedom of choice of providers because you can see any Medicare provider in the United States. You can choose which supplement coverage plan best meets your needs. For instance, six of the standardized plans include coverage for emergency care which you may want if you travel abroad. Medigap Medicare supplement plans give you peace of mind if you anticipate the need for frequent health care now or in the future.
Learn More From Our Sources
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed March 2023
- Medicare | Find a Medigap policy that works for you | Last accessed March 2023
- Medicare | How to compare Medigap policies | Last accessed March 2023
- Medicare | Medigap in Minnesota | Last accessed March 2023
- Medicare | Medigap in Massachusetts | Last accessed March 2023
- Medicare | Medigap in Wisconsin | Last accessed March 2023
- Medicare | Guaranteed issue rights | Last accessed March 2023