Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 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 healthcare process.
Medicare Supplement Insurance plans, also called Medigap plans, are offered by Medicare-approved private insurance companies to help bridge the gap between the charges you pay and what is covered by Medicare.
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. Medigap policies help with these costs and sometimes offer more coverage for excess charges and foreign travel health emergencies.
Who Should Get a Medicare Supplement Insurance Plan?
A Medicare Supplement Insurance plan may be a good choice for you if you:
- Like Original Medicare and want help paying for your portion of costs for services received.
- Want peace of mind that your insurance will pay for the majority of your Medicare-covered health costs without constraints of networks or need for referrals.
- Don’t mind purchasing a standalone Part D plan to cover prescription drugs.
What is a Medicare Supplement Insurance Plan?
Medicare Supplement Insurance plans provide additional coverage to supplement Original Medicare.
|Plan structure||Standardized plans regulated by the federal government and administered by private insurance companies that cover cost sharing requirements of Part A and Part B services.|
|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 facility 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 your 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 policy will serve as a secondary source of insurance. Medicare will be used first to pay for any Medicare-approved costs for healthcare 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 plan, as most doctors and health care facilities will automatically bill for you.
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
Medigap policies may include the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- 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
- Foreign travel emergency services
- Out-of-pocket limit
|Advantages of a Medicare Supplement Insurance Plan||Disadvantages of a Medicare Supplement Insurance Plan|
Compare your Medicare Supplement options
Compare benefits of standardized Medigap Plans:
|Medigap Benefits||Plan A||Plan B||Plan C||Plan D||Plan F*||Plan G*||Plan K||Plan L||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||$6,620 in 2022||$3,310 in 2022||N/A||N/A|
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of$2,490 in 2022 before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare 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 plan pays 100% of covered 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 may be eligible to purchase a Medigap Plan. 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 monthly premium for your Medigap plan. This premium varies depending on benefits offered, when you purchase your policy, how it is priced, and in which state you reside. Because Medigap plans are offered through private insurance companies, the companies set their premiums. Monthly premium costs may increase each year based on age, inflation, or other factors.
If you choose a high-deductible plan, 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 2022, the deductible amount for high-deductible Medigap plans is $2,490.
See how pricing and availability compare for three different Medigap plans for a 65 year old female in Chicago, Illinois who doesn’t use tobacco in 2021:
|Plan||Monthly premium range||Number of Plans available|
|Plan A||$74 to $329||69 total
*62 (attained age)
~3 (issue age)
|Plan G||$106 to $367||71 total
*64 (attained age)
~3 (issue age)
|Plan N||$81 to $350||66 total:
*62 (attained age)
~1 (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 if you purchase a plan as soon as you are eligible for Medicare and enrolled in Parts A and B. Medigap Open Enrollment starts on the first day of the month that you turn 65 and are enrolled in both Parts A and B and lasts for six months. An insurance company is not allowed to use medical underwriting to decide whether to accept your application or change the price during this time.
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 insurance company 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 care coverage, you should consider a Medigap Plan to offset the portion of costs that Medicare doesn’t pay. As with Original Medicare, you have freedom of choice of providers because you can see any Medicare provider in the U.S. You can choose which 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 plans give you peace of mind if you anticipate the need for frequent healthcare now or in the future.
Learn More From Our Sources
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed January 2022
- Medicare | Find a Medigap policy that works for you | Last accessed January 2022
- Medicare | How to compare Medigap policies | Last accessed January 2022
- Medicare | Medigap in Minnesota | Last accessed January 2022
- Medicare | Medigap in Massachusetts | Last accessed January 2022
- Medicare | Medigap in Wisconsin | Last accessed January 2022
- Medicare | Guaranteed issue rights | Last accessed January 2022