There’s a reason why Medicare Supplement Insurance is also known as Medigap — its primary purpose is to cover you for some of the “gaps” in coverage that exist with Original Medicare. If you have an optional Medicare Supplement plan in addition to your basic Original Medicare plan, you’ll be covered for many of the copays or coinsurance and other out-of-pocket costs beyond what Medicare will pay for.
Although Medigap coverage comes at a price, it can be a good choice for many people, especially those who have frequent visits to the doctor or hospital. Let’s take a deeper look at what Medicare Supplement Insurance — Medigap — offers, what it costs, and who is eligible.
Benefits Offered by Medicare Supplement Insurance Plans
There are ten different plans available through the Medicare Supplement Insurance program, although not all companies offer all plans, and several plans are in the process of being phased out. These plans are given letter designations: Plan A, Plan B, and so forth. Note that these are different from Original Medicare’s Part A and Part B.
Although the plans are administered by various private insurance companies, they generally feature the same coverage across the board. That is, Plan A in New York will be similar to Plan A in California. Three states, however — Massachusetts, Minnesota, and Wisconsin — feature different parameters from the rest of the country; you’ll want to read your plan’s documentation carefully to find out what is covered.
In the other 47 states, Medicare Supplement Insurance generally covers:
- Copays or coinsurance for Medicare Part A (hospital) costs, up to 365 days after your Medicare benefits are exhausted
- Copays or coinsurance for Medicare Part A hospice care
- Copays or coinsurance for Medicare Part B
- The first three pints of blood used during surgery or any other medical procedure
Some Medicare Supplement Insurance plans cover additional expenses, such as deductibles, skilling nursing care, or emergency care needed during international travel. None of the plans, however, cover long-term care, or vision, dental, or hearing care — if you wish for this coverage, you’ll want to explore Medicare Advantage or other private coverage, rather than Medicare Supplement Insurance.
Compare Medicare Supplement Insurance Plans
It can take a little work to determine which of the ten Medicare Supplement Insurance plans is right for you, since each offers different benefits. This chart can help make it clear. Note, however, that as of January 1, 2020, Plans C, F, and a variant of F called High Deductible Plan F will only be available for purchase for those who were first eligible for Medicare before 2020; they’re being phased out for those who do not fit that category, though those who have the plans may keep them.
Medicare Supplement Insurance Plans A through G offer benefits at the cost of higher premiums, with limited out-of-pocket costs; the other plans feature lower premiums, but you may have to pay for certain health care costs, as detailed on the chart. Costs covered in general are limited to Medicare-eligible expenses.
|Benefit||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan K||Plan L||Plan M||Plan N|
|Coinsurance and coverage for Medicare Part A (hospital) benefits||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||$20 copay for doctor visits; $50 copay for emergency room visits|
|Copay or coinsurance for Medicare Part B||Yes||Yes||Yes||Yes||Yes||Yes||50% covered||75% covered||Yes||Yes|
|First three pints of blood used during surgical procedure||Yes||Yes||Yes||Yes||Yes||Yes||50% covered||75% covered||Yes||Yes|
|Coinsurance or copay for hospice||Yes||Yes||Yes||Yes||Yes||Yes||50% covered||75% covered||Yes||Yes|
|Coinsurance for skilled nursing facility care||No||No||Yes||Yes||Yes||Yes||50% covered||75% covered||Yes||Yes|
|Deductible for Medicare Part A||No||Yes||Yes||Yes||Yes||Yes||50% covered||75% covered||50% covered||Yes|
|Deductible for Medicare Part B||No||No||Yes||No||Yes||No||No||No||No||No|
|Medicare Part B excess charges||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel emergency care (up to plan limits)||No||No||80% covered||80% covered||80% covered||80% covered||No||No||80% covered||80% covered|
Medicare Supplement Insurance Plan Costs
Although each Medicare Supplement plan is similar to others of the same name across the country, prices for the plans vary, depending on what extra benefits are involved and how each company prices them. Your primary cost will be a monthly premium that you pay to the company administering your plan. For some plans, you may also be required to pay a deductible for your Medicare Parts A or B coverage, and/or all or part of certain copays or coinsurance. Because of these factors, and your ability to customize your coverage through the plan you choose, there is no one standard cost for Medigap coverage.
It’s important to do your homework before you choose the Medicare Supplement policy that will provide the most benefits for your unique situation. Fortunately, the government makes it easy to compare plans at the Medicare website. At the site’s “find a Medigap policy” page, you can enter your zip code and see all the plans that are available in your state, along with details on costs, benefits, and deductibles.
Medicare Supplement Insurance Plan Eligibility
You are eligible for Medicare Supplement Insurance if you are enrolled in Original Medicare Part A and Part B. There is an open enrollment time of six months that begins on the day your Medicare Part B begins. During this period, insurers must accept your application for coverage regardless of your medical history — including any preexisting conditions. Once that period has passed, however, they may take your health history into account when underwriting your policy.
To be enrolled in Medicare Part A and Part B, one of the following needs to be true:
- You are a U.S. citizen or permanent resident and are 65 or older; and you are receiving Social Security or Railroad Retirement benefits, or are eligible to receive them.
- You have been entitled to Social Security disability benefits for at least 24 months.
- You have Lou Gehrig’s disease (amyotrophic lateral sclerosis)
- You have permanent kidney failure that requires regular dialysis or a kidney transplant
Medicare Supplement Insurance Plan Enrollment
As we noted, the best time to sign up for Medicare Supplement Insurance is right after you begin receiving Medicare Part B, which is usually around your 65th birthday. During the six months following this time, the company you choose to be insured with must allow you to enroll, even if you have an illness that requires extensive medical care.
This is worth noting because according to the Centers for Medicare and Medicaid Services, more than half of the people approaching 65 have some type of preexisting condition. Those preexisting conditions can range from treatable illnesses such as asthma to cancer, diabetes, or other serious diseases.
Since many illnesses require expensive medical interventions, if you do not sign up during the six-month open enrollment period, insurers may balk at giving you a policy; either denying coverage, withholding coverage for a certain length of time, or charging additional fees to make up for the fact that you are a higher risk for them.