What is Medigap Insurance
Medigap, known as Medicare Supplemental Insurance, is a policy designed to be used by seniors aged 65 and older. However, individuals who receive Social Security benefits, disability benefits, or Railroad Retirement benefits can qualify, even if they aren’t 65 years old.
Individuals suffering from ESRD (end-stage renal disease) or ALS (amyotrophic lateral sclerosis) may also qualify for Medicare and Medigap insurance. Medigap supplemental insurance can help those who qualify to pay for the out-of-pocket medical costs that Medicare doesn’t cover.
Most obtain 40-80% coverage of their medical expenses, but having a limited or fixed income can still make that gap difficult for some seniors. Decrease some of those out of pocket costs with Medicare, such as:
- Copayments
- Coinsurance
- Deductibles
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Medigap Enrollment Period (MOEP)
Enrolling in Medigap supplemental insurance is automatic for people turning 65 years of age. Individuals who want to receive the benefits of Medicare and Medigap can register for the program three months before their 65th birthday and four months after or during an annual open enrollment period.
If you are automatically enrolled in Medicare and Medigap, you don’t have to worry about renewing your coverage every year. In addition, this automatic enrollment means that individuals won’t be turned away from an insurance policy or charged more for pre-existing medical conditions that they may have.
During the open enrollment period, you have the chance to switch plans if you aren’t happy with your current one. This means that you can change from Original Medicare to a Medicare Advantage plan or vice versa. You can test out this new plan, see if it works for you, and if it does, keep it throughout the next year and have it automatically renewed.
Some Medigap and Medicare Advantage plans are packaged differently, depending on what insurance company you purchase these policies from and where you live. However, they should all offer the same coverage if they are a licensed insurance agent. Some Medicare Advantage plans or Medigap plans don’t have prescription drug coverage, dental coverage, hearing, or vision coverage. So if you need any of those services, be sure to choose a Medicare, Medigap, or Medicare Advantage policy that offers that insurance coverage.
Medigap Plans
There are a few Medigap plans that people can choose from. Each year some of these options can change.
As of January 1st, 2020, Medigap plans sold to those new to Medicare are not allowed to cover the Part B deductible. This new regulation means that Plans C and F are not available since January 1st, 2020.
If you have either of these two plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1st, 2020, you’ll be able to keep it. In addition, if you were a Medicare Beneficiaries before January 1st, 2020, but not yet enrolled, you can buy one.
Medigap Plans A and B
Part A and Part B offer basic health insurance coverage that helps with medical care costs involving hospice care, miscellaneous medical expenses, and hospitalization coverage such as:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- Blood (first 3 pints)
- Part A hospice care coinsurance or copayment
Licensed private insurance companies will charge a premium for these two plans and lower deductibles.
Medigap Plan C
This plan has a higher coverage limit than Medigap Plans A and B. Plan C offers the same coverage that A and B do, adding in coverage for skilled nursing care and medical care that might be required while traveling or living abroad.
As long as you’re enrolled in Part B of Original Medicare and were eligible before 2020, you can register for Plan C. If you were not eligible for Medicare until after 2020, you wouldn’t be eligible to enroll in Plan C.
Medigap Plan F and G
- Coverage for 100% of the excess charges that can occur from Medicare Part B (medical insurance).
- Costs that can come from skilled nursing care.
- Emergency medical care you might require when traveling or living abroad.
This plan allows policyholders to choose a high-deductible option to keep the monthly or annual premium rate lower. However, Plan F will not be available for new beneficiaries of Medicare.
In the new year, Medigap Plan G will be the most popular Medicare supplement plan for 2021. It has excellent coverage for relatively low premiums. It’s almost identical to Plan F except for one small difference: with Plan G, you pay the annual Part B deductible yourself, rather than having Plan F pay it for you.
Medigap Plans K, L, and N
In different states, these three Medigap plans might be combined in different ways. However, no matter how they are packaged or named, they will offer the same services as Medigap Plans K, L, and N.
These plans offer the highest level of Medigap insurance coverage. As a result, they can help financially take care of specialized hospital care, the services provided by doctors, skilled nursing care, and all deductibles coming from Medicare Part A. In addition, each plan comes with a maximum out-of-pocket payment. So, policyholders know precisely how much they’ll need to pay in case of a medical event or emergency.
If You live in Massachusetts, Minnesota, or Wisconsin
If you live in Massachusetts, you can buy Medigap, but the policies are different.
Basic benefits include:
- Inpatient hospital care: Part A coinsurance plus 365 additional days after Medicare coverage ends
- Medical costs: Part B coinsurance (usually 20%)
- First 3 pints of blood (each year)
- Part A hospice coinsurance or copayment
Medigap plans
Core Plan Covers:
- Basic benefits
- 60 days per calendar year of inpatient days in mental health hospitals
- State-mandated benefits such as yearly Pap tests, mammograms, and varying state-mandated services
Doesn’t cover:
- Part A: inpatient hospital deductible
- Part A: skilled nursing facility coinsurance
- Part B: deductible
- Foreign travel emergency
Supplement 1 Plan Covers:
- Basic benefits
- Part A: inpatient hospital deductible
- Part A: skilled nursing facility coinsurance
- Part B: deductible.*
- Foreign travel emergency
- 120 days per calendar year of inpatient days in mental health hospitals
- State-mandated benefits such as yearly Pap tests, mammograms, and varying state-mandated services
*Note: Supplement 1 Plan (which includes coverage of the Part B deductible) will no longer be available to new Medicare beneficiaries after January 1st, 2020.
Supplement 1A Plan Covers
Basic benefits:
- Part A: inpatient hospital deductible
- Part A: skilled nursing facility coinsurance
- Foreign travel emergency
- 120 days per calendar year of inpatient days in mental health hospitals
- State-mandated benefits such as yearly Pap tests, mammograms, and varying state-mandated services
If you live in Minnesota, you can buy Medigap, but the policies are different.
Medigap Basic plan covers:
- Basic benefits
- Part A: skilled nursing facility coinsurance (Provides 100 days of SNF care)
- Foreign travel emergency: 80%
- Outpatient mental health: 50%
- Medicare-cover preventative care
- Physical therapy: 20%
- State-mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
If you live in Wisconsin, you can buy Medigap, but the policies are different.
Basic benefits:
- Inpatient hospital care, which includes the Part A coinsurance
- Medical costs, which covers the Part B coinsurance (usually 20%)
- First 3 pints of blood each year
- Part A hospice coinsurance/copayment
Medigap plan
Basic Plan
Covers:
- Basic benefits
- Part A: skilled nursing facility coinsurance
- 175 days per lifetime in addition to Medicare’s benefit of inpatient mental health coverage
- 40 home health care visits in addition to those paid for by Medicare
- Various state-mandated benefits
Plans known as “50% and 25% Cost-sharing Plans” are available in Wisconsin. These plans are similar to standardized Plans K (50%) and L (25%). In addition, a high-deductible plan ($2,340) is also available.
Choosing a Medigap Plan
| 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 | ||||||||||
| Part B coinsurance or copayment | 50% | 75% | ||||||||
| Blood (first 3 pints) | 50% | 75% | ||||||||
| Part A hospice care coinsurance or copayment | 50% | 75% | ||||||||
| Skilled nursing facility care coinsurance | 50% | 75% | ||||||||
| Part A deductible | 50% | 75% | 50% | |||||||
| Part B deductible | ||||||||||
| Part B | ||||||||||
| Foreign travel exchange (up to plan limits) | 80% | 80% | 80% | 80% | 80% | 80% | ||||
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $7,220 in 2025 | $3,610 in 2025 | N/A | N/A |
* Plans F and G also offer a high-deductible plan in some states. You must pay Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,800 in 2024 before your policy pays anything. (You can’t buy Plans C and F if you were new to 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 ($240 in 2024), the Medigap plan pays 100% of covered services for the rest of the calendar year. *
**Plan N pays 100% of the Part B coinsurance. You must pay 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 an inpatient admission.
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There are many options when it comes to Medicare and Medigap insurance. However, it is always best to research and look into your medical needs before choosing a policy. The basic level of coverage offered by Original Medicare can be great for some people, while others require more specific care and medical insurance coverage.
Specific plans will work better for certain people. Look at your Medicare, Medicare Advantage, and Medicare Supplemental Insurance options to see what kind of medical insurance you need, which plan covers you best, and if it fits within your budget.
Suppose you need dental, prescription drug coverage, medical insurance for traveling abroad, or other specific care. In that case, Medigap insurance can help supplement your Medicare health insurance plan to provide you with another layer of insurance protection.
Medigap FAQ
Does Medicare Supplement Insurance Cover Everything?
Medicare Supplement Insurance does not cover everything. A Medicare Supplement plan does not cover all of the following:
- Long-term care
- Private-duty nursing
- Eyeglasses
- Hearing aids
- Dental care
Can I Change My Medigap Plan Anytime?
If you would like to cancel your existing Medigap coverage to enroll in another Medicare Supplemental plan or enroll in Medicare Advantage, you need to be careful with your timing. Each year, you are free to make changes and switch plans easily regarding Medicare Parts C and D during the Medicare Open Enrollment period.
However, with Medigap plans, you only have a one-time enrollment window when you turn 65. After that, you have 30 days to decide if you want to keep the new Medigap policy during your “free look period.” This period begins when you get your new Medigap policy.
Don’t cancel your first Medigap policy until you’ve decided to keep the second Medigap policy. You’ll need to pay both premiums for one month.
According to Medicare.gov, you have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:
Your Medicare Advantage Plan is:
- Leaving Medicare
- Stops giving care in your area
- You are moving out of the plan’s service area
- Your Original Medicare coverage is paid by an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays, and that plan is ending.
- You have Original Medicare and a Medicare SELECT policy and move out of the Medicare SELECT policy’s service area.
- You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65. Within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)
- You dropped a Medigap policy to join a Medicare Advantage Plan (or switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)
- Your Medigap insurance company goes bankrupt, and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
- You leave a Medicare Advantage Plan or drop a Medigap policy because it hasn’t followed the rules or misled you.
Does Everyone Need a Medicare Supplement Policy?
While not all seniors choose to purchase a medicare supplement policy, they are highly encouraged to do so. Medigap can help with medical costs you know you will have as you age, in addition to surprise medical events. Medicare and Medicare supplemental insurance is designed to help seniors afford medical care and know that they are covered for various medical services.
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