Medigap Supplement Insurance: Complete Guide to Medicare Supplements

Medigap (Medicare Supplement Insurance) policies are designed to help pay for costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. Understanding Medigap can help you better manage your healthcare expenses.

What is Medigap?

Medigap is private insurance that supplements Original Medicare (Parts A and B). It helps pay for:

• Medicare Part A and Part B deductibles
• Copayments and coinsurance
• Emergency care during foreign travel
• Excess charges from providers who don't accept Medicare assignment

Standardized Medigap Plans

Medigap policies are standardized and labeled with letters. Here are the main plans available:

Plan A (Basic Coverage)

• Part A coinsurance and hospital costs
• Part B coinsurance or copayment
• First 3 pints of blood

Plan B

Plan A benefits plus:

• Part A deductible

Plan C (Comprehensive)

Plan B benefits plus:

• Part B deductible
• Skilled nursing facility coinsurance
• Foreign travel emergency (80% of costs)

Plan D

Plan B benefits plus:

• Skilled nursing facility coinsurance
• Foreign travel emergency (80% of costs)
• Part B excess charges

Plan F (Most Comprehensive)

Plan C benefits plus:

• Part B excess charges

Note: Plan F is only available to those who became eligible for Medicare before January 1, 2020.

Plan G (Popular Choice)

Same as Plan F except:

• Does NOT cover the Part B deductible
• Available to all Medicare beneficiaries

Plan K (Cost-Sharing)

Covers 50% of most benefits with an annual out-of-pocket limit of $6,940 in 2024.

Plan L (Cost-Sharing)

Covers 75% of most benefits with an annual out-of-pocket limit of $3,470 in 2024.

Plan M

Plan A benefits plus:

• 50% of Part A deductible
• Skilled nursing facility coinsurance
• Foreign travel emergency (80% of costs)

Plan N

Plan A benefits plus:

• Part A deductible
• Skilled nursing facility coinsurance
• Foreign travel emergency (80% of costs)
• Part B coinsurance (except up to $20 copay for office visits and $50 copay for ER visits)

Medigap Enrollment

Open Enrollment Period

Your Medigap Open Enrollment Period is the 6-month period that begins when you're 65 or older and enrolled in Medicare Part B. During this time:

• You have guaranteed issue rights
• Companies cannot deny coverage or charge more due to health conditions
• You can buy any Medigap policy sold in your state

Guaranteed Issue Rights

You have guaranteed issue rights in certain situations, such as:

• Your Medicare Advantage plan leaves Medicare or stops serving your area
• You move out of your plan's service area
• Your employer stops providing health coverage
• You were misled when you bought your plan

Medigap vs Medicare Advantage

Key Differences:

• Provider Choice: Medigap works with any Medicare provider; Medicare Advantage has networks
• Prescription Drugs: Medigap requires separate Part D; Medicare Advantage often includes drugs
• Additional Benefits: Medicare Advantage may include dental/vision; Medigap focuses on cost-sharing
• Travel: Medigap works nationwide; Medicare Advantage is geographically limited

Choosing the Right Medigap Plan

Consider These Factors:

• Your Health Status: Frequent medical care may benefit from comprehensive coverage
• Budget: Balance premium costs with potential out-of-pocket expenses
• Travel Habits: Foreign travel coverage may be important
• Provider Preferences: Whether you see providers who accept Medicare assignment

Popular Plan Choices:

• Plan G: Comprehensive coverage with predictable costs
• Plan N: Lower premiums with small copays
• Plan K or L: Lower premiums with cost-sharing and out-of-pocket limits

Important Medigap Rules

• You cannot have both Medigap and Medicare Advantage
• Medigap doesn't cover prescription drugs - you need Part D
• Plans are standardized but premiums vary by company
• You can switch Medigap plans, but may face medical underwriting
• Medigap premiums typically increase with age

Tips for Buying Medigap

• Enroll during your Open Enrollment Period when possible
• Compare premiums from multiple insurance companies
• Check the company's financial rating and customer service record
• Understand how premiums are priced (community-rated, issue-age, or attained-age)
• Don't buy more coverage than you need
• Keep your current coverage until your new policy begins