Medigap plans help pay for out-of-pocket costs associated with Original Medicare.
Medigap (also known as Medicare Supplement Insurance) covers the out-of-pocket health care costs you may incur with Original Medicare (parts A and B). There are 10 standard Medigap plans in most states. These plans have letter names and are sold by private insurance companies. The state regulates the premiums. The amount you pay for monthly premiums will depend on your location, the coverage you have and your age. Medicare Advantage plans do not include Medigap plans.
What Medigap policies are available?
Medigap plans pay for some of your out-of pocket health care costs, after Medicare Part A and Medicare Part B have paid their share. Medigap policies can help cover:
- Part A and part B coinsurance.
- Copayments for Part A and PartB
- Part A Deductible: Every plan except one pays the Part A deductible for hospitalization ($1,484 per 60-day benefit period).
- Part B Deductible: Medigap plans that are sold to new beneficiaries starting January 1, 2020 won’t be able to pay the Part B deductible ($203 in 2021). Plans C and F, two of the 10 standard plans, cover the Part-B deductible, but they are not available to new enrollees. People who have Plans C and F can keep their plans while they take advantage of the Part-B deductible coverage.
- Foreign travel emergency services: Many plans cover up to 80% of medically required emergency services in foreign countries after you have met a $250 deductible.
What Medigap policies don’t cover
Medigap policies don’t cover:
- Long-term care.
- Vision care (including eyeglasses).
- Dental care.
- Hearing aids.
- Private duty nursing.
- Prescription drugs: Medigap policies sold after January 1, 2006 are not allowed to cover prescription drugs. However, if your plan includes prescription drug coverage before this date, the coverage will be maintained. You can receive prescription drug coverage through a Medicare Part D plan.
Medigap vs. Medicare Benefit
Private insurance companies offer both Medicare Advantage and Medigap plans. However, they operate in different ways. Medigap plans are for people who have purchased Original Medicare (Part A or B). They fill in gaps in Original Medicare by covering additional costs such as copays and coinsurance. Medicare Advantage plans are an alternative to Original Medicare. They provide the same coverage as Medicare Part A, Part B, and often additional benefits. It is not possible to have both a Medigap and a Medicare Advantage plan at once.
Medigap policies can be compared easily because they are standard. Each Medicare Advantage Plan is different so it can be challenging to compare costs.
What you’ll have to pay
Medigap plans have premiums that you pay, but they aren’t standard. Private insurers may charge different premiums for the exact same plan. Your insurer may offer discounts to certain individuals, such as married couples or non-smokers. This can impact your premium costs. You’ll probably pay lower premiums if your Medicare Select policy covers a network of providers.
If you are not enrolled during the initial open enrollment period, you may be subject to higher premiums. In some cases, your health may be a factor in raising your premiums.
F and G Medigap plans may have high deductibles, but lower premiums. Medicare Supplement Plan F is not available to new enrollees. The policy will kick in if you don’t pay $2,370 of Medicare costs.
For foreign emergency medical services coverage, there is a $250 deductible
When should you enroll in Medigap Insurance
It can be difficult to enroll in Medigap policies. If you don’t carefully follow the enrollment rules, you could end up paying more or being denied coverage.
During Medigap open enrollment period
This is the 6-month period that begins when you turn 65 and enroll in Medicare Part B. You can purchase any Medigap policy in your state during this period, regardless of your current health status. Insurers must charge pre-existing conditions at the same rate as people in good health during this six month Medigap enrollment period.
Outside open enrollment period
In all but four states that allow Medigap coverage, insurers can use medical underwriting to deny coverage or charge more if you apply after the open enrollment period. This means that you might have to pay higher premiums or get denied coverage if your pre-existing conditions include asthma, heart disease, diabetes, or a pending operation.
Switching Medicare plans during open enrollment
Many people switch to Medicare Advantage or Medicare PartD prescription drug coverage during the annual Medicare open enrollment period. This allows them to choose a plan that best suits their financial and health needs. Some Medicare beneficiaries also switch from Original Medicare plans to Medicare Advantage plans.
Moving from Medicare Advantage to Original Medicare and Medigap Insurance is more difficult. Medigap insurance can consider your health status before issuing you any policy, as you will likely have passed the initial enrollment period of six months.
Medigap and other insurance
Medigap pays for out-of pocket costs that are not covered by Original Medicare Parts A or B.
Medigap doesn’t work with Medicare Advantage plans. It is against the law to sell a Medigap policy to a Medicare Advantage beneficiary.
Prescription drug coverage is available through Medicare Part D
Prescription drug coverage is not allowed in Medigap plans that were sold after January 2006. You can change your Medigap policy to include prescription drug coverage if you have an older policy. You must have prescription drug coverage that is “creditable,” meaning that it pays at least the same as Medicare standard drug coverage. Otherwise, you will be subject to the Medicare Part D penalty. If you are without creditable prescription drugs coverage for more than 63 days, this will happen. You should sign up as soon as possible after dropping your previous coverage.
Employer- or union-sponsored insurance
You can postpone enrollment in Medicare B if you have group coverage from an employer or union. Your Medigap enrollment will be delayed until the first day of the month you enroll in Medicare Part B. No matter your health status, if you sign up for Medigap within the six-month enrollment period you will receive a policy.
How to compare plans
Start by determining which of the various lettered plans will fit your health care needs.
Medigap policies in Massachusetts, Minnesota, and Wisconsin are different. Click on the name of the state to find out more about Medigap there.
After you have chosen the type of plan that you would like, you will need to compare the prices offered by all the insurance companies in your area. Prices can vary greatly, but coverage is the exact same for every lettered plan. This tool on Medicare.gov can help you compare prices. Your State Health Insurance Assistance Program (SHIP) or your state insurance department can also help.