What is a Medigap Plan?
Original Medicare pays for many, but not all, health care services and supplies. Check out the Medicare and You Handbook from Uncle Sam to learn more.
A Medigap policy, sold by private insurance companies, can help pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. Medicare doesn’t pay any of the premiums for a Medigap policy.
Every Medigap policy must follow Federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies can sell you only a “standardized” Medigap policy identified in most states by letters. All plans offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.
What do Medigap Plans cover?
Original Medicare only covers 80% of your Part B expenses. The other 20% comes out of your pocket if you do not have a Medicare Supplement policy (also referred to as Medigap). If you were to have a lengthy stay in a hospital or expensive treatments at outpatient facilities, you can see how that could add up.
Which Medigap Plans Can I Choose From?
How to read the chart: If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).
Plans that are highlighted in green above are the 3 most popular plans that clients choose when selecting a Medigap/Medicare Supplement plan.
Insurance companies may charge different premiums for exactly the same Medigap coverage. As you shop for a Medigap policy, be sure you’re comparing the same Medigap policy (for example, compare Plan A from one company with Plan A from another company).
What is not covered by Medigap Plans?
Things that are not covered by Original Medicare on your Medigap Plan:
- Routine dental, vision, and hearing exams
- Hearing aids
- Eyeglasses or contacts
- Long-term care or custodial care
- Retail prescription drugs
More About Medigap Policies
You must have Part A and Part B.
You pay a monthly premium for your Medigap policy in addition to your monthly Part B premium.
A Medigap policy only covers one person. Spouses must buy separate policies.
It’s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap costs.
The best time to buy a Medigap policy is during the 6-month period that begins on the first day of the month in which you’re 65 or older and enrolled in Part B. (Some states have additional open enrollment periods.) After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
If you’re under 65, you won’t have this open enrollment period until you turn 65, but state law might give you a right to buy a policy before then.
If you have a Medigap policy and join a Medicare Advantage Plan (like an HMO or PPO), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums. If you want to cancel your Medigap policy, contact your insurance company. If you drop your policy to join a Medicare Advantage Plan, in most cases you won’t be able to get it back.
If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare. Contact your State Insurance Department if this happens to you.
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