Medicare Supplement (Medigap) Insurance
Medicare Supplement, or Medigap, plans fill in some of the gaps in coverage in Original Medicare, such as deductibles, coinsurance, copayments, and overseas emergency health coverage. These are costs you'd normally be responsible for paying out of pocket.
In 47 states, there are 10 standardized Medigap plans available, each labeled by the letters A through N. These plans are available through private insurance companies, and insurance companies aren't required to offer all 10 plan types. However, any insurance company that sells Medicare Supplement policies must offer at least Plan A and, if they offer any other Medigap policy, must also offer either Plan C or Plan F.
Keep in mind that Medicare Supplement plans can only be used to pay for Original Medicare expenses; these plans can't be used to pay for costs you may have in Medicare Part C. If you enroll in a Medicare Advantage plan, you can keep your Medigap plan as long as you keep paying the monthly premium, but you won't be able to use your Medigap benefits to pay for your Medicare Advantage plan costs.
Medicare Supplement plans generally let you use any provider that accepts Medicare. Some states sell Medicare SELECT plans, which is a type of Medigap plan that requires members to use in-network providers. If you're enrolled in a Medicare SELECT plan, be sure to use the plan's network providers to be covered by the plan (although you'll be covered for emergency or urgent care).
Medicare Supplement plan coverage
Most states have up to 10 Medicare Supplement plan types available, each labeled with a different letter of the alphabet (for example, Plan A). Each of the 10 Medicare Supplement plans offers a different level of coverage, but benefits are standardized across each lettered plan type. This means that for Medigap plans of the same letter category, you'll get the exact same benefits, no matter which insurance company you purchase the plan from or where you live. For example, a Plan A in Florida will cover the same benefits as a Plan A in North Dakota. Some companies may offer additional innovative benefits.
Please note that if you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement insurance options are different than those available in the rest of the country. These states standardize their Medicare Supplement coverage differently than other states. For more information on Medigap coverage in Massachusetts, Minnesota, or Wisconsin, contact your state insurance department. Or, alternatively, contact eHealth to get personalized assistance with your Medigap questions from a licensed insurance agent.
In the rest of the United States, insurance companies can only offer Medigap coverage from among the standardized plan options. All Medicare Supplement plans offer full or partial coverage for the following basic benefits:
- Medicare Part A coinsurance costs up to an additional 365 days after Original Medicare benefits are exhausted
- Medicare Part A hospice care coinsurance or copayment
- Medicare Part B coinsurance or copayment
- First three pints of blood each year
Plans that include additional coverage, such as Plan F, may also offer a variation of the following additional benefits:
- Medicare Part A deductible
- Medicare Part B deductible
- Medicare Part B excess charges
- Skilled nursing facility care coinsurance
- Foreign travel emergency care (up to plan limits)
Two Medigap plans (Plan K and Plan L) cover an out-of-pocket limit. Once your health-care costs (including the Medicare Part B deductible) have reached the plan's limit, your Medigap plan will cover 100% of covered medical expenses for the rest of the year. It's worth noting that Original Medicare doesn't include a yearly out-of-pocket limit, meaning there's no maximum cap on the amount you could spend for health care in a given year. If you get into a medical emergency or have a chronic condition that requires a lot of ongoing care, your health expenses can add up quickly.
Since Medigap coverage is standardized across each letter category, it can help to familiarize yourself with what each plan type covers: See this article for a detailed, side-by-side comparison of Medigap benefits across all 10 plans.
Remember, Medicare Supplement coverage is meant to work alongside your Original Medicare coverage; as its name implies, Medigap plans provide supplemental, not stand-alone, benefits. You'll need to remain enrolled in Original Medicare, Part A and Part B, for your hospital and medical coverage. If you want prescription drug coverage, you can get it through a stand-alone Medicare Prescription Drug Plan, since Medigap plans don't provide coverage for medications.
Keep in mind that Medigap plans don't cover benefits like routine vision or dental, hearing, or wellness programs. You may be able to get coverage for some of these items through a Medicare Advantage plan.
Medicare Supplement plan costs
Although private insurance companies are required to offer the same benefits for each lettered plan, these companies are allowed to vary the premium costs they charge for this coverage. So if you're looking for Medigap coverage, it's a good idea to shop around to find a Medicare Supplement plan that is right for both your medical and financial needs.
Keep in mind that insurance companies use different methods to price their Medigap plans. The pricing method that a company uses can affect both the premium amount you pay when you first enroll in a Medicare Supplement plan, as well as your long-term costs.
Insurance companies can price, or "rate," their Medigap plan premiums in the following ways:
- Community no-age-rated: These plans charge premiums that are the same for all plan enrollees, regardless of age.
- Issue-age-rated: These plans base premiums on your age when you first enrolled in the policy. Therefore, the younger you are when you enroll in this type of plan, the lower your premium will be. Premiums don't increase with age.
- Attained-age-rated: Like issue-age-rated, these plans also base premiums on your age when you first buy the policy. However, unlike issue-age-rated plans, premiums increase as you get older.
As you can tell, the premium listed when you first join a Medigap plan may not necessarily be how much you'll pay later on. For example, attained-age-rated Medigap plans may be lower when you first enroll if you join the plan when you're younger. However, because premium costs increase with your age, your costs could go up considerably over time. On the other hand, community-rated and issue-age-rated Medicare Supplement plans may initially have higher premiums, but these costs don't increase as you get older, so your costs may end up being lower overall over time.
Keep in mind that, regardless of the rating method used, insurance companies may increase premiums to adjust for inflation. In addition, other factors like location or medical underwriting may affect the costs you pay for your Medicare Supplement coverage. Before enrolling in a Medigap plan, always ask the insurance company how it sets its premiums to get a more accurate idea of how much you will pay for your Medigap coverage -- both when you first enroll and later on.
Keep in mind that your Medigap premium is separate from any expenses you may have for Original Medicare. You'll need to keep paying your Medicare Part B premium (along with a premium for Part A if you don't get it for free).
Medicare Supplement plan eligibility and enrollment
To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B.
Some states may offer Medigap plan options to beneficiaries under 65 who qualify for Medicare because of disability or certain conditions (such as end-stage renal disease). Federal law doesn't require states to sell Medicare Supplement insurance to beneficiaries under 65. However, depending on where you live, some states may offer Medigap coverage to beneficiaries under 65; eligibility and the specific available options may vary by state. If you're a Medicare beneficiary under 65 and interested in purchasing Medicare Supplement insurance, contact your state insurance department to learn if you're eligible for Medigap coverage in your state.
Medigap Open Enrollment Period
The best time to enroll in a Medicare Supplement plan is generally during your Medigap Open Enrollment Period, which begins automatically on the first day of the month that you are both age 65 or older and enrolled in Medicare Part B. This period lasts for six months, and once it's over, you can't get it again. During this time, you have guaranteed-issue rights, meaning that by law, you can join any Medigap plan offered in your service area, regardless of pre-existing conditions. Insurance cannot turn you down for coverage due to your health status if you enroll in a policy during your Medigap Open Enrollment Period.
Once your Medigap Open Enrollment Period is over, you may have more difficulty joining a Medicare Supplement plan for the first time or switching plans. Insurance companies may require medical underwriting and can reject your application based on your medical status. If you can find a Medigap plan that will accept you, you may be charged higher premiums if you have pre-existing conditions.
After your Medigap Open Enrollment Period has passed, you may have guaranteed-issue rights in certain situations, including (but not limited to):
- Your Medigap plan goes bankrupt.
- Your Medigap plan misled you or didn't follow the rules.
- You lose your Medigap coverage through no fault of your own.
- You disenrolled from your Medigap plan to enroll in a Medicare Advantage plan for the first time at age 65 and change your mind within the first year. If you switch back to Original Medicare, you have a trial right to get back your original Medigap plan if your former insurance company still offers that plan. If your original Medigap plan is no longer available, you have a right to enroll in any Medigap Plan A, B, C, F, K, or L offered by an insurance company in your state.
The specific rules about which Medicare Supplement plans you may be able to enroll in may vary, depending on the reason you have guaranteed-issue rights.
Once you're enrolled in a Medicare Supplement plan, your plan is generally guaranteed renewable as long as you continue to pay your plan premium. This means that your Medigap insurance company can't cancel your policy because you have health problems (as long as you're paying your monthly premiums). If you cancel your policy or leave your Medigap plan on your own, it's important to understand that you may not be able to get back the same plan or may have difficulty enrolling in a different plan unless you have a situation that gives you guaranteed-issue rights.
Do you have questions about how Medicare Supplement coverage works? Feel free to contact eHealth to discuss your Medicare needs with a licensed insurance agent; we can help you find Medigap coverage that may work for your situation.
To learn about Medicare plans you may be eligible for, you can:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as eHealth Insurance Services, Inc.
- Call eHealth's licensed insurance agents at 1-888-519-2029, TTY users 711. We are available 7 days a week from 8AM to 8PM ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
- Or enter your zip code where requested on this page to see quotes.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
eHealthInsurance is operated by eHealthInsurance Services, Inc., a licensed health insurance agency certified to sell Medicare products.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.
Last Updated Date: 10/15/2016