Are you facing out-of-pocket Medicare costs? Medicare Supplement Insurance, also called Medigap, can help cover some Medicare deductibles and other costs.
Medicare Supplement Insurance (also called Medigap) is a type of private insurance plan that can work alongside your Original Medicare coverage to help cover some out-of-pocket Medicare costs such as copayments, coinsurance and deductibles.
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For example, you have to meet the Medicare Part B deductible ($203 in 2021) before Part B will start covering some of the costs of your care. And once it does, you are still typically responsible for a 20 percent Part B coinsurance for approved services.
A Medicare Supplement Insurance plan can help provide coverage for some of these out-of-pocket Medicare costs.
You typically pay a monthly premium to belong to a Medigap plan.
* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020,... you may still be able to enroll in Plan F or Plan C as long as they are available in your area.
1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3 Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.+ Read more
What can Medicare Supplement Insurance plans cover?
Medicare Supplement Insurance can provide coverage for some or all of the following costs:
First three pints of blood needed for a transfusion
Skilled nursing facility coinsurance
Hospice care coinsurance
Emergency care received outside the U.S.
There are 10 Medicare Supplement Insurance plans available in most states. They are designated a plan letter (Medigap Plan A, B, C, D, F, G, K, L, M and N), and each type of plan offers a different combination of some or all of the above coverage.
Medicare Supplement Insurance is sold by private insurance companies, so the cost of a plan can differ between one carrier or location and another.
There are a few other things that may affect the cost of a Medigap plan:
The amount of coverage offered by the plan
Whether or not medical underwriting is used as part of the application process
The age at which you join the plan
Eligibility for any discounts offered by the carrier
Gender (women often pay less for a plan than men)
In order to be eligible for a Medicare Supplement Insurance plan, you must be at least 65 years old, enrolled in Medicare Part A and Part B and reside in the area that is serviced by the plan.
Some states – but not all – allow Medicare Supplement Insurance enrollment for Medicare beneficiaries under the age of 65.
The following states require insurance companies to offer at least one Medicare Supplement plan to Medicare beneficiaries under 65:
California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont and Wisconsin.
If you are currently enrolled in a Medicare Advantage (Part C) plan, you will not be eligible to sign up for a Medicare Supplement Insurance plan. You must disenroll from your Medicare Advantage plan before you can join a Medigap plan.
During your Medigap Open Enrollment Period, insurance companies are not allowed to use medical underwriting to determine your premium rates when you apply for a policy. This means that if you apply for a plan during this period, you cannot be charged more due to your age or health history.
Once your six-month open enrollment window ends, you may be subject to underwriting and may pay higher plan premiums. Insurance companies also reserve the right to deny you a policy based on the results of the underwriting. That’s why it’s highly advisable to take advantage of your Medigap open enrollment period.
There are some special enrollment periods for Medicare Supplement Insurance that give you guaranteed issue rights, which means insurance companies can't use underwriting in your application process. You have to meet specific criteria to qualify for one of these special enrollment periods.
If one of the following situations applies to you, you may qualify for a Medigap special enrollment period:
You received a Medicare Supplement Insurance plan through your employer, and that coverage ended.
You belong to a Medicare Advantage plan, and the plan stops serving your area or you move out of the plan’s service area.
You have a Medicare SELECT plan, and you move out of the plan’s service area.
You joined a Medicare Advantage plan or PACE when you first became eligible, and you decided to leave the plan within one year of enrolling.
You dropped a Medigap plan in favor of a Medicare Advantage or Medicare SELECT plan, and you wish to switch back to a Medigap plan within one year.
You are enrolled in a Medigap plan, and the plan ends through no fault of your own.
You are enrolled in a Medicare Advantage or Medigap plan provided by a company that misled you or was found to have not followed certain regulatory rules.
Frequently asked questions about Medicare Supplement Insurance
What is the difference between Medicare Supplement and Medicare Advantage?
Medicare Supplement plans and Medicare Advantage plans work very differently, and you can't have both at the same time.
Medicare Supplement plans work alongside your Original Medicare coverage to help cover out-of-pocket Medicare costs like deductibles and coinsurance.
Medicare Advantage plans replace your Original Medicare coverage. Many plans also offer other benefits such as prescription drug coverage or dental care, which Original Medicare doesn't typically cover.
What should I look for in a Medicare Supplement plan?
With 10 different types of standardized Medigap plans and a range of benefits they can offer (not to mention the range of monthly premiums for each plan), it can be helpful to take the time to compare the Medigap options available where you live.
There are a number of different Medicare Supplement Insurance companies across the nation. The companies that sell Medigap plans in your area may vary. You can learn more about them by comparing company ratings and reading customer reviews.
Medigap Plan F covers more out-of-pocket Medicare costs than any other standardized type of Medigap plan. In exchange for their monthly premium, Plan F beneficiaries know that all of their Medicare deductibles, coinsurance, copays and other out-of-pocket costs will be covered.
For many Medicare Supplement beneficiaries, this piece of mind and ease of use are the reasons they chose to enroll in Plan F.
New Medicare beneficiaries who first became eligible for Medicare on or after January 1, 2020 will no longer be able to enroll in Medigap Plan F or Plan C.
If you already had Plan F or Plan C, you can keep your plan. If you became eligible for Medicare before Jan. 1, 2020, you can apply for Plan F or Plan C after this date if either plan is available where you live.
Also new in 2020 is high-deductible Plan G, which offers comparatively lower monthly premiums in exchange for having to meet an annual deductible before Plan G benefits kick in.
1 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
Where you've seen coverage of Christian's research and reports:
Plan F and Plan G are the most comprehensive Medicare Supplement Insurance plans available. Discover the key differences between Medicare Supplement Insurance Plan F and the Medigap plan that may soon become the most popular Medigap plan, Medigap Plan G. Read more
You can change your Medigap plan any time, but you may have to go through medical underwriting unless you have a guaranteed issue right, depending on what state you live in. Learn about switching Medigap plans with the help of a licensed insurance agent. Read more
Use this Medicare Supplement Insurance plans comparison chart to compare your potential 2021 coverage options and find the right Medigap plan for your needs. Compare Plan F, Plan G and other Medigap Plans. Read more