MediGap
(also Referred to as Medicare Supplements

What Is MediGap?
(Also referred to as Medicare Supplement Plans)

A Medicare Supplement, also known as Medigap, is a private insurance policy designed to help cover some of the healthcare costs that Original Medicare does not pay for. Medicare Supplement plans work alongside Original Medicare (Parts A and B) to help reduce or eliminate out-of-pocket expenses such as deductibles, copayments, and coinsurance.

A Medicare Supplement plan does not replace Medicare. Instead, Medicare remains the primary insurance, and the supplement helps pay the remaining approved costs after Medicare pays its share.

How Medicare Supplement Works

When a beneficiary has Original Medicare and a Medicare Supplement plan, Medicare pays first for covered medical services. After Medicare processes the claim, the Medicare Supplement plan helps cover the remaining eligible costs based on the specific plan benefits.

For example, if a beneficiary visits a doctor or receives inpatient hospital care, Medicare pays its portion of the approved amount, and the Medicare Supplement plan may pay some or all of the remaining balance depending on the plan selected.

Medicare Supplement Eligibility

To enroll in a Medicare Supplement plan, a beneficiary must be enrolled in Medicare Part A and Part B. Medicare Supplement plans are generally available to individuals who are enrolled in Original Medicare and are not enrolled in a Medicare Advantage plan.

A beneficiary cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time.

Medicare Supplement vs Medicare Advantage

Medicare Advantage and Medicare Supplement plans are two different ways beneficiaries can receive Medicare coverage.

Medicare Advantage plans replace Original Medicare as the way benefits are administered and typically include Part A, Part B, and often Part D benefits through a private insurance company.

Medicare Supplement plans work alongside Original Medicare and are designed to help control medical costs by reducing deductibles, copays, and coinsurance.

Medicare Advantage plans often focus on additional benefits such as dental, vision, hearing, transportation, and over-the-counter allowances, while Medicare Supplement plans focus primarily on predictable medical cost sharing and nationwide provider access.

Standardized Medicare Supplement Plans

Medicare Supplement plans are standardized by the federal government. This means that a Plan G from one insurance company provides the same basic medical benefits as a Plan G from another insurance company.

The difference between carriers is typically the premium, underwriting guidelines, rate history, customer service, and additional company features.

The most common Medicare Supplement plans sold today include:

Plan G

Plan G is the most popular Medicare Supplement option for newly eligible Medicare beneficiaries. It covers nearly all Medicare-approved expenses after the Part B deductible is met, leaving the beneficiary responsible mainly for the annual Part B deductible.

Plan F

Plan F provides the most comprehensive coverage and covers the Part B deductible. However, Plan F is only available to individuals who became Medicare eligible before January 1, 2020.

Plan N

Plan N offers lower premiums in exchange for some cost sharing. Beneficiaries may have office visit copays, emergency room copays, and are responsible for Part B excess charges where applicable.

Medicare Supplement Benefits

Depending on the plan selected, Medicare Supplements may help cover:

Medicare Part A hospital deductible and coinsurance.

Medicare Part B coinsurance or copayments.

Skilled nursing facility coinsurance.

Part A hospice coinsurance.

The first three pints of blood.

Medicare Part B excess charges (on certain plans).

Foreign travel emergency coverage (on certain plans).

Medicare Supplement Open Enrollment Period

The Medicare Supplement Open Enrollment Period is the beneficiary's strongest opportunity to enroll because medical underwriting is not required.

This period begins when an individual is age 65 or older and enrolled in Medicare Part B. It lasts for six months.

During this period, the beneficiary can purchase any available Medicare Supplement plan without being denied coverage or charged more due to health conditions.

Medicare Supplement Underwriting

Outside of Open Enrollment or Guaranteed Issue situations, Medicare Supplement applications may require medical underwriting.

During underwriting, the insurance company reviews the applicant's health history and may approve, deny, or adjust premiums based on health conditions.

Unlike Medicare Advantage, Medicare Supplement plans do not have annual enrollment periods where everyone can freely switch plans without underwriting.

Guaranteed Issue Rights

Guaranteed Issue Rights allow certain beneficiaries to purchase a Medicare Supplement plan without medical underwriting after specific qualifying events.

Examples include losing employer coverage, leaving a Medicare Advantage plan during a trial period, a Medicare Advantage plan leaving the service area, or a Medicare Supplement carrier becoming insolvent.

Guaranteed Issue rights generally provide a 63-day window to apply for coverage after the qualifying event.

Medicare Supplement Provider Access

One of the biggest advantages of Medicare Supplement plans is provider flexibility.

Because Medicare Supplements work with Original Medicare, beneficiaries can generally see any doctor or hospital nationwide that accepts Medicare assignment. There are typically no provider networks like those found with many Medicare Advantage plans.

Medicare Supplement Prescription Drug Coverage

Medicare Supplement plans do not include prescription drug coverage.

If a beneficiary chooses Original Medicare with a Medicare Supplement, they will generally need a separate Medicare Part D Prescription Drug Plan for prescription coverage.

Feel free to reference the chart below to get a visual of what is covered by supplement plans!