Medigap, Explained Clearly.
Medicare Supplement Insurance, also called Medigap, is private insurance designed to work with Original Medicare and help pay certain out-of-pocket costs that Original Medicare does not pay.
What Is Medicare Supplement Insurance?
Medigap works alongside Original Medicare — it does not replace it.
Original Medicare includes Medicare Part A and Part B. When Medicare covers an eligible service, Medicare generally pays its share first. A Medicare Supplement policy may then help pay certain remaining Medicare-approved costs according to the benefits of the specific Medigap policy.
Original Medicare
Part A + Part B
Medicare Supplement / Medigap
Helps with certain out-of-pocket costs
When applicable, separate Part D prescription drug coverage may be added.
Medigap does not replace Medicare Part A or Part B, and it is not Medicare Advantage.
What Can a Medigap Policy Help With?
Coverage depends on the standardized Medigap plan you choose.
Coinsurance
Certain Medicare coinsurance amounts may be covered depending on the Medigap plan.
Copayments
Certain Medicare copayments may be covered depending on the policy.
Deductibles
Certain Medigap plans may help pay the Medicare Part A deductible. Medigap plans sold to people new to Medicare on or after January 1, 2020 cannot cover the Medicare Part B deductible.
Hospital Cost Sharing
Certain costs associated with Medicare-covered inpatient hospital care may be covered according to the policy.
Foreign Travel Emergency
Some Medigap plans include limited foreign travel emergency benefits.
Benefits vary by standardized plan. Not every Medigap plan covers every cost listed above.
Medigap Plans Are Standardized.
In most states, Medigap policies are identified by letters. Policies with the same plan letter provide the same standardized Medigap benefits regardless of which insurance company sells the policy.
Same Plan Letter
Policies with the same standardized plan letter provide the same standardized Medigap benefits, no matter which insurance company sells the policy.
Same Plan Letter = Same Standardized Medigap Benefits
But Premiums May Differ
Premiums can vary between insurance companies even when the standardized benefits are the same.
Not every insurance company offers every Medigap plan, and plan availability may vary.
Your Provider Access Follows Original Medicare.
A standard Medigap policy does not replace Original Medicare's provider rules.
With Original Medicare, you can generally use any doctor or hospital in the United States that accepts Medicare.
Medicare pays its share of eligible Medicare-covered services first, and the Medigap policy pays according to its policy benefits.
Medicare SELECT policies, where available, may have provider-network requirements for full supplemental benefits.
Medigap Does Not Replace Part D.
Newly sold Medigap policies do not include Medicare prescription drug coverage.
Medigap policies sold after 2005 do not include Medicare prescription drug coverage. If you want Medicare drug coverage, you can generally enroll in a separate Medicare Part D plan when eligible.
Original Medicare
Part A + Part B
Medigap
Supplemental coverage
Part D
Drug coverage, when applicable
What Medigap Generally Doesn't Cover
Medigap is designed primarily to help with certain cost sharing associated with Original Medicare.
- Long-term custodial care
- Routine dental care
- Routine vision care
- Hearing aids
- Eyeglasses
- Private-duty nursing
- Prescription drugs in newly sold Medigap policies
Medigap is designed primarily to help with certain cost sharing associated with Original Medicare. It should not be confused with dental, vision, long-term care, prescription drug, or other supplemental insurance products.
Your Medigap Open Enrollment Period Is Important.
Your federal Medigap Open Enrollment Period is a one-time 6-month period that generally begins the first month you are age 65 or older and enrolled in Medicare Part B.
During this period, you have federal protections that generally allow you to buy any Medigap policy sold in your state without medical underwriting being used to deny coverage because of your health.
Coverage generally begins without a health-based delay, although a waiting period for certain pre-existing conditions may apply in some situations. Prior creditable health coverage may reduce or eliminate that waiting period.
THIS IS NOT THE SAME AS MEDICARE'S ANNUAL ENROLLMENT PERIOD.
The federal Medigap Open Enrollment Period does not automatically repeat every year.
What If My Medigap Open Enrollment Period Has Ended?
You may still be able to apply for a Medigap policy after your Medigap Open Enrollment Period. However, depending on your situation and applicable state law, an insurance company may be allowed to use medical underwriting, availability may be more limited, or the policy may cost more.
Certain situations may provide guaranteed-issue rights, and some states provide additional consumer protections.
Eligibility and enrollment protections depend on the individual situation and applicable state law.
Still Working or Covered Through an Employer?
If you delay Medicare Part B because you have qualifying employer-sponsored coverage, your Medigap Open Enrollment Period generally does not begin until you enroll in Part B.
Medicare enrollment decisions can depend on the type of employer coverage and your individual circumstances.
Review Before Enrolling
Individualized enrollment advice depends on your specific circumstances. Before making changes, it helps to review your employer coverage details with someone who understands how it interacts with Medicare and Medigap timing.
Medigap and Medicare Advantage Are Different.
Medicare Supplement / Medigap
- Works with Original Medicare
- Helps with certain eligible Original Medicare cost sharing
- Prescription drug coverage is generally handled separately through Part D
Medicare Advantage
- An alternative way to receive Medicare Part A and Part B coverage through a Medicare-approved private plan
- Plan networks, costs, rules, and benefits may vary
- Most plans include Medicare drug coverage
You cannot use a Medigap policy to pay Medicare Advantage copayments, coinsurance, deductibles, or premiums.
If you are enrolled in Medicare Advantage, you generally cannot buy a Medigap policy unless you are switching back to Original Medicare.
Thinking About Leaving Medicare Advantage for Original Medicare?
Do not assume that Medigap coverage will automatically be available simply because you leave Medicare Advantage.
Depending on your circumstances, you may have a federal trial right, another guaranteed-issue right, or additional rights under state law. Review your eligibility for Medigap before making changes to existing coverage.
Don't Compare Medigap by Premium Alone.
Standardized benefits make Medigap easier to compare, but there are still important details to review.
Plan Letter
Make sure you are comparing the same standardized Medigap plan design.
Monthly Premium
Premiums for the same standardized plan can differ by insurance company.
How Premiums May Change
Understand how the insurance company determines premiums and how rates may change over time.
Company Availability
Not every company offers every Medigap plan.
Eligibility
Confirm whether Open Enrollment, guaranteed-issue protections, medical underwriting, or other rules apply.
Additional Policy Details
Review applicable discounts, household discounts, policy administration, and other carrier-specific terms where available.
What Will Medigap Cost?
Medigap premiums vary based on several factors.
Medigap policies generally have a separate monthly premium. Premiums vary based on the policy, insurance company, location, and other factors.
You must continue paying your Medicare Part B premium while you have Medicare Supplement coverage.
A separate Medicare Part D premium may also apply if you enroll in prescription drug coverage.
Is Medigap Worth Exploring?
Whether Medigap fits your situation depends on your coverage preferences, eligibility, budget, provider needs, prescription coverage, and other circumstances.
Medigap Is Not the Same as Other Supplemental Insurance.
Medicare Supplement Insurance is designed to work with Original Medicare. Separate products such as cancer, critical illness, hospital indemnity, dental, or vision coverage are different types of insurance.
Understand the Details Before You Choose.
As an independent licensed insurance broker, Ike can help you understand available Medicare Supplement options from multiple insurance carriers he represents.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE for information on all of your options.