How Medigaps Can Supplement Your Health Care

Understanding Medigap: How Supplemental Plans Can Help Cover Medicare Costs

Medigap plans—also known as Medicare Supplement plans—are health insurance policies designed to work alongside Original Medicare. These plans are sold by private insurance companies and help cover many of the out-of-pocket costs that Medicare Parts A and B do not fully pay.

If you have a Medigap policy, Medicare pays its share of approved medical expenses first. Your Medigap plan then helps pay part or all of the remaining costs. This can include deductibles, coinsurance, and copayments that would otherwise come directly out of your pocket.

It’s important to remember that Medigap plans only work with Original Medicare. If you are enrolled in a Medicare Advantage Plan, you cannot purchase or use a Medigap policy.

What Do Medigap Plans Cover?

Medigap policies are designed to fill the “gaps” in Medicare coverage. Depending on the plan you choose, a Medigap policy may help pay for:

• Medicare deductibles
• Coinsurance and copayments
• Hospital costs beyond what Medicare covers
• Skilled nursing facility coinsurance
• Emergency health care when traveling abroad

Some Medigap plans even cover services that Original Medicare does not cover at all, such as certain types of foreign travel medical care.

Choosing the Right Plan

In most states, there are up to 10 standardized Medigap plans to choose from, labeled A, B, C, D, F, G, K, L, M, and N. Each lettered plan offers a specific set of benefits, and plans with the same letter provide the same coverage no matter which insurance company sells them. However, premiums can vary widely between companies.

A few states—such as Wisconsin—structure their Medigap options differently, often using a base plan with optional riders instead of the standard lettered plans.

One important change to be aware of: if you became eligible for Medicare on or after January 1, 2020, you cannot purchase Medigap plans that cover the Medicare Part B deductible (specifically Plans C and F). Those who were eligible before that date are still allowed to enroll in those plans.

When Can You Enroll?

Timing is critical when it comes to buying a Medigap policy. The best time to enroll is during your Medigap Open Enrollment Period. This is a seven-month window that begins three months before your 65th birthday, includes your birth month, and ends three months after.

During this period, insurance companies cannot ask you medical questions or deny coverage based on pre-existing conditions. After this window closes, you may have to go through medical underwriting, which could result in higher premiums—or even denial of coverage.

Some states also offer additional protections that allow individuals to purchase a Medigap policy at other times without medical restrictions.

Tips for Shopping for a Medigap Policy

Buying a Medigap plan can feel overwhelming, but taking the time to research and prepare can make the process much easier. Here are a few important steps to consider:

• Confirm that you are eligible to purchase a Medigap policy
• Understand when you have guaranteed rights to buy without medical underwriting
• Compare the benefits of different standardized plans
• Learn how pre-existing conditions may be handled
• Understand how insurance companies set and adjust premiums
• Make a list of questions to ask before choosing a plan

Because premiums and pricing methods differ from company to company, it’s important to look beyond just the monthly cost and consider long-term value as well.

Getting Help Along the Way

Medigap plans can be confusing, especially with so many options and rules to navigate. Working with a licensed insurance agent or Medicare specialist can help simplify the process and ensure you choose a plan that fits your health needs and budget.

Having a trusted professional guide you through the choices can reduce frustration, answer your questions, and help you feel confident in your decision.