Paul Sanchez
Medicare Supplement Insurance, also known as Medigap, is extra insurance that helps cover costs not included in Original Medicare Parts A and B, such as copayments, deductibles, and coinsurance. These plans are available to those aged 65 and over and can be purchased from private insurance companies. The best time to enroll in a Medicare Supplement Insurance plan is during the Open Enrollment Period, which is a six-month period that starts on the first day of the month in which you turn 65 or older and are enrolled in Medicare Part B. To find plans available in your area, you can enter your ZIP code on the websites of insurance providers.
| Characteristics | Values |
|---|---|
| What is Medicare Supplement Insurance? | Extra insurance to help pay your share of out-of-pocket costs in Original Medicare. Also known as Medigap. |
| Who can buy it? | Those aged 65 and over with Medicare Parts A and B. In some states, it is available to those under 65 with Medicare due to disability or end-stage renal disease. |
| When to buy it | The best time to enroll is during the Medicare Supplement Open Enrollment period, which is the six-month period that starts the first day of the month in which you turn 65 and are enrolled in Medicare Part B. |
| How to buy it | You can apply for a plan online or by phone. |
| Where to buy it | You can enter your zip code to find plans available in your area. |
| Which plan to choose | Each plan is named with a letter, like A, F, G, and N. Plans A through G generally provide benefits at higher premiums with limited out-of-pocket costs, while Plans K through N are cost-sharing plans offering lower premiums and higher out-of-pocket costs. |
| How much does it cost? | Each plan has a different monthly premium, which you pay out-of-pocket before Medicare or the supplement plan pays. The premium varies with the amount of benefits selected. |
| What does it cover? | Depending on the plan, it may cover Medicare deductibles, copayments, and coinsurance. Some plans offer coverage when you travel outside the U.S. |
| What isn't covered? | Medigap policies generally do not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs. |
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What You'll Learn
Understanding Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, is extra insurance that helps cover costs not included in Original Medicare (Parts A and B). Medigap policies can be purchased from private health insurance companies and help pay for out-of-pocket expenses, such as copays, coinsurance, and deductibles. These policies provide flexibility, allowing you to visit any doctor or hospital in the US.
To enrol in a Medigap policy, you typically need to have Original Medicare, including Part A (Hospital Insurance) and Part B (Medical Insurance). When you buy a Medigap policy, both Medicare and the Medigap insurance company will each pay their share of the covered healthcare costs. You will be responsible for paying the monthly Medicare Part B premium, as well as a premium to the Medigap insurance company. As long as you stay up-to-date with your premium payments, your Medigap policy is guaranteed to be renewable annually.
Medigap policies are standardized by the federal government and must comply with federal and state laws. These policies are typically named with letters such as Plan A, F, G, and N. Each plan offers different coverage and benefits, with Plan A having a lower premium but requiring you to pay a deductible for hospital visits, while Plan F provides broader coverage of out-of-pocket costs. It's important to compare Medigap policies as costs can vary.
You can find Medicare Supplement Insurance plans offered by various insurance providers, such as Anthem, which provides competitively priced plans with different coverage options. When choosing a plan, it's recommended to consider your specific healthcare needs and budget to ensure you select the most suitable coverage. Additionally, your plan options may vary depending on your region or county, so providing your ZIP code during the search can help narrow down the available plans in your area.
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Eligibility requirements
To be eligible for Medicare Supplement Insurance (also known as Medigap), you must be enrolled in Original Medicare, which includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Most people get Part A for free, but some have to pay a premium. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. An individual who is receiving monthly Social Security or RRB benefits at least four months before turning 65 will get Part A automatically at age 65 without needing to file a separate application.
In most states, age is a requirement for Medicare Supplement eligibility. Federal law does not require insurance companies to sell Medicare Supplement insurance plans to people under 65. If you are under 65 and have Medicare due to a disability or a certain health condition such as end-stage renal disease (ESRD) or Lou Gehrig's disease (ALS), you may have to wait until you turn 65 to buy the Medicare Supplement insurance plan you want, or any policy at all. However, many states require insurance companies to offer at least one kind of Medicare Supplement insurance plan to people under 65 with Medicare.
You are guaranteed issue for Medigap during a six-month window that begins when you are at least 65 years old and enrolled in Medicare Part B. This period is known as the Medigap open enrollment period and is often the only time you can choose a Medigap policy without medical underwriting in many states. During your open enrollment period, you are guaranteed Medicare Supplement coverage. When applying outside of this period, there may be limits based on your previous health history or medical conditions, and you could be denied acceptance.
Medigap is an optional insurance policy, and purchasing one means you will need to pay a monthly premium on top of the monthly Part B premium required by Medicare. To be eligible for Medicare, you must be a U.S. citizen or a permanent legal resident for at least five continuous years, in addition to having one of the following qualifications: diagnosed with end-stage renal disease (ESRD), receiving disability benefits from the Social Security Administration or the Railroad Retirement Board.
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Enrollment periods
Medicare Supplement Insurance, also known as Medigap, is an extra insurance policy that you can buy from a private insurance company to help pay your share of out-of-pocket costs in Original Medicare. To be eligible for Medicare Supplement Insurance, you must be enrolled in Original Medicare Parts A and B.
There are specific enrollment periods when you can join, switch, or drop a Medicare plan. These enrollment periods are windows of time when you can make changes to your insurance plan, and they vary depending on your personal circumstances. Here are the key enrollment periods you should know about:
Initial Enrollment Period:
When you turn 65, you have a seven-month window to enroll in Medicare. This includes the three months before the month you turn 65, your birth month, and the three months after you turn 65. During this time, you can enroll in Original Medicare Parts A and B, a Medicare Advantage Plan (Part C), and a standalone Medicare prescription drug plan (Part D).
Medigap Open Enrollment Period:
If you are enrolled in Medicare Parts A and B and are 65 or older, you are eligible for the Medigap Open Enrollment Period. This is a one-time, six-month enrollment period that starts the first month you have Medicare Part B. During this time, you can enroll in any Medigap policy sold in your state, and insurance companies cannot deny you coverage due to pre-existing health conditions. After this period, your options to buy a Medigap policy may be limited, and the policy may cost more.
Special Circumstances:
In certain situations, you may be able to join, switch, or drop a Medicare plan outside of the standard enrollment periods. For example, if you move to another state or service area, you can switch your Medicare plan starting one month before you move and up to two months after you move. Additionally, if you qualify for a guaranteed issue right, you may be able to buy a Medicare Supplement Insurance policy outside of your Open Enrollment Period without underwriting or higher premiums. For example, if you lose other health coverage or move out of your Medicare Advantage Plan's service area, you may qualify for a guaranteed issue right.
Annual Medicare Open Enrollment Period:
Each year, from October 15 to December 7, anyone can make changes to their Medicare coverage. During this time, you can switch between Original Medicare and a Medicare Advantage Plan, join or drop a prescription drug plan, or update your coverage by switching plans or insurers.
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Plan options and benefits
Medicare Supplement Insurance, also known as Medigap, is an additional insurance policy that can be purchased from a private company. This policy helps cover costs that Original Medicare—Part A (Hospital Insurance) and Part B (Medical Insurance)—does not. Generally, you need to have both Part A and Part B to be eligible for Medigap.
Medigap policies help cover costs like coinsurance, copayments, and deductibles. Some policies also offer coverage for travel outside the U.S. However, Medigap generally does not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs.
The specific benefits and coverage of Medigap plans can vary. Plans A through G typically offer benefits at higher premiums, resulting in lower out-of-pocket costs for the policyholder. In contrast, Plans K through N are cost-sharing plans, offering similar benefits at lower premiums but with higher out-of-pocket costs.
The availability and naming of Medigap plans may differ depending on your state of residence. For example, in Massachusetts, Minnesota, or Wisconsin, the naming convention for Medicare Supplement Plans may differ from the standard "Plans A through N."
It is important to note that if you are under 65, there may be restrictions on purchasing a Medigap policy, or the policy may be more expensive. Additionally, there is a six-month window after enrolling in Part A and Part B during which it is easier to purchase a Medigap policy. If you do not buy a Medigap policy within this initial period, you may face difficulties in purchasing a policy or may have to pay higher prices.
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Costs and coverage
Medicare Supplement Insurance, also known as Medigap, is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. Medigap policies help lower your share of costs for Part A and Part B services in Original Medicare.
Medigap plans cover Parts A (hospitalization) and B (medical services) but not C (Medicare Advantage) and D (drug coverage). You can choose from 10 standardized Medicare supplement plans, and the price for each lettered plan will differ, but all plans with the same letter offer the same coverage and benefits. The premium amount is the only difference between policies with the same plan letter sold by different companies. There can be significant differences in the premiums that different insurance companies charge for the same coverage, so be sure to compare Medigap plans with the same letter.
Medigap plans don't cover Medicare Advantage or Part D drug plans, but some may include vision, dental care, or long-term care. The benefits in each lettered plan are the same, no matter which insurance company sells it. You must pay a monthly premium for Medicare coverage and part of the costs each time you get a covered service. The Medicare supplement plans that offer the most coverage will usually cost more each month.
Your Medicare out-of-pocket costs can change yearly based on inflation, so it's important to research the best Medicare supplement insurance plans annually. When you buy a Medigap policy, you'll pay the private insurance company a monthly premium, and you also have to pay your monthly Medicare Part B premium. The average monthly premium among all Medicare supplement policyholders was $217. Nearly 39% of policyholders chose Plan G, the most comprehensive plan for new beneficiaries.
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Frequently asked questions
Medicare Supplement Insurance, also known as Medigap, is extra insurance that helps pay your share of out-of-pocket costs in Original Medicare.
To sign up for Medicare Supplement Insurance, you must first have Original Medicare Parts A (Hospital Insurance) and B (Medical Insurance). You can then choose a plan that meets your needs, such as Plan A or Plan F, and pay a monthly premium. You can apply for Medicare Supplement Insurance online or by phone.
Medicare Supplement Insurance plans help cover costs that Original Medicare doesn't, such as copayments, coinsurance, and deductibles. However, they typically do not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs.
