Haris Ashley
Medicare Supplement Insurance, also known as Medigap, is an additional insurance plan that covers costs that Original Medicare (Part A and B) does not. Medigap is extra insurance that can be purchased from a private health insurance company to cover out-of-pocket costs. There are up to 10 Medicare Supplement plans offered in each state, ranging from basic to comprehensive coverage. It is important to note that Medicare Supplement Insurance is different from Medicare Advantage, and one cannot have both plans simultaneously. The best time to enroll in Medicare Supplement Insurance is during the six-month open enrollment period when individuals turn 65 and are enrolled in Medicare Part B.
| Characteristics | Values |
|---|---|
| Other names | Medigap |
| Type of insurance | Private health insurance |
| What it adds on to | Original Medicare (Part A and B) |
| Who it is for | People aged 65 or older, or younger than 65 and eligible for Medicare due to disability |
| What it helps pay | About 20% of the Medicare expenses that Original Medicare doesn't cover |
| When to apply | Any time during the year, but the best time is during the Open Enrollment period |
| How to apply | Online or by phone |
| Who to contact | The insurance company that sells the specific policy, or an agent who sells the specific policy |
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Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, is a form of private health insurance that builds on Original Medicare (Part A and B). It helps cover the out-of-pocket costs that Original Medicare does not, which can be substantial, as Medicare typically covers around 80% of healthcare costs. Medigap policies can be purchased from private insurance companies and help pay for about 20% of Medicare expenses.
Medigap is not the same as Medicare Advantage, and individuals can have either one or the other, but not both. Those aged 65 and above, enrolled in Original Medicare Part A and Part B, are eligible for Medicare Supplement Insurance. However, it is important to note that Medicare Supplement Insurance is also available to those under 65 who are eligible for Medicare due to disability or End-Stage Renal Disease.
There are up to 10 Medicare Supplement plans offered in each state, named Plan A through Plan N. The types of plans available differ by state, but each policy offers standardised basic benefits. These plans range from basic to comprehensive coverage. It is recommended to understand your healthcare and financial needs to choose the right plan.
Medigap policies can be purchased at any time during the year, but the best time to enroll is during the six-month open enrollment period, which begins when an individual turns 65 and enrolls in Medicare Part B. Some states may have additional open enrollment periods, including for those under 65. If you miss your open enrollment period, you may lose the right to a Medicare supplement policy without regard to your health. Thus, it is important to be mindful of the timing of enrollment.
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Eligibility
Medicare Supplement Insurance, also known as Medigap, is extra insurance that can be purchased from a private health insurance company to help cover out-of-pocket costs in Original Medicare (Medicare Part A and Part B). To be eligible for a Medicare Supplement Insurance plan, you must first meet certain requirements and enrol during specific periods.
To be eligible for a Medigap policy, you must generally be enrolled in Original Medicare, including Part A (Hospital Insurance) and Part B (Medical Insurance). In most states, age is also a factor, and federal law does not require insurance companies to sell Medicare Supplement plans to individuals under 65. However, some states may offer plans to individuals under 65 who are eligible for Medicare due to disability, End-Stage Renal Disease (ESRD), or other specific health conditions.
Enrolment Periods:
The best time to enrol in a Medicare Supplement Insurance plan is during the Medigap Open Enrollment Period. This is a six-month window that begins when you are 65 or older and enrolled in Medicare Part B. During this period, you are guaranteed issue for Medigap, and insurance companies cannot deny coverage due to pre-existing health conditions. After this period, your options to purchase a Medigap policy may be limited, and the policy may be more expensive.
In some cases, you may have the option to apply for a new Medigap policy when you relocate, as applications can be submitted at any time. However, your medical history may be considered when determining eligibility and premiums in most states. Additionally, some states may have additional open enrollment periods, including those for individuals under 65, and there may be situations where acceptance is guaranteed outside of the standard Medigap Open Enrollment Period.
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Enrollment
Medicare Supplement Insurance, also known as Medigap, is an additional insurance plan that can be purchased from a private insurance company. It helps to cover out-of-pocket costs in Original Medicare, including deductibles, copayments, and coinsurance. It is important to note that Medigap is only available to those who already have Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance).
Medigap offers a one-time, six-month open enrollment period for individuals 65 or older when they first enrol in Medicare Part B. During this initial enrollment period, insurance companies cannot deny coverage based on pre-existing health conditions. This open enrollment period does not extend to beneficiaries under 65, and federal law does not require insurance companies to sell Medigap policies to this age group. However, some states offer Medigap policies to individuals under 65, and certain situations may grant guaranteed issue rights to purchase Medigap outside of the standard enrollment period. These rights are typically associated with specific "trial" periods or the loss of previous coverage.
To enrol in a Medigap policy, individuals must be 65 or older and enrolled in Medicare Part B. The open enrollment period begins on the first day of the month that these criteria are met and lasts for six months. During this time, individuals can select a plan that suits their needs from any Medigap policy sold in their state. It is important to be mindful of the timing, as options to purchase Medigap may be limited, and prices may increase after the initial enrollment period.
The process of enrolling in a Medigap plan involves choosing a specific plan and then selecting "Enroll" on Medicare.gov/plan-compare. Alternatively, individuals can contact the plan provider by phone, website, or paper form. It is essential to provide the required information and ensure that the enrollment period has not ended.
In certain circumstances, individuals may have the option to purchase a Medigap policy outside of the standard open enrollment period. These situations are often referred to as "guaranteed issue rights" or "Medigap protections." For example, if an individual is under 65 and has Medicare due to a disability or End-Stage Renal Disease (ESRD), they may be able to purchase a Medigap policy once they turn 65. It is recommended to consult the State Insurance Department to understand the specific rights and options available under state law.
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Plan types
Medicare Supplement Insurance, also known as Medigap, is an additional insurance policy that can be purchased from a private health insurance company to help pay for out-of-pocket costs not covered by Original Medicare (Parts A and B). These costs can include copays, coinsurance, and deductibles. Medigap policies are generally only available to those who already have Original Medicare, which covers hospital insurance (Part A) and medical insurance (Part B).
Medigap plans are standardised by the federal government and are named with letters like A, F, G, and N. Each plan offers different benefits, and the best plan for an individual depends on their specific needs and budget. For example, Plan F is only available to those who were eligible for Medicare before January 1, 2020, while Plan G includes non-Medicare-covered acupuncture and chiropractic benefits.
Medicare Supplement plans provide flexibility, allowing individuals to see any doctor or hospital in the US that accepts Medicare patients. These plans can also be transferred to during the Open Enrollment Period, which begins on an individual's birthday month and ends 60 days after, without undergoing a medical exam.
Medicare Supplement plans do not typically include prescription drug coverage, dental, vision, or hearing coverage. However, individuals can complement their coverage with standalone plans, such as a prescription drug plan, to meet their specific needs.
Medicare Advantage Plans are an alternative to Original Medicare, combining its benefits with additional ones like prescription drug coverage. These plans usually require the use of doctors and hospitals within the plan's network, which can limit an individual's choice.
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Cost
The cost of Medicare Supplement Insurance, also known as Medigap, varies based on several factors, including age, location, health, insurance company, and plan type.
Age
The cost of Medigap policies can be priced using three different rating structures: community-rated, issue-age-rated, and attained-age-rated. With community-rated pricing, everyone with the same plan pays the same premium, regardless of age. Issue-age-rated pricing is based on the age at which the policy is purchased, with younger people generally paying lower premiums than older people. Attained-age-rated pricing is based on the current age, meaning costs increase as the policyholder ages.
Location
The cost of Medigap plans also varies depending on where you live. The same plan can have different prices in different areas.
Health
Your health can also impact the cost of Medigap plans. If you don't have guaranteed issue rights, you may have to undergo medical underwriting, which could result in higher premiums.
Insurance Company
The choice of insurance company also affects costs, as each carrier sets its own rates. Different insurance companies may charge significantly different premiums for the same coverage, so it's important to compare plans with the same letter across different companies.
Plan Type
The type of Medigap plan chosen will also influence the cost. There are 10 standardized Medigap plans, each with a different letter, and the price for each lettered plan varies. Additionally, some plans have out-of-pocket limits, such as Plan K and Plan L, which cap the maximum amount you'll have to pay out of pocket.
Other Factors
Other factors that can influence the cost of Medigap plans include your gender and smoking status. Additionally, some companies offer discounts that can reduce the cost, such as discounts for being married, being a non-smoker, paying annually, or using electronic funds transfer.
The average monthly premium among all Medicare supplement policyholders was $217 as of March 2025. However, Medigap plans can range from as low as $30-$40 per month on the lower end to hundreds of dollars per month on the higher end. It's important to compare plans and choose a company based on price, as well as coverage and benefits.
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Frequently asked questions
Medicare Supplement Insurance, also known as Medigap, is private health insurance that adds on to Original Medicare (Part A and B). It helps cover the out-of-pocket costs that Original Medicare does not, which is usually around 20% of the total healthcare costs.
You can apply for a Medicare Supplement Insurance plan at any time during the year. However, the best time to enroll is during your Open Enrollment period. This is a six-month period that starts on the first day of the month in which you turn 65 and are enrolled in Medicare Part B. You can apply online or by phone.
There are up to 10 Medicare Supplement plans offered in each state, ranging from basic to comprehensive coverage. The plans are named alphabetically, from Plan A to Plan N. The types of plans offered differ depending on the state, but each policy is standardized and offers the same basic benefits.
