Understanding Medigap

Medigap (also called Medigap Supplement) is insurance sold by private companies that helps fill in the gaps in Medicare. Medigap is not part of Medicare.[1]

Even though Medigap is not part of Medicare, it is highly regulated and standardized in terms of benefits and cost-sharing.

In most states Medigap plans are identified by the letters A – N.

You can compare Medigap plans here. Below are a few more important things to know about Medicare Supplement / Medigap when comparing plans:

Medigap Basics

  • You must have Medicare Part A and Part B to get Medigap.
  • Medigap is highly standardized and regulated. Every Medigap policy must follow federal and state laws, and must be clearly identified as “Medicare Supplement Insurance.”
  • All Medigap plans are standardized and guaranteed to be renewable each year. However, the only time Medigap is guaranteed issue is when you first become eligible for Medicare.
  • Medigap fills in the gaps that Original Medicare (Parts A and B) doesn’t cover. Medigap is a supplemental insurance that pairs with Original Medicare, it doesn’t replace it. It covers costs that Original Medicare doesn’t cover and it can also cover services Original Medicare doesn’t like care when you travel outside of the US.
  • Medigap is different than Medicare Advantage (Medicare Part C).
  • You cannot have both Medigap and Medicare Advantage.
  • You can pair Medigap with a standalone Part D drug plan.
  • Unlike Medicare Advantage, Medigap is not part of Medicare.

Medigap Benefits, Cost Sharing, and Network

  • All Medigap plans A – N offer the same core benefits and cost-sharing. So for example, all letter plans A – N offer 100% coverage of Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.
  • All Medigap plans have the same network, they can be used at any doctor or provider that takes Medicare.
  • Some letter plans offer additional benefits and unique cost-sharing amounts. For example, Plan B provides 100% coverage of the Part A deductible, while Plan K covers 50%.

Premiums and Insurers

  • Premiums can differ by region. So the cost of plan A won’t be the same
  • Each insurer sets their own rates for Medigap plans and can offer their own selection of Medigap plans. Although, insurers have to follow specific rules such as 1. Insurers must offer Medigap Plan A if they offer any Medigap policy, and 2. Insurers must also offer Plan C or Plan F if they offer any plan.
  • Region, gender, age, tobacco use, and eligibility for household discounts can all impact insurance rates.
  • Each letter plan offers the same exact benefits and cost-sharing as other plans that share a letter with it. That means for example, one Medigap F policy from one insurer will always be comparable to another Medigap F policy.

TIP: Not all Medigap letter plans A – N are offered in every region, and some may not be offered in general depending on when you became eligible for Medicare. For example Plans C and F aren’t available to people who are newly eligible for Medicare after January 1, 2020.

Citations

  1. What’s Medicare Supplement Insurance (Medigap)? Medicare.Gov.