How Do I Choose the Right Medigap Coverage?

Medigap, also known as Medicare Supplement or Medicare Supplemental Insurance, is a type of health plan that Medicare members can purchase to help take care of their out-of-pocket health care costs and some medical treatments that Original Medicare doesn’t cover. There are up to 10 Medigap plans you may be able to choose among, so you will need to weigh their costs and coverage options to decide which plan is the best fit for you.

Keep reading to learn more about Medigap such as what is and isn’t covered and how you can know if you are eligible for a policy.

What Is Medigap (Medicare Supplemental Insurance)?

Medicare Supplement Insurance, or Medigap, is an add-on to Original Medicare sold by private insurance companies. It generally covers your share of the costs for covered services and may pay for some services that aren’t covered at all by Medicare Parts A or B. All Medigap plans cover 100% of your coinsurance for inpatient care covered by Part A and at least a portion of your copays or coinsurance for outpatient care covered by Part B.^[1]

How Does Medigap Work?

Since Medicare Supplemental Insurance is an add-on to Original Medicare, Medigap coverage generally extends to any medical provider that accepts Medicare, which includes nearly 99% of all non-pediatric doctors in the United States.^[2] The exception is if you purchase Medicare SELECT, which is a variant of Medigap available in some states that only covers care within a more limited network of doctors and hospitals.^[3]

What Types of Medigap Options Are There?

There are currently 10 different types of Medicare Supplemental plans — A, B, C, D, F, G, K, L, M and N — eight of which are readily available for new Medicare enrollees. You should note that, if you aren’t already enrolled in Medigap Plan C or F, you can only sign up for one of them now if you became eligible for Medicare before 2020 but haven’t yet enrolled.^[1] Another four Medicare Supplement Insurance plan types — E, H, I and J — were discontinued in 2010, meaning there is no way for new Medicare enrollees to obtain them.^[4]

The names of these plans are standard in every state except for Massachusetts, Minnesota and Wisconsin.

As a result, throughout most of the country, Medigap plans that have the same letter name provide the exact same benefits regardless of what insurer you buy them from, meaning the only difference between them is their cost.^[3]

What Does Medigap Cover?

See the below table for a breakdown of commonly covered health care costs and benefits under Medigap and which plans cover each of them within a given year.^[1]

You may want to note that Plans K and L are the only Medigap plans that come with an annual out-of-pocket limit. As of 2024, the yearly limit for Plan K is $7,060, while the yearly limit for Plan L is $3,530.^[1]

What Isn’t Covered?

The following types of care and equipment are not covered by any Medigap plan:^[5]

• Long-term care
• Dental or vision care
• Hearing aids
• Eyeglasses
• Private duty nursing
• Prescription drugs (unless you purchased your plan before 2005)

Who Is Eligible for Medigap?

Anyone over the age of 65 who has already enrolled in Medicare Parts A and B is eligible for Medigap. However, you cannot use Medigap and Medicare Advantage at the same time. In fact, it’s illegal for someone to sell you a Medicare Supplement Insurance policy while you’re enrolled in a Medicare Advantage plan unless you intend to switch back to Original Medicare.^[6]

You’re eligible for guaranteed issue coverage during your Medigap open enrollment period, which begins at the start of your first month on Medicare Part B after turning 65 and lasts for six months. You may also qualify for guaranteed issue Medigap in other situations like if you move out of your Medicare Advantage plan’s service area or decide to switch back to Original Medicare within a year of enrolling in Medicare Part C. Outside of these scenarios, you could be denied Medigap coverage or could have to pay more for coverage depending on your medical history.^[7]

While the federal government only requires Medigap carriers to sell policies to Medicare members over the age of 65, the majority of state governments require insurers to offer at least one type of Medigap plan to members under the age of 65 who are eligible for Medicare because they have a disability or end-stage renal disease.^[7]

 

How Much Does Medigap Cost?

The cost of Medicare Supplemental Insurance depends on factors like your age, sex, location, tobacco use and, if you don’t qualify for guaranteed issue coverage, health status. To get an idea of how much coverage can cost, see the following table for an overview of Medigap prices for several different plans in California.^[8]

Keep in mind that, since Medigap is purchased in addition to Original Medicare, you will still have to pay for Medicare Part B and, if you don’t qualify for premium-free coverage, Part A. In 2024, Part B costs $174.70 to $594 per month depending on your income, while Part A costs either $0, $278 or $505 per month depending on how long you or your spouse worked and paid Medicare taxes.^[9]

How To Get the Best Medigap Coverage

It’s important to compare prices from three to five different health insurance providers to make sure you’re getting the best deal on your Medigap policy, especially since plan benefits are exactly the same across all insurers. If you intend to contact insurance companies one at a time, be prepared to share lots of information like your age, address and health status over and over again.

Of course, you can simplify the process by letting SmartFinancial help you buy a Medigap policy instead. You’ll only need to input your information one time into our online questionnaire, after which we can set you up with agents who are prepared to help you find the policy you need. Click here if you’d like to compare Medicare quotes today.