A Comprehensive Guide to Medicare Supplement Insurance
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One of the stressful parts of being an older adult is wondering if you have the right health insurance coverage for your present and future needs. While Medicare offers quality coverage, it doesn't pay for everything. One way to avoid unexpected medical expenses is to enroll in Medigap, also known as Medicare Supplement Insurance. Read on to find out if you're eligible, what the plans cover, and how to ensure you choose the best plan at the lowest cost.
Medigap helps fill in the gaps in Medicare's coverage by lowering out-of-pocket expenses such as deductibles, coinsurance, and copayments for services and supplies. Seniors are eligible for Medigap the month they turn 65. At that time, the six-month Medigap open enrollment begins. Medigap benefit plans may also be available to individuals under 65 due to disability or end-stage renal disease.
There are a total of 10 federally standardized Medigap insurance plan options. Each plan has been assigned a letter of the alphabet. If you became eligible for Medicare after January 1, 2020, Medigap Plans C and F are no longer available. However, individuals enrolled in these plans before January 1, 2020, may remain enrolled. Seniors who enrolled after January 1, 2020, have access to the other eight Medigap plans.
Each Medigap insurance plan has a different combination of benefits. Common benefits across most plans include:
Other benefits such as skilled nursing facility care, Medicare Part A and Part B deductibles, and foreign travel emergency health coverage vary based on the plan.
|Medigap Benefits||Plan A||Plan B||Plan C*||Plan D||Plan F*||Plan G||Plan K||Plan L||Plan M||Plan N|
|Medicare Part A Coinsurance and Hospital Costs (plus coverage for 365 additional days after Medicare benefits end)||100%||100%||100%||100%||100%||100%||100%||100%||100%||100%|
|Medicare Part A Hospice Care Copayment or Coinsurance||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Medicare Part B Medical Expenses Copayment or Coinsurance||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Skilled Nursing Facility Care Coinsurance1||None||None||100%||100%||100%||100%||50%||75%||100%||100%|
|Bloodwork (first three pints annually)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Medicare Part A Deductible||None||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Medicare Part B Deductible||None||None||Yes||None||Yes||None||None||None||None||None|
|Medicare Part B Excess Charge (for individuals who have Original Medicare)||None||None||None||None||100%||100%||None||None||None||None|
|Foreign Travel Emergency Health Care2||None||None||80%||80%||80%||80%||None||None||80%||80%|
|Annual Out-of-Pocket Maximum||N/A||N/A||N/A||N/A||N/A||N/A||$6,220||$3,110||N/A||N/A|
*Effective January 1, 2020, Medigap Plans C and F are no longer available to newly eligible individuals.
It's important to note, effective January 1, 2020, Medigap Plan F is no longer available for new enrollees. If you're a senior already enrolled in Plan F, nothing will change, and you will remain enrolled. Plan F was one of the most popular plans among older adults before it was discontinued for new enrollees.
Medigap Plan F is the most comprehensive plan, as it fills in all of the gaps (remaining expenses) from Medicare Part A and Part B. What makes the plan so attractive is its low premium cost versus high coverage of all coinsurance, copayments, and deductibles. The only out of pocket costs you incur is 20 percent of any foreign travel emergency health care.
For newly eligible seniors searching for a Medigap plan similar to Plan F, Medigap Plan G is an excellent option. Plan G offers close to the same comprehensive coverage as Plan F, except that Plan G does not cover the Medicare Part B annual deductible.
Except for your Medicare Part B deductible, Medigap Plan G covers costs for inpatient hospital charges, blood transfusions, ambulance transportation, and outpatient services, including doctor visits, lab work, and medical supplies such as durable medical equipment. Hospice and skilled nursing facility care are also covered under Medigap Plan G.
Medigap insurance will vary by state, person, and provider. Your Medigap premium may be based on factors including your gender, age, where you live, if you smoke, and your marital status.
Regarding cost, Louisiana, Massachusetts, and New Jersey tend to have the highest Medigap annual premiums, while Hawaii, New Mexico, and Iowa have the least expensive yearly costs. For example, Louisiana’s Medigap Plan D premiums range from $129-$4065 for a 65-year-old male that doesn’t use tobacco, while Hawaii's Plan D premiums range from $126-$285.5
|Medigap Plan||Average Monthly Cost*|
*Prices will vary by state, individual, and Medigap provider. The above numbers are estimated averages and should only be used as starting guidelines.
Did You Know: In addition to these ten Medigap plans, some states also offer a high-deductible version of Medigap Plan G.
Choosing the right Medigap plan can be stressful. You not only need to determine which plan best meets your current medical needs, but you'll also need to think of your future healthcare requirements. Choosing the “wrong” plan can result in costly out-of-pocket expenses should you need blood transfusions, hospice care, or skilled nursing facility care in the future.
Not all insurance companies sell Medigap insurance in your state, so start by compiling a list of what company options you have to choose from. Your State Health Insurance Department is an excellent resource for this information. In addition to the U.S. Government's Medicare Supplement Insurance guide, you can contact your State Health Insurance Assistance Programs (SHIP) for unbiased counseling and support.
Since Medigap is offered by private insurance companies, you can shop around, just as you would for a car or new TV. Comparing insurance companies will ensure you're receiving the best price for your selected Medigap plan.
Keep in mind, regardless of the insurance company, each Medigap Plan is federally standardized. This means the plans offer the same basic benefits. For example, Plan G from Aetna is identical to Plan G at other health insurance companies such as United Healthcare or Blue Cross Blue Shield. The bottom line: you'll receive the same plan coverage across the board, no matter which insurance company you select.
Before choosing your Medigap insurance company, contact three to five companies to compare costs. Important questions to ask include:
Pro Tip: Be sure to keep a detailed list of insurance companies you contact, representative names, the date of contact, and plan costs and details. Keeping this data organized will aid you in making a final decision.
You can enroll in your state's Medigap benefits at any time. However, when you enroll is key to receiving the best policy options and rates.
Take advantage of all Medigap has to offer by enrolling during Medigap's six-month open enrollment. Your Medigap open enrollment period begins the month you turn 65 and enroll in Medicare. During open enrollment, healthcare companies are federally required to provide Medigap with “no questions asked.” This means insurance companies cannot deny you a policy, even if you have health conditions.5
Did You Know: If you hold off on enrolling in Medicare Part B because you have group health coverage from your, or your spouse's, current employer, your Medigap open enrollment period won't begin until you sign up for Part B.6
If you choose to wait until after your six-month window, you can still apply for Medigap, but you may be denied insurance as you are no longer protected under federal requirements. After open enrollment, insurance companies can deny coverage due to preexisting or current health conditions or the prescription medications you take. If you are deemed eligible for coverage, you may have limited policy options, higher premiums, and a waiting period before receiving care for preexisting conditions.
It's essential to choose a Medigap plan that will properly cover your current and future health needs. For most individuals, you will not be able to change your Medigap plan once you have enrolled. However, if you fall under these two exceptions, you do have the ability to change plans:
Did You Know: You have lawful rights in certain situations that require insurance companies to sell or offer you a Medigap policy, even if you have health problems.7 These rights are known as guaranteed issue rights.
The names may sound similar, but Medicare Supplement Programs (Medigap) and Medicare Advantage Plans are two completely different insurance plans. Both are offered through private insurance companies but differ on coverage. Medicare Advantage Plans are based on in-network providers, require referrals, and typically cover prescription, vision, hearing, and dental costs (all with a copayment). You can change your Medicare Advantage plan annually.
In comparison, Medigap plans allow the flexibility of choosing your own providers; however, you are locked into your initial plan choice unless you fall under a federal exception. Medigap doesn't cover prescription drugs, vision, hearing, and dental. To receive prescription coverage, Medigap enrollees must purchase separate Medicare Part D coverage.7
For a more detailed comparison of these plans, visit our Medigap vs. Medicare Advantage guide.
Maureen joined SeniorLiving.org with more than 10 years of experience writing in health, lifestyle, and nutrition for premium brands like General Mills, Westinghouse, and Bristol Myers Squibb. Her passion for empowering older adults is evident in coverage of topics like retirement, health… Learn More About Maureen Stanley
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Medicare.gov. (2021). Skilled nursing facility (SNF) care.
Medicare.gov. (2021). Medigap & travel.
Medicare.gov. (2021). Supplement Insurance (Medigap) plans in Louisiana.
Medicare.gov. (2021). Supplement Insurance (Medigap) plans in Hawaii.
AARP. (2021). AARP Medicare Question and Answer Tool.
Medicare.gov. (2021). Medicare & You.
AARP. (2021). AARP Medicare Question and Answer Tool.
Medicare.gov. (2021). Drug coverage (Part D).