What is Medigap Coverage


A Medicare Supplement plan, also known as Medigap, is a health care coverage option through private insurance companies. These plans pay after Original Medicare pays.*

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Additionally, Medigap plans allow beneficiaries to receive health care from any doctor or hospital that accepts Medicare. These plans cannot drop beneficiaries due to any health issues.*

What Does Medigap Cover?

Medicare Supplement plans fill the gaps for which Part A and Part B leave the beneficiary responsible. Depending on the plan letter, Medicare Supplements cover copayments, coinsurances, deductibles, and more.*

It is essential to understand how Original Medicare works to know why Medigap plans exist. Primarily, Medigap policies cover the balance for most medically necessary services Original Medicare pays for.*

Often, Medicare Supplement plans also include foreign travel benefits. However, if Part A and Part B won’t typically cover a service, generally, your Medicare Supplement plan won’t either. Consequently, you would need to pay out-of-pocket for these services.*

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Medigap Plan Differences

Ten lettered plans are available in most states, plus high-deductible versions of two plans. These plans are standardized throughout the United States. This means that each plan must give beneficiaries the same benefits, no matter which carrier they choose.*

When considering which Medigap plan is best for you, it’s important to look at premium costs, out-of-pocket expenses, and your long-term projected health. Each of these factors can impact which plan will best suit your needs.*

Although there are ten plans available, most people enroll in one of three. These plans are Plan F, Plan G, and Plan N. This is due to their low-to-no out-of-pocket expenses.*

Medigap Limitations

Each Medigap plan has a different level of benefits. Thus, no two Medigap plans are the same. Insurers may choose which Medigap plans they want to offer. However, each carrier is required to provide at least the basic benefits through Plan A.*

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When using a Medigap plan alongside Original Medicare, coverage won’t require referrals. Additionally, your out-of-pocket expenses will never exceed those of Original Medicare. Some Supplemental plans also have out-of-pocket limits that can change from one year to the next, such as Plan K or Plan L.*

Is Medigap Free?

When you enroll in a Medigap plan, you will be responsible for a monthly premium. There are no government assistance programs to help cover the cost of a Medicare Supplement plan. Therefore, the policyholder is responsible for paying the entire premium each month. Missing a payment could cause a lapse in Medigap coverage.

Carriers consider a lapse in coverage due to nonpayment to be voluntary termination of the plan. If you wish to re-enroll, you will not qualify for guaranteed issue rights. Thus, you must answer underwriting health questions if you wish to re-enroll.*

Premium rates for Medigap plans depend on the level of coverage they offer. More comprehensive plans, like Plan F and Plan G, will have higher premiums. Conversely, lower benefit plans like the high-deductible plans will have a lower monthly premium.*

Choosing or Changing a Medigap Plan

When initially choosing a Medigap plan, everyone receives a 30-day free-look period as a trial run for their new plan. During this time, you will be able to make changes to your plan without penalty. However, you must still pay the monthly premium.*

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Surrounding your initial Medicare enrollment, you have a 12-month Open Enrollment Period to sign up for a Medigap plan with no underwriting health questions. This begins six months before your Part B effective date and ends five-months following.*

After your initial Open Enrollment Period, you are generally subject to underwriting health questions when making changes or applying to a Medigap plan. If making a change, it is recommended to keep your current coverage until the new Medicare Supplement carrier approves your application. This prevents an unintentional lapse in coverage if you face denial.*

Medigap Coverage and Other Insurance

Aside from Original Medicare, knowing how Medigap plans work with other insurances is essential. These include Medicare Advantage plans, employer health plans, and prescription drug plans.*

You cannot enroll in Medigap and Medicare Advantage plans simultaneously. This is due to the differences in coverage provided by both plan types. Beneficiaries must choose one or the other to prevent coverage denials.*

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Your Medicare Supplement coverage is unaffected when you enroll in a Part D plan. Rather than intertwining, Medigap and Part D plans work alongside one another to provide beneficiaries with both health and drug coverage.*

When you enroll in a Medigap plan, it is important to also enroll in a Part D plan. This way, you’ll avoid any late enrollment penalties in the future.*

Employer health plans can be confusing when you become Medicare-eligible. It’s best to not enroll in an employer health plan and a Medigap plan at the same time. Doing so would be a waste of money. Your Medigap coverage does not kick in until you reach the out-of-pocket maximum for your group coverage.*

*

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How to Apply for Medigap Coverage

Applying for Medigap coverage can feel like a daunting task, but it doesn’t have to be. Our licensed agents are Medicare experts who help guide you through the enrollment process from start to finish. Give us a call or complete our online rate form to speak with a licensed agent today.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

4 thoughts on “What is Medigap Coverage

  1. Are there rules and time lines for leaving a medigap plan to a Medicare advantage plan?

    These commercials confuse my benes and I like to give good advice

    1. Hi Angela! If you want to leave Medigap and enroll in a Medicare Advantage plan, you can do so during the Annual Enrollment Period in October. However, be cautious when doing so. Make sure to really understand the differences between these two supplemental coverage options. Most beneficiaries leave Advantage to go to Medigap, not the other way around. There are many reasons why some may find Advantage plans are bad for their healthcare needs. The good news is, if you want to give Advantage a try, you’ll have trial-rights to switch back to Medigap within 12-months if you’re unhappy.

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