Medicare Supplement (Medigap) Insurance
What It Is
Section titled “What It Is”Medicare Supplement (also commonly referred to as Medigap) plans are offered by private insurers designed to work alongside Original Medicare (Parts A & B). It helps pay for costs that Medicare doesn’t fully cover, such as deductibles, coinsurance, and copayments.
What Medicare Supplement Plans Cover
Section titled “What Medicare Supplement Plans Cover”- Part A Coinsurance & Hospital Costs: Extends coverage beyond the standard 60-day hospital stay.
- Part B Coinsurance & Copayments: Helps cover the 20% you normally pay out of pocket.
- Blood: Covers the first 3 pints of blood (Medicare covers the rest).
- Hospice Care Coinsurance: Helps with costs not fully covered under Part A.
- Skilled Nursing Facility Coinsurance: Included in many supplement plans.
- Foreign Travel Emergency Care: Medicare Supplement plans C, D, F, G, M, and N provide foreign travel emergency coverage, paying 80% of billed charges for emergency care after a $250 deductible, subject to a $50,000 lifetime limit. Additionally, they only cover emergency care up to the first 60 days of a trip.
Coverage varies depending on the plan (Plans A–N), each standardized by Medicare.
Costs Associated with Medicare Supplement Plans
Section titled “Costs Associated with Medicare Supplement Plans”- Premiums: Paid monthly to the private insurer, in addition to your Part B premium.
- Standardization: Plans are standardized—Plan G from one insurer offers the same benefits as Plan G from another (only the premium differs).
- No Networks: Medicare Supplement works with any provider that accepts Medicare nationwide.
Enrollment Rules
Section titled “Enrollment Rules”Eligibility
Section titled “Eligibility”- You must have Original Medicare (enrolled in both Medicare Parts A & B), reside in the plan’s service area, be a U.S. citizen or permanent resident for at least five consecutive years, and be at least 65 years old to purchase a Medicare Supplement plan.
Medigap Open Enrollment Period
Section titled “Medigap Open Enrollment Period”- Lasts 6 months starting the month you turn 65 and are enrolled in both Parts A and B.
- During this time, you can buy any supplement plan without medical underwriting (no health questions).
Applying for Medicare Supplement After Your Open Enrollment Period Has Passed
Section titled “Applying for Medicare Supplement After Your Open Enrollment Period Has Passed”- After your Medigap Open Enrollment Period has passed, you may still be able to enroll in a supplement plan, but the insurer may be able to deny coverage or charge you a higher premium based on your health history.
Medicare Supplement vs. Medicare Advantage
Section titled “Medicare Supplement vs. Medicare Advantage”- Medicare Supplement: Supplements Original Medicare, covering gaps in deductibles and coinsurance.
- Medicare Advantage (Part C): Replaces Original Medicare with a bundled private plan.
You cannot have both Medicare Supplement and Medicare Advantage at the same time. In addition, it is important to remember that you may not be able to switch from a Medicare Advantage plan back to Original Medicare and a supplement plan during the next open enrollment period depending on your health status.
Example
Section titled “Example”A retiree with Original Medicare and frequent doctor visits:
- Without a Medicare Supplement policy: Pays 20% coinsurance for every visit.
- With Medicare Supplement Plan G: Most out-of-pocket costs are covered, leaving only the Part B deductible.
Consumer Takeaway
Section titled “Consumer Takeaway”Medicare Supplement is a supplemental insurance policy that helps cover the costs Original Medicare leaves behind. It’s ideal for consumers who want predictable expenses, nationwide provider access, and peace of mind against high out-of-pocket costs.