What is Medigap? 

Even after taking healthcare Insurance, one expense that never seems to stop bothering is the out-of-pocket expenses. But don’t worry, there is a counter to that problem too!

Medigap is a type of private health insurance that supplements original Medicare in the United States. It helps pay for some of the out-of-pocket costs that Medicare does not cover, such as deductibles, coinsurance, and copayments.

In this blog, you’ll learn in detail about Medigap and how it can benefit you or your loved ones:

What is Medigap and How Does It Work?

An original Medicare referred to as Plan A and B does not cover all the expenses related to any illness. Medigap, the same as Medicare Supplement Insurance, is a health insurance plan provided by private companies to cover costs that are not covered by an Original Medicare plan. 

What is the Connection Between Medigap and Original Medicare?

Original Medicare is a health insurance plan for seniors 65 years and older, younger people with disabilities, and patients with end-stage renal disease and amyotrophic lateral sclerosis diseases. It pays for your medical and healthcare expenses but there are a few out-of-pockets expenses that you have to incur. 

Medigap is the insurance plan that covers those out-of-pocket expenses. Medigap is run by private companies.

How Does Medigap Supplement Insurance Differ from Medicare Advantage?

Medicare Advantage plan or Medicare Part C is run by private companies and provides Medicare Part A and Part B benefits. It is an alternative to Original Medicare’s Part A and Part B plan. Medigap on the other hand, is also run by private companies but it covers out-of-pocket expenses that the original Medicare does not cover. 

What Are the Different Types of Medigap Plans?

There are 10 standardized Medigap plans available in most states, labeled Plan A, B, C, D, F, G, K, L, M, and N. In 2010, the federal government standardized the types of Medigap plans, creating 10 options, and in 2015, Congress decided to prohibit Medigap from covering the annual deductible for Part B, which pays for doctor visits and other outpatient services.

The Medigap plans are consistent in all but three states: Massachusetts, Minnesota, and Wisconsin have their own standard policies. Because the Medigap plans are standardized, an A or F plan sold by one insurer covers the same things as an A or F plan from another insurer. When shopping for the best Medigap plan for your needs, it can help to compare Medigap quotes.

Here is a brief overview of the 10 types of Medigap plans:

  1. Plan A: This is the most basic Medigap plan, covering only a few benefits, such as coinsurance for hospital stays and hospice care.
  2. Plan B: This plan covers everything in Plan A, plus the Medicare Part A deductible.
  3. Plan C: This plan covers everything in Plan B, plus some additional benefits, such as skilled nursing facility care and emergency medical care while traveling abroad. Note that Plan C is no longer available to people newly eligible for the program.
  4. Plan D: This plan covers everything in Plan B, plus some additional benefits, such as skilled nursing facility care.
  5. Plan F: This plan is the most comprehensive Medigap plan, covering everything in Plan C, plus the Medicare Part B deductible and excess charges. Note that Plan F is no longer available to people newly eligible for the program.
  6. Plan G: This plan covers everything in Plan F, except for the Medicare Part B deductible.
  7. Plan K: This plan covers only a portion of the benefits covered by other Medigap plans, but it has a lower monthly premium.
  8. Plan L: This plan covers only a portion of the benefits covered by other Medigap plans, but it has a lower monthly premium than Plan K.
  9. Plan M: This plan covers everything in Plan D, except for the Medicare Part B deductible.
  10. Plan N: This plan covers everything in Plan D, except for the Medicare Part B deductible and excess charges.

It is important to note that Medigap plans do not typically offer any additional benefits. Instead, they pick up the out-of-pocket costs associated with Medicare. When comparing Medigap plans, it is important to focus on the big-ticket items, such as your 20 percent share of the cost of doctor visits and your 20 percent share of the cost of durable medical equipment.

Here is a comparison chart of the 10 different types of Medigap plans:

Medigap PlanPlan APlan BPlan CPlan DPlan FPlan GPlan
K
Plan
L
Plan MPlan N
Part A Coinsurance and Hospital CostsYesYesYesYesYesYes50%75%YesYes
Part B Coinsurance or CopaymentYesYesYesYesYesYes50%75%YesYes
Blood (First 3 Pints)YesYesYesYesYesYes50%75%YesYes
Part A Hospice Care Coinsurance or CopaymentYesYesYesYesYesYes50%75%YesYes
Skilled Nursing Facility Care CoinsuranceNoYesYesYesYesYes50%75%YesYes
Part A DeductibleNoYesYesYesYesYes50%75%YesYes
Part B DeductibleNoNoNoNoYesNoNoNoNoNo
Part B Excess ChargesNoNoNoNoYesYesNoNoNoYes
Foreign Travel EmergencyNoNoYesNoYesYesNoNoNoYes
Out-of-Pocket LimitNoNoNoNoNoNo$6,220$3,110NoNo

Note: The chart above provides a general overview of the benefits offered by each Medigap plan. The availability of these plans may vary by state, and some states may offer additional or different Medigap plans. When comparing Medigap plans, it is important to consider your specific needs and budget to find the best plan for you.

How Do Medigap Coverage Options Vary Between Plans?

Medigap coverage options differ in plans based on a combination of different benefits that each plan provides, such as:

  1. Part A coinsurance and hospital costs up to an extra 365 days after the Medicare benefits are exhausted 
  2. Part B coinsurance or copayment
  3. First 3 pints of blood
  4. Part A hospice care coinsurance or copayment
  5. Skilled nursing facility care coinsurance
  6. Part A and Part B deductible
  7. Part B excess charge 
  8. Foreign travel exchange 
  9. Out of Pocket limit 

What is the Medigap Comparison Process for Choosing a Plan?

Consider the following steps while choosing a Medigap plan:

  1. First and foremost, check your age, location, enrollment in part B, and enrollment period eligibility before applying to a Medigap plan. 
  2. Utilize the Medigap comparison tool to determine which Medigap plan suits you the best. Compare plans’ costs and benefits. 
  3. List out your healthcare and medical needs, and choose a Medigap plan that considers your level of coverage, the monthly premium, the deductible, the coinsurance, the copayment, and the out-of-pocket limit of each plan.
  4. Get price quotations from different insurance companies that offer your plans and choose the one according to your convenience. 
  5. Make sure to enroll in Medigap in the enrollment period only otherwise you might have to pay the penalty or straightaway a denial. 

How Much Does Medigap Cost?

Different Medigap plans cost as follows:

Medigap Plan TypeMedigap Cost Range (Monthly)
Medigap Plan A $181 – $380
Medigap Plan B$238 – $329
Medigap Plan C $288 – $364
Medigap Plan D$290 – $334
Medigap Plan F$278 – $495
Medigap High-deductible Plan F $70 – $156
Medigap Plan G$241 – $413
Medigap High-Deductible Plan G$70 – $148
Medigap Plan K$82 – $189
Medigap Plan L$172 – $279
Medigap Plan M$268 – $314
Medigap Plan N$196 – $320

What are the Medigap Eligibility Criteria for Enrollees?

To be eligible to get a Medigap plan, you need to:

  1. Enrolled in Original Medicare part A and part B
  2. You must be 65 or older, or 65 or younger with a qualified disability, or end-stage renal disease in some states.
  3. You must be a resident of the US or a citizen of the US who has lived at least 5 years in the US.
  4. You must be in a state that provides a Medigap plan at the time of enrollment.

How Do Medigap Costs Compare to Medicare Part A, Part B, and Part D?

Medigap premiums are paid in addition to Medicare Part A and Part B. Medigap does not have to do anything with Medicare Part C and Part D. 

What Are the Benefits and Drawbacks of Medigap?

Benefits of Medigap:

  1. Medigap covers the additional fees of Medicare Part A and Part B. 
  2. Medigap has a range of easy-to-compare plans
  3. There is a guaranteed 6-month enrollment period on being eligible 
  4. All Medigap plans to provide an additional 365 days in hospital
  5. Medigap has nationwide coverage 

Drawbacks of Medigap:

  1. Medigap premiums can be expensive 
  2. The process of switching Medigap plans is difficult
  3. You might get a total denial from getting Medigap on missing enrollment period 
  4. All Medigap plans do not cover hospital deductibles
  5. Medigap does not cover Medicare Plan D or prescription drugs 
  6. Medigap doesn’t cover elective surgeries 

How Does Medigap Relate to Long-Term Care and Financial Planning?

Long-term care is the type of care that you need in case of chronic illness or disability that obstructs you from performing daily tasks such as showering or even moving around. Medigap does not cover long-term care. 

If you frequently need Medicare services, Medigap can help you with financial planning in the long run as it reduces your total expenses by cutting some major out-of-pocket expenses. 

How Do I Choose the Right Medigap Plan for Me?

Choosing the right Medigap plan can be tricky, as there are many options to consider. The first thing to do is understand the differences between Medigap plans and what they cover.

Medigap plans are sold by private insurance companies and are standardized, so Plan A from one company offers the same coverage as Plan A from another company. The plans offer different levels of coverage for things like copays, coinsurance, and deductibles in Original Medicare.

When looking at plans, think about your health needs and budget. Typically, plans with more coverage have higher premiums. If you have extensive healthcare needs, a plan with more coverage may be better so you have less out-of-pocket costs.

However, if you are relatively healthy, a plan with less coverage may suffice and save you money on premiums. Also consider your prescription drug needs. Some Medigap plans cover prescription copays while others do not. Once you narrow down a few options, compare the plans in detail and calculate potential out-of-pocket costs based on your expected healthcare utilization.

Also make sure your doctors accept the Medigap plan you choose. Ultimately, find the plan that provides the right balance of coverage and premiums for your situation. Speak to an insurance agent or your State Health Insurance Assistance Program (SHIP) for help comparing plans.

What Role Do Medigap Agents Play in the Selection Process?

Medigap agents are licensed professionals who help you select the right Medigap plan. Medigap agents help you:

  1. Determine the best Medigap plan by explaining each plan and how they relate to the original Medicare.
  2. List out your medical and healthcare needs and shortlist a plan for you that fits your budget 
  3. Help you with the application process and solve your queries.
  4. Continue helping you after the enrollment in the Medigap plan

How Can I Obtain Medigap Quotes to Compare Plans?

You can obtain Medigap quotes by:

  1. Utilizing Medigap plan comparison tools that allow you to enter your details and help you predict the monthly premium and rating of the different Medigap plans.
  2. Get price quotations from different Medigap Insurance companies in your state
  3. Contact a Medigap agent who can help you with determining costs for different Medigap plans

How Can I Avoid Medigap Scams and Protect Myself?

There are people who might try to sell you fake medigap plans and charge you for services that you will not receive. Medigap scams not only cost you money but can also jeopardize your identity. To avoid medigap plans, you should:

  1. Not give out any personal information to anyone who calls without a valid identity or visits you uninvited in the name of Medigap agent or professional.
  2. Not sign any document without reading the whole thing thoroughly. 
  3. Do not give any money upfront as Medigap does not need any enrollment fee
  4. Not fall for high-pressure tactics as no Medigap agent or service provider will force you to take the plan
  5. Do not enroll into a Medigap plan that is not approved by your state insurance department