Medicare Supplement insurance (Medigap)
Medicare Supplement insurance, commonly referred to as “Medigap,” helps pay for certain Medicare out-of-pocket costs like deductibles, copayments, coinsurance and other costs.
What Do Medigap Plans Cover?
There are 10 standardized Medigap plan options to choose from in most states. (Minnesota, Massachusetts, and Wisconsin have different options.)
The basic benefits offered by Medicare Supplement plans are standardized by the federal government, but you buy the plans from private insurance companies, not the government.
You can use the 2020 Medigap plan chart below to compare the benefits that are offered by each type of plan. Use the scroll bar at the bottom of the chart to view all plans and information.
An Explanation of your Medicare out-of-pocket costs
- Part A coinsurance and hospital costs
Medicare Part A requires you to pay coinsurance costs for your inpatient hospital care after you meet your Part A deductible. Each of the standardized Medigap plans available in 2021 offer full coverage of Part A coinsurance costs.
- Part B coinsurance and copayments
When you use Medicare Part B for covered outpatient care and medical items, you are typically required to pay 20% of the Medicare-approved amount for the services or devices you receive (after your meet your Part B deductible). Each type of Medigap plan offers full or partial coverage for your 2021 Part B coinsurance and copay costs.
- First three pints of blood
Medicare requires you to pay for the first three pints of blood you may need for a transfusion. Medicare will then pay for additional blood that may be needed in your procedures. Each Medigap plan provides full or partial coverage for the costs of your first three pints of blood.
- Part A hospice care coinsurance and copayments
After you meet your Part A deductible, you are typically responsible for certain coinsurance and copay costs if you receive hospice care. Each Medigap plan offers at least partial coverage for these coinsurance/copay costs.
- Part A coinsurance for skilled nursing facility
If you receive inpatient care in a skilled nursing facility, you will typically be responsible for paying Part A coinsurance costs. Medigap Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M and Plan N each provide full or partial coverage for your Part A coinsurance costs in a skilled nursing facility.
- Medicare Part A deductible
You must pay the Medicare Part A deductible out of your own pocket before your Part A coverage kicks in. The Part A deductible is not an annual deductible, which means you could potentially have to pay it more than once in a single year. In 2021, The Part A deductible is $1,484 per benefit period. Medigap Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M and Plan N each provide full or partial coverage for your Part A deductible in 2021.
- Medicare Part B deductible
You must pay the Part B deductible out of your own pocket before your Part B coverage kicks in. In 2021, the Part B deductible is $203 per year. Medigap Plan F and Plan C both cover the Part B deductible in full. Medicare beneficiaries who become eligible for Medicare on or after January 1, 2020, will no longer be able to enroll in Plan F or Plan C. If you enroll in either plan before 2020, you will be able to keep your plan. If you are eligible for Medicare before January 1, 2020, you may be able to enroll in Plan F or Plan C after that date if either plan is available where you live.
- Medicare Part B excess charges
If you visit a health care provider that does not accept Medicare assignment, this means that they do not accept Medicare reimbursement as payment in full for their services. These providers are allowed to charge you up to 15% more than the Medicare-approved amount for their services. You are responsible for paying these costs out of your own pocket. Medigap Plan G and Plan F both cover Part B excess charges in full.
- Foreign travel emergency care
Medicare only covers the cost of emergency care received outside of the U.S. and U.S. territories under limited circumstances. Medigap Plan C, Plan D, Plan F, Plan G, Plan M and Plan N each cover 80% of the costs for covered emergency medical care you receive when traveling abroad.
Remember: Plan F and Plan C are not available to beneficiaries who become eligible for Medicare in 2020 or after.
Who Is Eligible for Medicare Supplement Insurance?
In order to be eligible for a Medicare Supplement plan, you must be:
- Enrolled in Medicare Parts A & B (Original Medicare)
- 65 or older, or have a disability
If you are under the age of 65 but qualify for Medicare because of a disability, you may or may not be able to purchase a Medigap plan, depending on where you live.
Certain states require insurance companies to sell Medigap to people under 65, but this is not a federal requirement. Insurance companies in some states may not sell Medigap plans to people under age 65, even if you qualify for Medicare Part A and Part B because of a disability.
Will My Doctor Accept My Medigap Plan?
Medigap is accepted by any health care provider who accepts Medicare insurance. Medigap may be purchased and used in the following areas:
- Every U.S. state and the District of Columbia
- Puerto Rico
- U.S. Virgin Islands
- Northern Mariana Islands
Is Plan F the Best Medigap Plan?
Choosing the best Medigap plan for you will depend on your unique health care needs and your budget.
Certain types of Medigap plans are more popular than others. Medigap Plan F was the most popular plan in 2019. About 55% of Medigap policyholders were enrolled in Plan F.1
The plan that is growing the fastest in popularity is Plan G. From 2016 to 2017, Plan G saw a 31 percent increase in enrollment, while Plan F remained stable at just two percent growth.1
Each type of standardized Medigap plan with the same letter has the same benefits, no matter which company you buy from or where you live.
That means Plan A from one insurance company – such as Aetna – includes the same benefits as Plan A from a different insurance company. The only differences may be the plan prices and who is providing the coverage.
Comparing Medigap Policy Quotes
Because Medigap plans are sold by private insurance companies, the selection of plans will not be the same in every county or state. The cost of each plan offered by each insurer may also differ. It can be helpful to compare Medicare Supplement quotes.
Call today to speak with a licensed insurance agent who can provide you with a list of Medigap plans available where you live.
An agent can help you review the costs and coverage of each plan to help you decide on the best Medigap plan for your needs.
When Should I Sign Up For Medigap?
The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period (OEP).
- Your Medigap OEP begins the day you are at least 65 years old and enrolled in both Medicare Part A and Part B. Your Medigap Open Enrollment Period lasts for six months.
- If you sign up for a plan during this enrollment period, insurance companies will not be allowed to use medical underwriting to determine your rates. This means that you cannot be charged more – or denied a policy altogether – due to your health.
If you apply for a Medigap plan after your Open Enrollment Period, insurance companies reserve the right to use underwriting to determine your plan premium.
You may be charged more if you are in poor health, or you could be denied coverage entirely.
How Much Is Medigap Per Month?
Although the benefits included in a Medigap plan remain consistent no matter where the plan is sold or by whom, the cost of the Medigap premiums can vary based on a number of factors.
The average cost of a Medicare Supplement Insurance plan can vary based on a number of factors, such as age, gender, smoking status, health and where you live.
Different Medicare Supplement Insurance companies may use different pricing systems to determine their plan rates. These define if and how your Medigap premiums will increase in future years.
- Attained-age pricing bases your Medigap premium on your current age, and your premium continues to increase as you age.
This is the most common pricing structure for Medigap insurance companies.
- Community-rated pricing doesn’t let your age affect your Medigap premiums.
For this pricing structure, a 65-year-old applicant would be quoted the same rate as a 75-year-old. Premiums do not increase based on age, but can increase based on inflation.
- Issue-age pricing bases your premium cost on how old you are when you first buy the policy. The premium rate is fixed and does not change as you age.
For these policies, the initial premium cost might be more expensive than an attained-age policy, but it might cost less in the long term. This pricing method is less commonly used by insurers.
Is It Better to Have Medicare Advantage or Medigap?
Medicare Supplement policies and Medicare Advantage plans (Medicare Part C) serve two different purposes.
- Medicare Advantage plans provide all of the same coverage as Medicare Part A and Part B, and some Medicare Advantage plans cover things like prescription drugs, routine dental and vision care, gym memberships and more.
A Medicare Advantage plan replaces your Original Medicare coverage with a plan that’s sold by a private insurance company.
- A Medigap plan works alongside your Original Medicare coverage to cover some of the out-of-pocket costs that Original Medicare doesn’t pay for.
You cannot have a Medicare Supplement policy and a Medicare Advantage policy at the same time.
Find Medicare Supplement Plans Where You Live
Call today to speak with a licensed insurance agent who can help you compare Medigap plans in your area so that you can find a plan that fits your coverage needs and your budget.
1 AHIP. The State of Medigap 2019. (May, 2019). Retrieved from www.ahip.org/wp-content/uploads/IB_StateofMedigap2019.pdf.