Learn About Medicare Supplement Insurance
Welcome to the Medicare Supplements page on MedicareWire!
On this page you can find and compare Medicare supplements in your area (above) and learn all about how Medicare supplements work (below). Our goal is to help you determine if Medicare supplement insurance is right for you, and find the right plan at the best cost, if it is.
Let's start at the beginning.
Why is Medigap Insurance Necessary?
Original Medicare offers basic health insurance coverage. For most people it takes care of about 80 percent of all major medical bills. For the remaining 20 percent you must pay out of your own pocket or purchase Medicare supplement insurance
Without a Medigap plan to supplement your Medicare coverage, a chronic illness, injury, even a short stay in the hospital, will run your medical bills into the thousands. A critical illness, like cancer or heart disease, could end up costing you your home, cash savings, or both.
Unless you are already poor, the Government will not give you additional assistance to help pay your medical bills, no matter how big they grow. This is why having additional insurance, to fill the gaps created by Medicare, is so important. That's what Medicare supplement insurance does for you. It pays some or all of the major medical bills that Medicare doesn't pay (your 20% share).
What are Medicare Supplement Plans?
Medicare supplement insurance is Medicare gap insurance sold by private insurance carriers, not the government. However, the plans are strictly regulated by Medicare and state insurance regulators.
A Medicare supplement can help you pay some of the costs baked into Original Medicare, including your co-payments, coinsurance and deductibles. To fully understand Medicare supplement insurance, and how it protects you, you first need to understand how it works with your Medicare.
How Do Medigap and Medicare Work Together?
Medigap plans are designed to work in lock-step with your Original Medicare benefits. When you supplement your Part A and Part B coverage with a Medigap policy, Medicare pays its portion first and then your own Medigap plan kicks in to pay its share, up to the limits of the policy.
The important thing to understand about Medicare supplement insurance is that if Medicare doesn't cover a service, your Medigap plan can't cover it, either. The one exception to this rule is foreign travel healthcare coverage. Although Medicare does not cover you when you travel, it does allow Medigap plans to offer this coverage.
A Supplement Protects You From Medical Bills
The whole idea behind supplement plans is to protect you from big medical bills due to illness or medical emergencies. For instance, let's say you fell and need to be transported to the emergency room by ambulance and you're admitted into the hospital for your injury. This simple event uses both your Medicare Part A (inpatient) and Medicare Part B (medical) coverage, and each has its own costs and deductibles.
In this instance, you immediately owe the Medicare Part B deductible ($185 in 2019) for the emergency transportation services. In this case, if the ambulance cost is $500, your deductible pays the first $185, Medicare pays 80 percent of the remainder ($252), and you pay the remainder ($63).
In most cases, if you visit the emergency room and are admitted, as an this example, your Medicare Part A will cover a portion of the costs. In 2019 you pay:
- $0 coinsurance for each benefit period for days 1-60 spent in the hospital
- $341 coinsurance for days 61-90 in each benefit period
- $682 coinsurance per each “lifetime reserve day” beyond day 90 in each benefit period
- All costs beyond lifetime reserve days
Remember, however, you must first pay your Part A deductible before Medicare pays its portion. In 2019 the Part A deductible is $1,364 per benefit period.
So, as you can see, this one simple incident would end up costing you a minimum of $1,612. If you divide this cost out over 12 months ($134 per month), you're well on your way to covering the cost of a Medigap plan.
What Does Medicare Supplement Insurance Cover?
A Medicare Supplement (Medigap) policy is private medical insurance that covers some of the gaps in Original Medicare. There are 11 federally standardized plans available. Each Medigap plan is represented by a letter: A, B, C, D, F, G, K, L, M, N, and a high-deductible version of Plan F.
Fast Facts About Medicare Supplement Policies
By federal law, all insurance companies that sell Medicare Supplement policies must offer Plan A (core coverage benefits). Additionally, if a company offers additional plans, it must also offer either Plan C and/or Plan F.
Each of the standardized plans provide the same basic benefits. In this way, a Plan A policy sold by Health Net in San Diego, California will have the same benefits as a Plan A policy from AARP in Tampa, Florida. All Medicare Supplement plans offer the same basic set of coverages, which includes Medicare Parts A and B coinsurance or copayment amounts, blood, and additional hospital benefits not covered by Original Medicare.
In many states, you can purchase a supplement policy called Medicare SELECT. These policies follow the standards of regular Medigap plans. The difference is that the provider requires you to use their network providers, much like a traditional HMO or PPO. The benefit is a significant cost savings on the monthly premium.
Please note that Plans D and G purchased on or after June 1, 2010, have different benefits than the same plans purchased before June 1, 2010. Also, Plans E, H, I, and J were discontinued and can no longer be sold. If you have one of these plans you can keep it or purchase a new policy. The standardized plans do not apply in Massachusetts, Minnesota and Wisconsin.
Part A Expenses Covered by Medigap
- Coinsurance for hospital stays: All Medigap plans cover the coinsurance on hospital costs, up to an additional 365 days after your Original Medicare hospital benefits have run out.
- Copayment or coinsurance for hospice care: Medigap plans cover 50 to 100 percent of your copayments and coinsurance for Part A hospice care expenses, depending on the plan option you choose.
- Medicare Part A deductible: Although Plan A does not cover the deductible, the remaining plans cover 50 to 100 percent of this cost.
Part B Expenses Covered by Medigap
- Copayment or coinsurance: Medicare supplements pay for 50 to 100 percent of your Part B copayment and coinsurance amounts (based on the plan).
- Medicare Part B deductible: Only plans C and F cover the deductible making them the two most popular plans.
- Part B excess charges: When a healthcare provider declines Medicare's "assignment" for a particular procedure or visit, Part B excess charges will be incurred. These excess charges are only covered by Medigap plans F and G.
Foreign Travel Coverage
Medicare provides coverage in the United States and its territories only. For this reason some of the Medigap plans cover foreign travel emergencies (up to the plan limits). If you travel you may want to consider Plans C, D, F, G, M, and N.
Blood Coverage with Medigap
Original Medicare only pays for blood after the third pint. Most hospitals receive blood from subsidized blood banks at no cost. However, in the even a hospital must purchase additional blood for you, then you will be charged. All Medicare supplement plans cover up to 100 percent of the cost for the first three pints of blood.
Skilled nursing facilities are healthcare facilities providing short- and long-term care for people with critical medical conditions that can't be managed at home. While coinsurance for skilled nursing care is not covered by Plans A or B, all other plans cover 50 to 100 percent of these costs.
Health Services Not Covered By Medigap
You now know what a Medigap plan can cover, and it's equally important to learn what they don't cover. This way you won't be surprised. Here are the services people look for most and are often surprised that they are not covered by Original Medicare or Medigap coverage:
- Long-term care (care in a nursing home)
- Private-duty nursing
- Hearing aids
- Vision and corrective lenses
- Routine dental care
Are Medicare Supplements and Supplemental Insurance the Same Thing?
When Medicare supplement policies were first introduced, in the 1990’s, they were referred to as Supplemental Medicare Insurance. To help avoid confusion, Medicare adopted the term "Medigap". Therefore, Medigap and Medicare Supplement are interchangeable terms. However, Medigap is not the same as supplemental insurance.
While Medigap is a type of supplemental insurance, it's only available to Medicare beneficiaries. The most common form of supplemental health insurance is available to persons covered by a group health plan through their employer or union. You're probably familiar with the quacking duck TV commercials by AFLAC. That's supplemental disability insurance.
Generally speaking, supplemental health insurance is a policy designed to pay the bills that a health plan does not cover. Supplemental health insurance policies can also cover specific conditions or situations, including dental, vision and critical illness, such as cancer. Long-term care insurance, that pays for nursing home care or home health care is another popular option.
Who is Eligible for Medicare Supplement Insurance?
Supplemental Medicare insurance (aka, "Medigap") is health insurance sold by private insurance companies to cover the "gaps" in Original Medicare. All Medigap policies supplement traditional Medicare coverage, Parts A and B, so you must qualify for Medicare Part A and Medicare Part B in order to be eligible for supplemental coverage. Age is the primary qualifying factor, however, there are also compatibility issues with other types of Medicare insurance.
Can people under 65 get Medigap insurance?
If you qualify for Medicare benefits due to a disability or End-Stage Renal Disease (ESRD), you may be able to purchase Medicare supplement insurance. It all depends on where you live. Each state has it's own board of insurance that regulates the sale of insurance products. Even though Federal law establishes nation-wide Medicare policy, it does not mandate that insurance companies must sell Medigap policies to people under 65. There are 29 states that require insurers to sell policies to people who are eligible for Medicare, regardless of their age:
* Only available to people with ESRD.
** Not available to people with ESRD.
Although the insurance board in your state may not require insurers to sell Medigap policies to people under 65, some insurance companies do. In most cases, due to less competition and higher risk, the cost will be higher and you can be denied coverage for preexisting conditions. Be sure to visit your state's board of insurance web page to review your rights.
Am I eligible if I have Medicare Part D?
Medicare supplements and Medicare Part D (prescription drug plans) are 100% compatible. In fact, the combination of your Original Medicare, a Part D plan and a Medigap Plan F offers the most coverage you can buy.
If you have Medicare Part D and you like the benefits it offers, there is no need to change when you purchase a Medicare supplement policy. There are some Medicare insurance agents that will try to convince you that there are benefits in buying Part D from your Medigap insurer, but this is not the case.
Am I eligible if I have Medicare Advantage?
Medicare Advantage and Medicare supplements are not compatible. In rare circumstances you might be eligible to enroll in a Medicare Advantage Plan and buy a Medigap if you are eligible for "trial rights."
Your trial rights (a 12 month period starting on your birth month) permit you to enroll in a Medicare Advantage Plan for a brief trial period when turn age 65. Should you decide that Medicare Advantage is not to your liking, you can switch back to Original Medicare. Before going back to Original Medicare, you are eligible to apply for a Medigap policy. Your agent will make sure that the effective date of the Medigap policy coincides with the end date of your Medicare Advantage Plan. That way you can avoid a breaks in your medical coverage.
In most cases you also have the right to buy a supplemental policy if:
- You move out of your Medicare Advantage Plan's service area;
- You leave a Medicare Advantage Plan because the company has misled you or broken rules; or
- Your Medicare Advantage Plan stops providing services in your area.
In all of these cases, you can purchase any Medigap Plan A, B, C, F, K, or L available by carriers in your state. Don't forget, however, that you are required to switch back to Original Medicare before you can purchase a Medigap policy.
Am I eligible for Medigap if I receive Medicaid?
Medicaid benefits are not the same as Medicare benefits, so Medigap policies do not apply. If you have Medicaid, don't forget that you will be covered through the new Affordable Care Act ("Obamacare"), starting 1 January, 2014, and will have the ability to get your healthcare coverage through your state's health insurance exchange.
When Can I Buy a Medigap Plan?
The best time to purchase a Medicare supplement is during your individual enrollment period (IEP). During this critical period you cannot be denied supplemental health insurance for any reason.
Your IEP is a six month window that begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. So if you turn 65 on January 3rd but do not enroll in Medicare Part B until February 25th, your IEP will begin on March 1st, which is the first day in which you are age 65 and enrolled in Part B.
CRITICAL: Once your IEP starts it cannot be changed. There are no exceptions.
Some states have an open enrollment period for eligible individuals under the age of 65, and a second enrollment period when they turn 65. Be sure to check with your state's Insurance Department for specifics.
Why It's Critical To Get Enrolled During Your IEP?
Medicare Supplement Insurance companies use medical underwriting formulas to decide if they will accept your application and how much they need to charge to cover their risk. However, during your individual enrollment period, health insurance providers cannot turn you away or charge more than the Medicare approved rate. Here are the insurance carrier restrictions during your IEP:
- Can't refuse to sell you any Medigap policy it offers
- Can't charge you a higher premium than they charge others who are 65 and older
- Can't Delay the start of your coverage
What's The Pre-Existing Condition Waiting Period?
An insurance company can't delay the start of your coverage during your IEP, however, in some cases it can make you wait for coverage related to a pre-existing condition. If the insurer has a pre-existing condition waiting period, it has the right to refuse to cover your out-of-pocket costs for any services related to this condition for up to six months. During this period your Original Medicare will provide coverage, but you are required to pay the coinsurance or copayment.
Be aware that the insurer can only delay your coverage if your medical condition was diagnosed and/or treated in the six-month period before your policy starts. Here are a few basic examples of what could be considered a pre-existing medical condition:
|Your health situation||Is this a pre-existing condition?|
|You have a long-term condition, such as diabetes, that you take medication for on a daily basis.||Yes|
|Five months ago, your doctor diagnosed you with hypertension.||Yes|
|Last year you were treated for back pain, but you have not been treated for this condition in the past 10 months.||No|
Can I Get Around The Waiting Period?
Certain pre-existing conditions may allow you to avoid or shorten the waiting periods if you meet these criteria:
- You buy a supplement policy during your IEP, and
- You are replacing creditable health coverage, and
- You've had at least 6 months of continuous prior coverage, and
- You did not have a break in coverage for more than 63 days
If you purchase a policy when you have a guaranteed issue right, the insurance company can't use a pre-existing condition waiting period.
What If I Delay Medicare Part B Enrollment?
For most people it's best to enroll in Medicare Part B when first eligible. By doing so you will avoid paying a late enrollment penalty.
The exception is when you or your spouse are still working and have group health insurance benefits through your employer or union. When your coverage ends through your employer you can enroll in Part B without a penalty and your six-month individual enrollment period will begin.
In the event that you elect to enroll in Part B while you still have employer coverage, your individual enrollment period starts. Unless you buy a supplemental policy right away — even though you still have coverage through your employer— you will lose your IEP benefits. Every company and union has different rules, so contact your employer or union benefits administrator to get more information.
What If My Individual Enrollment Period Has Passed?
If you apply for a policy after your IEP you are no longer protected by Federal laws, except under certain limited situations. In other words, there's no guarantee your application will be accepted if you don't meet medical underwriting requirements.
How Much Do Medicare Supplements Cost?
For most seniors, the number one factor considered when evaluating Medicare Supplement plans is the cost of the monthly premium. Monthly premiums for supplemental insurance plans are not regulated, so what you pay is completely dependent on the plan you choose (e.g., Plan A, B, C, etc.) and the insurance company you contract with.
Medicare supplemental insurance companies are allowed to establish premiums. They do so based on actuarial formulas. As a result, plan costs vary. In other words, if you are shopping for a Plan F policy, the same plan from company A may cost less than it does from company B, even though both Plan F policies provide the exact same benefits.
How Insurance Companies set Medicare Supplement Prices
Supplement plan prices vary widely because each insurance company decides how it will set the premium amounts for its policies. Here's how insurers rate policies:
- Community-rated: This is also known as "no-age-rated," because regardless your age the premium is the same. Community-rated premiums increase with inflation and demographic information, but they ignore age.
- Attained-age-rated: These policies are less costly at the beginning but increase automatically as you age. Premiums will also increase with inflation and other risk factors.
- Issue-age-rated: Also known as "entry-age-rated," because your premium rate is based on your age when you purchase the policy. Your premium will be the same as the other seniors your age in your geographic area. Premiums will increase with inflation and other factors, but not due to your age.
As you can now see, it's critical that you ask your Medicare Supplement agent how an insurance company prices its policies. This factor will affect how much you pay both now and in the long term.
As with most other products, health insurance plans are affected by inflation and rising health care costs. Unless you live in a state that regulates rates, like Florida, you should anticipate that your premium will increase each year. That's why it is critical to compare rates each year.
What you pay for a Medicare Supplement may also be determined by your gender, where you live, and these common rate setting factors:
- Married people who buy two policies
- Those who pay their premiums using electronic funds transfer
- Those who pay their premiums yearly
- Medicare SELECT policies that require you to use specific network providers
- High-deductible option for Plan F
- Uses medical underwriting or bases the premium rate on your medical history if you don't have a guaranteed issue right or are not in your Medigap open enrollment period
What to Ask When Shopping for a Medicare Supplement
Many insurance carriers offer Medicare Supplement plans. It's important to shop and compare. Just make sure you're not comparing apples to oranges. In other words, if you're looking for a Plan A, make sure you are getting rate quotes for a Plan A from each company you call. If you are using an independent Medicare agent, they will provide the comparison data you need.
Here's what you should ask about each policy you compare:
- How is the policy priced (community-rating, issue-age-rating, or attained-age-rating)?
- If the policy is attained-age-rated: How often will the premium increase due to my age?
- How much is the premium amount for someone my age (advertised rate may be for an individual who just turned 65)?
- How much has the premium increased over the past five years?
- Do you offer any discounts (non-smoker, married couples, etc.)?
As you would expect, the more coverage the policy offers the more you're going to pay. However, due to the fact insurance companies compete for your business, premiums vary significantly. It pays to shop and compare.
Can I Get My Prescriptions with a Medigap Plan?
You can get prescription drug coverage through Medicare in one of two ways. The most common way is to buy a Medicare Part D Plan (aka, "PDP"). The second way is to enroll in a Medicare Advantage Plan that includes Part D (aka, "MAPD") . All PDPs sold today are 100% compatible with all Medigap supplemental Medicare policies. This is not true in the case of Medicare Advantage plans. You cannot purchase Medicare supplement insurance if you are enrolled in Medicare Advantage.
What Are My Options If I Don't Have Prescription Drug Coverage?
If you have Medicare Part A and Part B and a Medigap plan you have two options:
- Keep your Medicare supplement insurance and purchase the Medicare Part D plan of your choice. Be certain that the PDP you want covers your prescribed medications at a favorable rate; or
- Cancel your Medigap plan and get your coverage through a Medicare Advantage plan that includes Part D (an MAPD plan). When you enroll in a MAPD plan you will be automatically disenrolled from Original Medicare (Part A and Part B).
Timing is critical. Unlike your Medigap policy, you can only enroll in Medicare Part D and Medicare Advantage during the Annual Enrollment Period (AEP), which begins 15 October and ends on 7 December (Obamacare does not change Medicare's AEP dates). Even though you join during the open enrollment period, your coverage does not begin until 1 January. The only exception to this rule is when you turn 65. On that year you have an Individual Enrollment Period starting the month before your birthday and ending the month after your birthday.
What If I Have A Medigap Plan With Prescription Drug Coverage?
Some Medicare supplements sold prior to 2006 (Plans H, I, J) have limited prescription drug coverage. These insurance polices are no longer available. If you have a Plan H, I or J with prescription drug coverage, there are two options available to you:
- You can change your Medigap policy to one of the 10 lettered plans currently available and purchase a PDP plan. Before doing so, first compare the drug coverage your Medigap policy offers with the coverage provided by Medicare Part D plans sold in your state. Don't forget, the new healthcare law will eliminate the coverage gap in a few more years.
- Cancel your Medigap policy and enroll in a MAPD. This will give you all of your Medicare coverage, Parts A, B, and D, through an HMO or PPO private healthcare plan. When you enroll in Medicare Advantage, you will disenrolled from Original Medicare.
How Can I Save Money On A Medigap Plan?
Medicare supplement insurance premiums continue to increase. The increases have a lot to do with changes brought about by the Affordable Care Act (aka, Obama) and how these changes affect reimbursements to health care providers. As a result, a lot of seniors are asking how they can save money on their Medicare supplement.
Medigap policies, as the name implies, cover the gaps in your Original Medicare health insurance. As a general rule, once you have paid your annual Part B deductible, Medicare covers about 80% of the rest of the "reasonable charges". However, that still means that you're on the hook for 20% of copayments and coinsurances. This is where most seniors can save some money.
Medicare Co-payments and Coinsurance Explained
Co-payments are a fixed fee that you pay for various medical services. For instance, when you see your primary care physician you may have to pay a $20 co-payment, and seeing a specialist may cost $25. These fixed price fees are predetermined by Medicare based on the type of service.
Although it may sound like the same thing, a coinsurance is another out-of-pocket medical expense, but it is a percentage of the service cost instead of a fixed amount.
Copayments and coinsurances can really add up fast, especially if you see your doctor frequently or have a condition that requires hospitalization. If this sounds like you, then having a Medigap Plan F or a Medigap Plan G might be the best strategy. However, if you are very healthy and rarely see the doctor, you can save a lot of money by taking a little more risk. It all comes down to weighing your out-of-pocket expenses versus your supplemental insurance costs.
The following Medicare Supplement Plan Benefits Chart offers a quick look at the benefits provided by the ten standardized Medigap lettered plans (A through N).
[INSERT PLAN COMPARISON CHART HERE]
Evaluating Cost Differences
Let's assume that the Medicare-approved amount for a doctor's office visit is $75. In this case, Medicare pays $60 and your portion of the bill, the coinsurance, is $15. In other words, there's a $15 gap that has to be paid.
Medicare supplement insurance, or Medigap if you prefer, lowers your health care costs by covering the copayment and coinsurance gaps in your Original Medicare (Part A Hospital Insurance and Part B Medical Insurance) coverage. Using our example, if you have a policy that covers all of your Part B coinsurance, you will save $15 each time you need to see the doctor.
As you can see, having a policy that offers you full Part B gap coverage won't save you money if you don't use outpatient services regularly. However, if you see your doctor and specialists often, those fees add up fast and your full-coverage Medigap policy is saving you money.
Do the math. If you're paying $200 per month ($2,400 a year) for your Medigap policy but you're only saving $500 a year on copayments, you might want to consider a plan with a little less Part B coverage and a lower monthly premium.
Choose Your Medigap Plan Carefully
Saving money on copayments and coinsurance is smart, but you don't want to be penny wise and pound foolish. It's important to fully understand the costs and benefits of your supplemental Medicare policy. The right plan for you depends on your medical needs, expenses and budget. You don't want to buy more insurance than you can afford. At the same time, you don't want to put your savings or property at risk by not having enough coverage in the event you should become hospitalized or critically ill. That's why it's so important to do your homework and choose wisely.
What are the "Medigap Standardized Benefits?"
All Medicare Supplement Insurance policies (aka, "Medigap Plans") are required by law to provide a basic set of coverage benefits. These basic benefits include most Medicare Part A and Medicare Part B coinsurance amounts, blood, and additional hospital benefits not covered by Original Medicare.
- Part A Hospital Coinsurance
- Days 61-90 of a hospital stay in each Medicare benefit period
- Days 91-150 of a hospital stay. Medicare will only pay for these 60 days once during your lifetime
- Additional Part A Hospital Benefits
- An extra 365 days of inpatient hospital care after you use your Original Medicare hospital benefits
- Part B Coinsurance
- Pays for the Part B coinsurance after you meet your annual deductible
- Part A and B Blood Coverage
- Pays for the first three pints of blood per calendar year
- Part A Hospice Coinsurance
- Pays for outpatient prescriptions drug and inpatient respite care coinsurance
Medigap Standardized Policies
There are currently (as of FY 2019) a total of 11 standardized policies (A, B, C, D F, High Deductible F, G, K, L, M and N). Additionally, these plans may be offered as a SELECT policy, requiring you to use a specific network of providers (like a PPO).
The following links will direct you to a chart of information about each type of plan.
How Do I Get a Medigap Plan?
Medigap plans are supplemental insurance policies purchased through insurance carriers licensed in your state. The first step is to shop policies available in your state.
The good news is that Medicare Supplements are standardized using letters A through N. This means that a Medigap Plan A or Plan F sold by one insurance carrier is exactly the same as another. The only difference is the monthly premium.
Be a savvy senior and shop around and review your plan annually to make sure you're still paying a competitive rate.
Where Do I Buy a Medigap Plan?
You can purchase a Medicare supplement policy from a licensed agent or directly from the insurance carrier. An independent agent can help you compare policies from multiple carriers. You can locate an agents in your state by entering your zip code below.
Best Medigap Plans by State
The Medigap plan information on MedicareWire is maintained by David Bynon and was last updated on .