Key Takeaways
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Medicare Supplement (Medigap) plans help cover out-of-pocket costs that Original Medicare doesn’t pay, but they don’t replace Medicare or cover extra benefits like prescriptions, vision, or dental.
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Enrollment timing matters—your best option is during your Medigap Open Enrollment Period, which lasts for six months starting when you’re 65 and enrolled in Medicare Part B.
Understanding Medicare Supplement Plans
Medicare Supplement plans, also called Medigap, are designed to fill the gaps left by Original Medicare. While Medicare Parts A and B cover hospital and medical expenses, they don’t pay for everything. That’s where Medigap comes in, helping with copayments, coinsurance, and deductibles.
However, Medigap is not the same as other types of Medicare coverage. These plans do not include prescription drug benefits, so if you need medication coverage, you must enroll in a separate Medicare Part D plan. Additionally, Medigap plans do not offer extra benefits such as vision, dental, or hearing coverage.
How Medigap Works with Original Medicare
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Medigap works alongside Original Medicare (Parts A and B), not as a replacement.
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Medicare pays its share first, and then Medigap covers the remaining out-of-pocket costs.
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You must remain enrolled in Original Medicare to be eligible for a Medigap plan.
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Medigap plans do not work with Medicare Advantage plans—if you enroll in a Medicare Advantage plan, you cannot use Medigap coverage.
When to Enroll in a Medicare Supplement Plan
Timing is crucial when signing up for Medigap. Your best opportunity is during the Medigap Open Enrollment Period, which lasts six months and begins the month you turn 65 and are enrolled in Medicare Part B.
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During this period – You can enroll in any Medigap plan available in your area without medical underwriting.
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After this period – You may be subject to health screenings and could be denied coverage or charged higher premiums based on your health.
If you miss this window, you may have to wait for another opportunity to enroll, and coverage could be more expensive. Some states offer additional enrollment periods, but not all do.
What Medicare Supplement Plans Cover (and What They Don’t)
Covered by Medigap Plans
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Part A Coinsurance and Hospital Costs – Covers additional hospital days beyond what Medicare allows.
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Part B Coinsurance or Copayments – Helps reduce doctor visit and outpatient service costs.
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Blood (First 3 Pints) – Covers costs for necessary blood transfusions.
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Hospice Care Coinsurance or Copayments – Assists with end-of-life care expenses.
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Skilled Nursing Facility Coinsurance – Helps cover costs if you need extended skilled nursing care.
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Foreign Travel Emergency Coverage – Some Medigap plans help cover emergency medical care outside the U.S.
Not Covered by Medigap Plans
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Prescription Drugs – You’ll need a Medicare Part D plan for this coverage.
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Routine Dental, Vision, and Hearing Care – Medigap does not include coverage for exams, glasses, hearing aids, or dental work.
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Long-Term Care (Custodial Care) – Does not cover services like assisted living or nursing home stays.
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Private-Duty Nursing – Not included in Medigap coverage.
Choosing the Right Plan for Your Needs
Medigap plans are standardized, meaning each plan with the same letter offers the same coverage no matter where you buy it. However, prices can vary. Consider the following when selecting a plan:
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Your Current and Future Health Needs – If you expect high medical expenses, a plan with lower out-of-pocket costs might be better.
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Budget Considerations – Monthly premiums vary, so choose a plan that fits your financial situation.
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Coverage for Travel – Some Medigap plans cover emergency healthcare costs when traveling abroad.
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Guaranteed Renewability – Medigap plans are guaranteed renewable as long as you pay your premiums, meaning your coverage cannot be canceled due to health conditions.
How Costs Work with Medigap Plans
The cost of a Medigap plan depends on several factors, including:
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The plan you choose – Different Medigap plans cover different costs.
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Your age at the time of enrollment – Some pricing methods mean your premium will increase as you age.
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Your location – Costs can vary by state and region.
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Community-Rated, Issue-Age, and Attained-Age Pricing – How your premium is calculated can impact costs over time.
While Medigap helps reduce out-of-pocket expenses, you still need to pay a monthly premium in addition to your Medicare Part B premium.
Can You Change Medigap Plans Later?
Yes, but with some restrictions:
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If you switch plans after your Medigap Open Enrollment Period, you may be required to go through medical underwriting.
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Some states have annual enrollment opportunities where you can switch plans without restrictions.
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You may be eligible for a Special Enrollment Period if you lose other health coverage.
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If you drop a Medigap policy to join a Medicare Advantage plan but change your mind within 12 months, you may be able to get your Medigap plan back under certain conditions.
Understanding Guaranteed Issue Rights
Certain situations give you guaranteed issue rights, meaning an insurance company must offer you a Medigap plan without medical underwriting. Examples include:
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Losing employer-sponsored retiree coverage.
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Your current Medigap provider leaving the Medicare program.
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Moving to a new state where your current plan is not available.
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If your Medicare Advantage plan is discontinued or no longer available in your area.
How Medigap Differs from Other Medicare Options
It’s easy to confuse Medigap with other Medicare-related plans, but they serve different purposes:
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Medicare Advantage (Part C) – These are private insurance plans that replace Original Medicare, often including extra benefits like dental and vision.
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Medicare Part D – This is a separate prescription drug plan that Medigap does not cover.
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Employer or Retiree Coverage – Some retirees have employer-sponsored coverage that acts as secondary insurance to Medicare, which may eliminate the need for Medigap.
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Medicaid – If you qualify for Medicaid, you may not need a Medigap plan, as Medicaid may cover many of your out-of-pocket costs.
Making the Best Choice for Your Coverage
Before enrolling in a Medigap plan, take the time to compare options based on your healthcare needs and financial situation. You should also consider how often you visit the doctor, whether you travel frequently, and if you need additional benefits like prescription drug coverage.
Reviewing plan options and costs each year is important, as prices may change.
If you’re unsure which Medigap plan is right for you, reach out to a licensed agent listed on this website for professional guidance on making an informed choice.
