Medigap (Medicare Supplement Insurance)
You may be familiar with the four major parts of Medicare: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage)
But there is also another option to supplement your Original Medicare coverage for you to be aware of as a beneficiary: Medigap (Medicare Supplement Insurance).
What is Medigap?
Medigap (also known as Medicare Supplement Insurance) is optional, private insurance that helps cover the “gaps” left by Original Medicare (Parts A and B). These gaps include things like deductibles, copayments, and coinsurance; costs that can add up quickly (especially if you have ongoing medical needs or chronic conditions).
Medigap isn't a standalone plan. Instead, it works in conjunction with Original Medicare to help reduce your out-of-pocket payments. Medigap plans are standardized nationwide with the exception of a few states (options range between Plans A-N); each plan letter includes the same basic benefits regardless of the insurance company offering it.
Note: Price is the only difference between plans with the same letter that are sold by different insurance companies.
For beneficiaries who value predictable costs, flexibility to see any provider that accepts Medicare, and coverage that travels with them, Medigap may be for you.
What Does Medigap Cover?
Medigap policies help cover the out-of-pocket costs associated with Original Medicare; this includes things like copayments, coinsurance, and deductibles. Some Medigap policies also help cover services that Original Medicare doesn't cover, such as foreign travel emergency care.
Medigap Coverage Snapshot
| Covered or Partially Covered Under Medigap | Not Covered Under Medigap |
|---|---|
| Part A Hospital Insurance & Costs | Prescription Drugs |
| Part A Deductible (some plan letters) | Routine Dental, Vision, or Hearing Services |
| Part A Hospice Coinsurance or Copayments | Long-Term Care |
| Part B Coinsurance or Copayments | Private-Duty Nursing |
| Blood (For Transfusions; First 3 Pints) | |
| Skilled Nursing Facility Care Coinsurance (some plan letters) | |
| Foreign Travel Emergency Care (some plan letters) |
Medigap plans help fill some of the cost-sharing gaps in Original Medicare. While each plan letter covers different amounts, most Medigap policies help pay for:
Part A Hospital Coinsurance & Costs: Medigap covers Part A coinsurance and extends hospital coverage up to an additional 365 days after Medicare benefits are exhausted.
Part A Deductible: Most Medigap plans cover all or part of the large Part A hospital deductible, but coverage depends on the specific plan.
Part A Hospice Coinsurance or Copayments: Reduces out-of-pocket costs for hospice medications and respite care.
Part B Coinsurance or Copayments: Medigap helps to pay some or all of the 20% coinsurance you owe under Medicare Part B depending on the plan, which can significantly reduce your out-of-pocket costs for doctor visits and outpatient care.
Blood (For Transfusions; First 3 Pints): Original Medicare doesn't cover the first 3 pints of blood needed for transfusions, but Medigap helps pay for this.
Skilled Nursing Facility Care Coinsurance: Many plans help cover the significant daily coinsurance for longer skilled nursing facility stays.
Foreign Travel Emergency Care: Medigap Plans C, D, F, G, M, and N offer limited emergency coverage outside the United States.
What Does Medigap Not Cover?
While Medigap helps with cost-sharing, it does not expand your Medicare benefits. Medigap does not cover:
Prescription Drugs: You'll need a separate Medicare Part D plan for prescription drug coverage.
Routine Dental, Vision, or Hearing Services: Medigap doesn't pay for routine exams, eyeglasses, contacts, hearing aids, or dental care.
Long-Term Care: Custodial or assisted-living care is not included.
Private-Duty Nursing: Medigap won't cover private nurses.
If you need coverage for any of the things listed above, your next step would be to compare coverage in Medigap plans against coverage offered by Medicare Advantage plans. Medicare plan comparison tools like Healthpilot can help you compare both options easily.
Medigap Eligibility
To enroll in a Medigap policy, you must:
Be enrolled in Medicare Part A and Part B
Live in a state where the policy is offered (the Medigap plans available to you may differ based on your geographical location)
The best time to sign up is during your Medigap Open Enrollment Period: a 6-month window that begins the month you turn 65 and are enrolled in Part B. During this time, you have Guaranteed Issue Rights, meaning insurers cannot deny you or charge higher premiums due to pre-existing conditions.
If you miss your application deadline or apply outside of this window, insurance companies may require medical underwriting, potentially raising your premium (or denying coverage altogether).
Medigap Costs
Medigap costs may vary depending on your state, plan letter (A-N), insurer, age, gender, and health status (if underwriting applies). When it comes to budgeting for a Medigap plan, it's important to consider three things: premiums, deductibles, and out-of-pocket costs.
Medigap Premiums
Medigap plans come with their own monthly premium, meaning that you will pay a separate monthly premium for Medigap in addition to your Part B premium or Part A premium (if you do not qualify for free Part A).
As for specific costs, Medigap plan premiums vary widely due to the range of plan options, costs differing by insurance company, your location, and other factors. To get a better idea of the premium associated with your Medigap plan, we recommend using a trusted comparison tool like Healthpilot.
Medigap Deductible
Most Medigap plans don't have their own deductibles (with the exception of High-Deductible Medigap Plans G and F). On the contrary, Medigap works to help cover deductibles for Original Medicare (Part A only, unless you were eligible for Medicare prior to January 1, 2020).
Medigap Out-of-Pocket Costs
With Medigap, out-of-pocket costs are typically lower and more predictable because most plans cover all or most of Medicare's deductibles and coinsurance. Some plans, like Plan G, eliminate nearly all additional costs except the Part B deductible, while others, like Plan N, include only small copays. This is why Medigap policies don't have an annual out-of-pocket maximum.
How to Apply for Medigap
Applying for Medigap is usually simple; but as with most Medicare enrollment-related things, timing is everything.
If you enroll during your Medigap Open Enrollment Period (a 6-month period that starts the month you turn 65 and enrolled in Medicare Part B), you have the broadest access to coverage and the best pricing.
Outside of that window, your right to buy Medigap may depend on your health or special situations called Guaranteed Issue Rights (such as losing employer coverage or leaving Medicare Advantage due to situations out of your control).
We know this is a lot of information, and Medigap enrollment can be confusing; that's why Healthpilot is here to help. Our team of trusted agents and our proprietary Medicare plan finder and comparison tool exist to support you when you need it.
When to Enroll in Medigap
You can apply at any time you are enrolled in Medicare Part A and Part B, but approval is not always guaranteed. Your best opportunity is:
Medigap Open Enrollment Period: Begins in the month when you are 65 years of age and enrolled in Part B, lasts 6 months; gives you guaranteed access to any Medigap plan available in your state at the best available rate.
Guaranteed Issue Situations: You may have guaranteed access to Medigap if:
- Your Medicare Advantage plan leaves your service area, stops offering coverage, or you relocate to outside of the plan's coverage area
- You involuntarily lose coverage from an employer or union group health plan (including COBRA)
- Your Medigap policy is terminated for reasons outside of your control (i.e. your insurer goes bankrupt or violates their contract)
- You try Medicare Advantage when you first became eligible and decide that you want to switch back to Original Medicare within 12 months (this is known as your trial right)
- You switched or canceled a Medigap or Medicare Advantage plan due to misleading information
- In select states, you can also change your Medigap plan during a Special Enrollment Period (SEP)
How to Enroll in Medigap
After determining the Medigap plan that you'd like to sign up for, enrolling is typically straightforward:
Confirm that you are already enrolled in Medicare Parts A and B (Original Medicare).
Compare Medigap plans and premiums (using a plan comparison tool like Healthpilot).
Select a standardized plan letter (A-N); keep in mind that some plans may not be available to you due to your location or other factors.
Apply through Healthpilot or directly through the insurer
Outside of Open Enrollment or Guaranteed Issue, you may need to be approved through medical underwriting.
Once approved, you will receive your Medigap card, keep it and your Original Medicare card for coverage
Learn More About Medicare
Medigap FAQs
As with any Medicare or healthcare-related decision, the answer to this question heavily depends on your unique needs. Typically:
- Medigap is typically best for people who want predictable costs and nationwide provider flexibility.
- Medicare Advantage is typically better for those who want extra benefits and are okay with provider networks.
If you need help finding the right Medicare option for you, Healthpilot can help you compare both options based on your medications, doctors, and preferences so you can choose confidently.
No. Medigap only supplements Original Medicare; it does not include prescription drug coverage. If you require prescription drug coverage, you will need a separate Medicare Part D (Prescription Drug Coverage) plan for medications.
No; Medigap is only compatible with Original Medicare plans, and cannot be used with Medicare Advantage plans. That means that if you switch to Medicare Advantage, you cannot use your Medigap policy for cost-sharing.
Not everyone needs Medigap, but it could be a good choice for beneficiaries who want more predictable costs and nationwide access to providers. If you travel frequently, have ongoing health conditions, or want peace of mind knowing Medicare’s cost gaps are covered, Medigap might be a viable option for you.