Medicare Supplement Insurance (also called Medigap) are private insurance plans that work with Medicare Part A and Part B (Original Medicare). A Medigap plan can help pay for certain Medicare out-of-pocket costs, such as deductibles, copayments and coinsurance.
Medicare Supplement Insurance companies are sold by private insurance companies, so plan availability and costs may vary depending on where you live.
You can visit MedicareSupplement.com to compare plans from Medicare Supplement Insurance companies that provide plans in your area.
Medicare Part A and Part B help cover certain hospital costs and medical care expenses. You are typically responsible for paying some costs, however, such as Medicare Part A and Part B deductibles and coinsurance. Medigap plans help pay for some of these out-of-pocket costs.
Let’s consider an example to help explain how Medicare Supplement Insurance works.
Imagine that you visit a doctor because of an illness, and your doctor accepts Medicare assignment — meaning they accept the Medicare-approved amount for service as payment in full.
Medicare Part B will typically reimburse your provider for 80 percent of the Medicare-approved amount for your services. You are typically required to pay the remaining 20 percent (after you meet your annual Part B deductible, which is $185 in 2019). This remaining 20 percent is called your Medicare Part B coinsurance.
For the purpose of this example, let’s say your doctor bills Medicare $200 for your Medicare-approved services. This means you would be responsible for paying $40 out of pocket (20 percent of $200) for the appointment.
If you had a Medicare Supplement Insurance plan that covers 100 percent of the Part B coinsurance, your plan would pay the $40, not you.
The Medigap plans comparison chart below illustrates the 10 types of standardized Medicare Supplement Insurance plans that are available in most states (Wisconsin, Minnesota and Massachusetts have different options).
|Medicare Supplement Benefits||A||B||C||D||F1||G||K2||L3||M||N4|
|Part A co-insurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|Medicare Part B deductible||✓||✓|
|Medicare Part B excess charges||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
View an image version of this table.
Each standardized type of Medigap plan offers full, partial or no coverage for each of the following benefit areas:
The average cost per month of Medigap plans sold in 2018 ranged from $57.16 to $218.75, depending on the type of plan.1 The average cost of each type of Medigap plan can vary quite a bit from one plan type to another.
Factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.
For example, the average cost of Medigap Plan F in New York was $334.92 per month in 2018. The average cost for Medigap Plan F in Iowa was $141.04 per month in 2018.1
Learn more about Medicare Supplement Insurance rates in your state.
There are three different age-related pricing models that Medicare Supplement Insurance companies use to determine their Medigap plan rates. Each type of cost model can affect the average price of a given plan.
Medigap premiums can increase over time due to inflation and other factors, regardless of the pricing model your insurance company uses.
There are a few things to consider as you compare Medicare Supplement Insurance plans form different insurance companies.
Find out which Medigap plans are offered in your area. Consider your health care coverage needs and decide which Medigap plan offers the combination of benefits that works for you.
A licensed insurance agent can help you compare the benefits and costs of Medigap plans available where you live.
You may be eligible to enroll in a Medicare Supplement Insurance plan if you meet the following eligibility requirements:
Federal law does not require insurance companies to sell Medigap plans to individuals under the age of 65, even if they are eligible for Medicare because of a disability.
The following states do require insurance companies to make at least one Medigap plan available to qualified beneficiaries under the age of 65:
Keep in mind that insurance companies in other states (not on the above list) may also offer Medigap plans to people under 65. They are simply not required to do so under state law. If this is the case, you may not be able to buy a Medigap plan in your state if you are under 65.
If you are able to find a Medigap plan in your state, it may be considerably more expensive than it is for people 65 and older. Some states regulate how insurance companies price their Medigap plans for Medicare beneficiaries who are under 65.
Some of the states listed above might offer multiple Medigap policies to beneficiaries under 65. Some may even offer the same selection of plans that are available to those 65 and over.
Some states might only offer one type of Medigap plan to people under 65.
State laws regarding Medigap can vary considerably. Check with your state’s department of insurance to learn more about how Medigap is regulated where you live.
A good time to buy a Medigap plan is during your Medigap Open Enrollment Period (OEP), which begins as soon as you are at least 65 and enrolled in Medicare Part B.
During your Medigap Open Enrollment Period, Medicare Supplement Insurance companies can’t use your medical history or current health status to determine your eligibility for a Medigap plan or to charge you higher plan premiums.
Outside of your Medigap Open Enrollment Period, you may have what are called “guaranteed issue rights.”
Having a guaranteed issue right means Medicare Supplement Insurance companies cannot perform any medical underwriting in determining your Medigap premium. In other words, you cannot be charged more for a plan because of your health.
There are several circumstances that could qualify you for a Medigap guaranteed issue right.
A licensed insurance agent can help you compare plans that are sold by Medicare Supplement Insurance companies in your area.
Compare Medigap plans in your areaVisit MedicareSupplement.com
Copyright 2019 TZ Insurance Solutions LLC. All rights reserved.
1 TZ Insurance Solutions LLC internal sales data, 2019. This data is based on the Medicare Supplement Insurance policies TZ Insurance Solutions LLC has sold. It is not a comprehensive national average of all available Medicare Supplement Insurance plan premiums.
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
MedicareSupplement.com is owned and operated by TZ Insurance Solutions LLC. It serves as an invitation for you, the customer, to inquire about further information regarding Medicare Supplement Insurance. TZ Insurance Solutions LLC and the licensed insurance agents who may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on MedicareSupplement.com.