Coverage Comparison: Medicare Supplement Insurance (Medigap) vs. Original Medicare (Parts A and B)

Medicare Supplement Insurance (also called Medigap) is used along with Original Medicare (Part A and Part B) to help pay certain Medicare out-of-pocket costs.

These costs can include costs like Medicare Part A coinsurance, the Medicare Part A deductible or Part B coinsurance. Medigap plans do not typically offer additional benefits beyond what Original Medicare covers.

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Quick links in this guide:

Learn more about how Original Medicare and Medicare Supplement Insurance work, and explore the Medigap plans that may be available in your area.

Original Medicare vs. Medigap at a Glance

The chart below provides a brief summary of Original Medicare vs. Medicare Supplement Insurance.

  Original Medicare only Original Medicare + Medicare Supplement Insurance
How much will you pay in premiums? Most people will pay $135.50 for Medicare Part A and B in 2019. With a Medigap plan, you must pay your plan premium plus any Original Medicare premiums. The average premium paid for a Medigap premium in 2018 was $125.93 per month.3
What doctors can you visit? Any health care provider who accepts Medicare. If they do not accept Medicare assignment, you may be subject to excess charges./td> Any health care provider who accepts Medicare. If they do not accept Medicare assignment, your Medigap plan may (or may not) cover any excess charges.
Can I receive coverage for prescription drugs? No. Only a Medicare Part D plan or Medicare Advantage plan can provide prescription drug coverage. No. Only a Medicare Part D plan or Medicare Advantage plan can provide prescription drug coverage.
Can I receive coverage for routine dental, vision or hearing care? No. Only a Medicare Advantage plan or a standalone dental, vision, or hearing plan can provide coverage for such care. No. Only a Medicare Advantage plan or a standalone dental, vision, or hearing plan can provide coverage for such care.
Coverage of Medicare out-of-pocket costs No coverage of Original Medicare out-of-pocket costs, but MA plan out-of-pocket costs may be more affordable than what Original Medicare includes Coverage for Medicare Part A and B deductibles, copayments and coinsurance (depending on the plan)
Is there a limit to my out-of-pocket spending? No With certain plans, yes.
Can I enroll at any time? No. There are certain enrollment periods during which you may enroll in Original Medicare. Yes, but you may face higher premiums if you do not enroll during your Medigap open enrollment period.
What are the eligibility requirements?
  • 65 years old (or under age 65 with a qualifying disability)

  • Eligible for Social Security or Railroad Retirement Board benefits

  • U.S. citizen or permanent legal resident with at least 5 years of residency
Enrolled in Medicare Part A and Part B. If you are under 65, you may not be able to buy a Medigap plan where you live.
How do I enroll? Through the federal government By visiting MedicareSupplement.com.

Is Original Medicare better than Medicare Supplement Insurance?

Original Medicare and Medicare Supplement Insurance are two different things, but they are coverage options that you can use together.

You cannot have a Medicare Supplement Insurance plan if you aren’t enrolled in Original Medicare.

Original Medicare is federally funded and provided by the U.S. government and consists of:

Medicare Part A provides coverage when you’re admitted to a hospital or other inpatient facility.

Medicare Part B provides coverage for services and devices, such as certain doctor’s appointments and other outpatient services and durable medical equipment (DME).

Medicare Part B is optional coverage, but you must be enrolled in Part B in order to sign up for a Medicare Supplement Insurance plan.

What is Medicare Supplement Insurance vs. Medigap?

Medicare Supplement Insurance is also commonly called Medigap.

Medigap plans are sold by private insurance companies. Medigap plans help cover some of the out-of-pocket expenses that you may incur when using your Original Medicare coverage.

In other words, Medicare Supplement Insurance helps pay for some of the out-of-pocket “gaps” created by Medicare, hence the term “Medigap.”

There are nine potential benefits that can be covered by the 10 standardized Medicare Supplement Insurance plans sold in most states (Massachusetts, Minnesota, and Wisconsin have different standards).

Medicare Supplement Insurance Plans 2019
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.

Original Medicare eligibility vs. Medicare Supplement Insurance eligibility

Original Medicare eligibility

In order to be eligible for Medicare Part A, you must be:

  • At least 65 years old
  • Eligible for Social Security benefits (or Railroad Retirement Board benefits)
  • A U.S. citizen or permanent legal resident who has lived in the U.S. for at least five years

You may also be eligible for Medicare Part A if you are under 65 and have a qualifying disability.

If you are eligible for and enrolled in Medicare Part A, you can enroll in Medicare Part B.  

Medicare Supplement Insurance eligibility

You may be eligible to enroll in a Medicare Supplement Insurance plan if you meet the following eligibility requirements:

  • You are enrolled in Medicare Part A
  • You are enrolled in Medicare Part B
  • You are not enrolled in a Medicare Part C (Medicare Advantage) plan
  • You are not enrolled in an employer or union group health insurance plan
  • You reside in the area in which your desired Medigap plan is sold

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.

Original Medicare enrollment vs. Medicare Supplement Insurance enrollment

Original Medicare enrollment

In 2018, there were more than 59 million Medicare beneficiaries in the U.S.1  

Depending on your individual situation, you may be automatically enrolled in Original Medicare.

If you need to manually sign up for Medicare, the earliest time you can enroll in Original Medicare is during your Medicare Initial Enrollment Period (IEP).

Medicare IEP graphic

Your Initial Enrollment period lasts for seven months:

  • It begins three months before you turn 65
  • It includes your birth month
  • It extends for another three months after your birth month

If you are under 65 and qualify for Medicare due to disability, the 7-month period is based around your 25th month of disability benefits.

Medicare Supplement Insurance enrollment

As of 2016, 34 percent of Medicare beneficiaries were enrolled in a Medicare Supplement Insurance plan.

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.

Depending on the guaranteed issue you right you qualify for, you may not be able to purchase every plan type available.

There are several circumstances that could qualify you for a Medigap guaranteed issue right.

Original Medicare costs vs. Medicare Supplement Insurance costs

Original Medicare costs

Most people do not pay a premium for Medicare Part A in 2019. To qualify for premium-free Part A, you must have worked and payed Medicare taxes for 40 quarters (10 years).

If you paid Medicare taxes for only 30-39 quarters, your 2019 Part A premium will be $240 per month. If you paid Medicare taxes for fewer than 30 quarters, your premium will be $437 per month.

The standard Part B premium in 2019 is $135.50 per month.

The Part B premium is based on your income from two years prior (so your 2019 premium is dependent upon your 2017 income). Depending on your income, you may be required to pay an IRMAA (Income-Related Monthly Adjustment Amount).

You can use the chart below to see what your adjusted Part B premium amount would be in 2019, if you are required to pay one.

Medicare Part B IRMAA
2017 Individual tax return 2017 Joint tax return 2017 Married and separate tax return 2019 Part B premium

$85,000 or less

$170,000 or less

$85,000 or less

$135.50

More than $85,000 and up to $107,000

More than $170,000 and up to $214,000

N/A

$189.60

More than $107,000 up to $133,500

More than $214,000 up to $267,000

N/A

$270.90

More than $133,500 up to $160,000

More than $267,000 up to $320,000

N/A

$352.20

More than $160,000 up to $500,000

More than $320,000 up to $750,000

More than $85,000 up to $415,000

$433.40

More $500,000

More than $750,000

More than $415,000

$460.50

Original Medicare also includes certain deductibles, coinsurance and copayments, as well as potential excess charges.

Original Medicare costs can include, but aren’t limited to:

Certain Medigap plans can help cover some of these costs, as outlined in the plan comparison chart above.

Medicare Supplement Insurance costs

The average monthly premium for a Medicare Supplement Insurance plan in 2018 was $125.93 per month.3

It’s important to note that each type of Medigap plan offers a different combination of standardized benefits. Plans with fewer benefits may offer lower premiums.

Other factors such as age, gender, smoking status, health and where you live can also affect Medigap plan rates.

Learn about Medicare Supplement Insurance plans in your area

Original Medicare vs. Medicare Supplement Insurance is not an “either/or” type of comparison.

A licensed insurance agent can help you learn more about Medicare Supplement Insurance plans in your area and find a plan that works for you.

 

Learn about Medigap plans in your area

Visit MedicareSupplement.com