- Medigap plans can help you cover the out-of-pocket costs of Medicare.
- You can often choose from among 10 different Medigap plans.
- Medigap plans are standardized, which means they’re the same nationwide.
- Purchasing a Medigap plan when you first become eligible can save you money in the long run.
You can purchase Medicare supplement insurance, also known as Medigap plans, to help cover some of the costs of Medicare.
You’ll pay a monthly premium for your Medigap plan, and the plan will pay for costs that would normally fall to you, such as copayments for doctor’s office visits.
You can choose from among 10 Medigap plans. The plans are standardized across the United States; however, your cost will depend on your location and on the company you purchase your plan from.
You can check out the coverage offered by each plan in the chart below.
|Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan K||Plan L||Plan M||Plan N|
|Part B deductible||no||no||yes||no||yes||no||no||no||no||no|
|Part A hospital coinsurance||yes||yes||yes||yes||yes||yes||Yes||yes||yes||yes|
|Part A deductible||no||yes||yes||yes||yes||yes||50%||75%||50%||yes|
|Part B coinsurance||yes||yes||yes||yes||yes||yes||50%||75%||yes||yes (but with copays)|
|Blood (first 3 pints)||yes||yes||yes||yes||yes||yes||50%||75%||yes||yes|
|Skilled nursing facility care coinsurance||no||no||yes||yes||yes||yes||50%||75%||yes||yes|
|Part B excess charge||no||no||no||no||yes||yes||no||no||no||no|
|Foreign travel emergencies||no||no||80%||80%||80%||80%||no||no||80%||80%|
|Plan deductibles||$1,408 |
If you’re new to Medicare as of 2020, you actually have only 8 Medigap plan choices.
Due to recent changes to Medicare regulations, Plan C and Plan F are no longer available to new Medicare enrollees. This change applies only if you became eligible for Medicare starting on January 1, 2020, or later.
If you were eligible for Medicare in 2019 or earlier, you can still buy plans C and F.
Medigap plans, sometimes also called Medicare supplement plans, are optional plans you can add to your Medicare coverage to help pay for some of the out-of-pocket costs of Medicare.
The plans work alongside original Medicare. Original Medicare is made up of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medigap plans are specifically designed to cover the costs of original Medicare that normally fall to you.
Some costs that Medigap plans often cover include:
- extra fees
- healthcare while you travel
There are 10 different Medigap plans. The plans are standardized – so no matter what you state you live in or what company you purchase a plan from, your coverage will always be the same.
The premiums for your plan might differ depending on your location and the company, but the coverage itself won’t change. For example, Plan A covers the same medical costs in Texas as it does in Oregon.
This is true nationwide with three exceptions:
These states have their own Medigap plans. If you live there, you’ll see plans under different names and covering different costs.
All Medigap plans help you pay for the costs of Medicare. However, some plans are a lot more comprehensive than others. For example, while all plans cover Part A hospital coinsurance costs, only a handful of plans cover some skilled nursing facility coinsurance costs.
The right plan for you will depend on your needs and budget.
For example, if you’re planning on foreign travel, you can select a plan that covers foreign travel emergencies. Plans A, B, K, and L don’t offer foreign travel coverage, so they might not be the best choice for you.
Other considerations include:
- How much can you spend on a premium each month?
- How much do you typically spend on each covered expense?
- Do you have any surgeries or procedures that might require an upcoming hospital stay?
Looking ahead at your needs can help you select the best plan for you. The right Medigap plan might be very different depending on your care needs.
As another example, let’s say you were planning a total knee replacement in the coming months. You might need both an inpatient hospital and an inpatient skilled nursing facility stay during your recovery.
In this case, it could be helpful to have a plan like Medigap Plan G that covers your Part A deductible, Part A coinsurance, and skilled nursing facility coinsurance.
Medigap plans have monthly premiums you pay in addition to your costs for original Medicare. Part A doesn’t have a premium, but Part B has a standard premium of $148.50 in 2021. So, if you selected a Medigap plan with a $70 premium, you’d pay a total of $218.50 every month for your Medicare coverage.
Your costs will depend on your state and the plan you choose.
Companies that offer Medigap plans look at your age, gender, overall health, and more to determine your costs. Generally, plans that cover more costs have higher premiums, but this isn’t always the case.
In some states, plans F and G have high-deductible options. This option allows you to purchase either plan for a much lower monthly premium. However, you’ll need to meet your deductible before your plan will cover any costs.
You can search for plans in your area using Medicare’s plan finder tool. By entering your ZIP code, you can see all plans available to you and a price range for them.
You’ll need to be enrolled in original Medicare (parts A and B) before you can purchase a Medigap plan.
Depending on your circumstances, you could become eligible for Medicare by:
- turning 65 years old
- receiving Social Security Disability Insurance (SSDI) for 24 months at any age
- having a diagnosis of end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) at any age
You’ll need to sign up yourself if you’re enrolling because you’ve reached your 65th birthday. Your enrollment window runs from 3 months before the month of your birthday, through your birth month, to 3 months after that.
If you’re eligible through SSDI, you’ll automatically be enrolled after 24 months of receiving benefits. People who are eligible through either an ALS or ESRD diagnosis will also be automatically enrolled but don’t need to wait 24 months.
You can purchase a Medigap plan once you’ve enrolled in Medicare and have both parts of original Medicare.
Medigap plans are optional, but it can be a good idea to purchase a plan when you first become eligible for Medicare if you think you might need the coverage later.
This is because Medigap plans generally look at your health, age, and gender before giving you a price.
During your initial enrollment window, you sign up for a plan without this evaluation. Any plan you purchase during your initial enrollment must be offered to you at the rate given to people without health concerns or conditions.
This means that even if you have health conditions, you can buy an affordable Medigap plan during your initial Medicare enrollment. And if you’re in good health, you can still save you money down the road by buying a plan when you’re first eligible.
Plans are often much more affordable for younger Medicare members who are in good health. If your health declines, you could be denied any Medigap plan coverage.
For example, if you’re 65 years old and in good health, you might not be thinking about coverage for a skilled nursing facility stay. However, down the road when you’re 80 years old, you might need to stay at a facility following a hospital stay or procedure.
At that point, you might have trouble purchasing a Medigap plan. Even if you do find a plan, the cost to you will likely be much higher than if you had already purchased a plan earlier in life.
- You can select from among 10 different Medigap plans. Each plan covers a different combination of Medicare costs that you’d typically pay out of pocket.
- The plans are standardized no matter where you live or what company you select, but your price can vary.
- Medigap companies evaluate your coverage application by looking at your health, gender, and age. You could be charged a higher rate or even denied coverage if your health has declined.
- However, if you purchase a Medigap plan during your initial enrollment, you’re guaranteed to get a plan at the company’s best rates.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.
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