Medigap covers the “gaps” in insurance that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. Some Medigap plans also cover things like medical care when traveling abroad. Medigap plans are offered by private insurance companies that work with Medicare. After Medicare pays its share of the approved amount of your services, your Medigap policy will step in and pay its share. You can purchase a Medigap plan by choosing from licensed plans available in your state that fit your needs.
You will pay a monthly premium for your Medigap policy, in addition to the monthly premium you pay for Part B. You are eligible for a Medigap plan if you have Medicare Parts A and B already. Take note, however, that you can’t have Medigap plan and a Medicare Advantage plan at the same time. Medicare Advantage plans are another way to get Medicare benefits, but a Medigap policy is a supplement to your Original Medicare benefits.
The rules for Medigap’s offerings and benefits vary by insurance company and by state, however there are some similarities across Medigap Plans A, B, C, D, F, G, K, L M and N. A Medigap plan may make you wait up to 6 months for coverage if you have a pre-existing condition.
Your Medigap policy covers only you, and not your spouse. Also note that if you have a Medicare Savings Account (MSA) Plan, it’s illegal for anyone to sell you a Medigap policy.
Any Medigap plan is guaranteed renewable as long as you pay your premiums. There are also guaranteed issue rights associated with your Medigap policy, which give you a right to purchase a Medigap plan in certain scenarios.
When and how to enroll
Open enrollment for a Medigap plans is six months from the first day of the month of your 65th birthday if you are signed up for Medicare part B, or 6 months from the date you sign up for Part B.
You can purchase a Medigap policy from any insurance company in your state that is licensed to sell one. Compare plans to see which one fits your needs. Visit Medicare’s Medigap Policy Search to find a Medigap plan in your area.
Congressional bill will eliminate MedigapPlans C and F
Unfortunately for Medigap consumers, Congress passed a bill on April 14, 2015, which will eliminate Medigap Plans F and C, both of which cover the part B deductible for new Medicare beneficiaries. Plans C and F will be eliminated starting January 1, 2020.
Due to provisions in theMedicare Access and CHIP Reauthorization Act (MACRA) of 2015, no new Medigap plans C or F will be offered to newly-eligible Medicare beneficiaries starting in 2020. One of the purposes of the MACRA Act is to ensure doctors get paid fairly for serving Medicare patients. As of 2020, Medigap Plans will no longer be able to cover Part B deductibles. Medigap plans will still be able to cover Part A deductibles.
But there’s good news.If you joined Medicare prior to 2020 and if you already have a Medigap Plan C or F, you can still keep it after 2020. You will also be able to shop for and pick up or change companies for your Medicare supplement Plan F or C after 2020, but only if you already have the plan, you qualify medically, and you make any changes during a specified enrollment period.
For those who join (or are eligible for) Medicare Part A after 2020, the best plan for you might be a Medigap Plan G, which will be available with no medical underwriting requirements starting January 1, 2020. A new high-deductible Plan G will be created. Plan G covers most everything that Plan F does except for the Part B deductible. Plan N is also a popular plan.
To find a Medigap plan available in your area, click here, and enter your zip code.
What Medigap won’t cover
Note that Medigap plans do not cover:
- Prescription drugs
- Long-term care
- Hearing aids
- Private-duty nursing
Types of Medigap plans
Medigap offers 10 plans that are standard across most states (with the exception of Massachusetts, Minnesota, and Wisconsin, which have their own standard plans). Benefits and coverage are the same across all states, but premiums may differ, so it’s important to know which plan is right for you. Let’s take a closer look at the three most popular Medigap plans—Plan F, Plan G, and Plan N.
Medigap Plan F
Plan F is by far the most popular Medigap plan, with 55% of all Medigap beneficiaries enrolled in this plan. Plan F is so popular because it offers comprehensive benefits and first-dollar coverage, meaning Part A and Part B deductibles are covered, so you pay nothing before Medicare benefits kick in. This is the best plan for you if you have serious or chronic health conditions with a lot of medical expenses each year. However, this plan does have higher premiums, so weigh your pros and cons before choosing Plan F. Other coverage offered by Plan F includes:
- Part A and Part B deductible
- Part A and Part B coinsurance and copayment amounts
- Hospital coinsurance for a full year after Original Medicare Part A benefits are used up
- Part B excess charges
- Hospice care coinsurance
- Skilled nursing care coinsurance
- First 3 pints of blood per year (for approved procedures)
- Foreign travel emergency care at 80% (up to plan limits)
As previously noted, Plan F is being phased out starting in 2020. However, if you are already enrolled before 2020, you can keep your same coverage.
Medigap Plan G
Plan G is different from Plan F in only one regard: Plan G does not cover the Part B deductible. Otherwise, Plan F and Plan G function the same. Like Plan F, Plan G also offers coverage for Part B excess charges.
Plan F and Plan G both allow maximum flexibility to choose health care providers. If you see a provider that does not participate in Medicare, they can charge you up to 15% more than the standard Medicare rate. Unless you have Medigap Plan F or Plan G, you will pay this difference out-of-pocket.
There are no plans to phase out Plan G in 2020.
Medigap Plan N
Plan N strikes a balance between protection against catastrophic out-of-pocket expenses and affordable premiums. Plan N offers the same coverage as Plan F except:
- No coverage for Part B deductibles
- No coverage for Part B excess charges
- You may have a copay of up to $20 for doctor visits and $50 for hospital visits that don’t result in admission
Like Plan G, Plan N has no plans to be phased out in 2020.
What to keep in mind when choosing a Medigap plan
- No switching. Unless you move out of your policy service area, you may not be able to switch Medigap policies once you’re past your Initial Enrollment Period.
- Medical underwriting. Once your Medigap open enrollment period expires, you could be subject to medical underwriting if you apply for a new plan, meaning the insurance company can refuse coverage or charge higher premiums for your plan.
- No trading up. Some states have an annual enrollment period around your birthday month. You can change Medigap plans without medical underwriting, but only for plans with the same or lower benefits than your existing plan.
- Be informed. When enrolling, be sure to discuss options with an experienced Medicare broker who can do a cost-benefit analysis so you can enroll in the right plan the first time around.
If Plan F, Plan G, or Plan N doesn’t suit your needs, refer to the chart below to determine which Medigap plan is right for you.