What is a Medigap Plan?
A Medigap Plan, also known as Medicare Supplement Insurance, is a private health insurance policy designed to help pay some of the healthcare costs that Original Medicare (Part A and Part B) doesn’t fully cover.
These costs may include:
- Part A coinsurance
- Part B coinsurance
- Copayments
- Deductibles (depending on the plan and eligibility)
- Skilled Nursing Facility (SNF) coinsurance
- Foreign travel emergency benefits (available with certain plans)
Medigap policies are sold by private insurance companies but are standardized by federal law in most states, meaning a Plan G from one insurer offers the same core benefits as a Plan G from another insurer.
Why Do You Need a Medigap Plan?
Original Medicare does not pay 100% of your medical expenses. A Medigap policy helps reduce your out-of-pocket costs, making healthcare expenses more predictable.
Example
Suppose a Medicare-approved office visit costs $200.
- Medicare pays its approved share.
- The remaining Medicare-approved patient responsibility may be covered by the Medigap plan, depending on the specific plan.
Who Can Buy a Medigap Plan?
Generally, you must:
- Be enrolled in Medicare Part A
- Be enrolled in Medicare Part B
- Have Original Medicare
Note: Medigap policies cannot generally be used with Medicare Advantage (Part C) plans.
How Does Medigap Work?
- Visit a Medicare-approved provider.
- The provider bills Medicare.
- Medicare pays its portion.
- The remaining eligible balance is sent to the Medigap insurer (often automatically through crossover).
- The Medigap plan pays according to its benefits.
What Medigap Does Not Cover
Most Medigap plans do not cover:
- Prescription drugs (covered separately through Medicare Part D)
- Dental care
- Vision care
- Hearing aids
- Long-term custodial care
- Private-duty nursing
Medigap vs Medicare Advantage
| Medigap | Medicare Advantage |
|---|---|
| Works with Original Medicare | Replaces Original Medicare coverage |
| Helps pay Medicare cost-sharing | Provides Medicare benefits through a private plan |
| Freedom to see any provider who accepts Medicare | Usually network-based |
| Requires separate Part D for most outpatient drugs | Drug coverage is often included |
Quick Facts
- Sold by private insurance companies.
- Works only with Original Medicare.
- Helps reduce out-of-pocket costs.
- Benefits are standardized in most states.
- Different plans (A, B, D, G, K, L, M, N) provide different levels of coverage.
- Premiums vary by insurer, location, age, and pricing method.
Learn More (Official Resources)
For the complete details about Medigap plans, enrollment, standardized benefits, and Medicare rules, visit these official resources:
- Medicare – Medigap (Official): https://www.medicare.gov/health-drug-plans/medigap
- CMS (Centers for Medicare & Medicaid Services): https://www.cms.gov
- Medicare Handbook (“Medicare & You”): https://www.medicare.gov/publications
- State Health Insurance Assistance Program (SHIP): https://www.shiphelp.org
- National Association of Insurance Commissioners (NAIC) – Medigap Information: https://content.naic.org
These resources provide the latest information on plan availability, enrollment rules, pricing, and coverage.