What Is Medigap? A Clear Guide to Medicare Supplement Plans

Medigap (Medicare Supplement) plans can be a valuable addition to your Original Medicare coverage. Let’s answer the most common questions about these plans in a clear, straightforward way.

What is Medigap?

Medigap is private insurance that helps fill the “gaps” in Original Medicare coverage. These plans:

• Work alongside Original Medicare (Parts A and B)
• Are sold by private insurance companies
• Help pay for out-of-pocket costs
• Are standardized (same benefits regardless of company)

What does Medigap cover?

Medigap plans can help pay for:

Standard Benefits (Plan A)

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayment
• First 3 pints of blood
• Part A hospice care coinsurance or copayment

Additional Benefits (Plans B-N)

• Part A deductible
• Part B deductible
• Skilled nursing facility coinsurance
• Foreign travel emergency (up to plan limits)
• Excess charges

Note: Plans are standardized, meaning the benefits are the same for each letter plan, regardless of the insurance company.

How is it different from Medicare Advantage?

Medigap

• Works with Original Medicare
• No network restrictions
• No referrals needed
• No drug coverage (need separate Part D)
• Higher monthly premium
• Lower out-of-pocket costs
• No annual maximum out-of-pocket

Medicare Advantage

• Replaces Original Medicare
• Network restrictions
• May need referrals
• Often includes drug coverage
• Lower monthly premium
• Higher out-of-pocket costs
• Has annual maximum out-of-pocket

Who should consider Medigap?

Medigap might be right for you if you:

• Want freedom to see any doctor who accepts Medicare
• Travel frequently
• Want predictable healthcare costs
• Don’t want to deal with networks or referrals
• Can afford the monthly premium
• Want comprehensive coverage

When can I enroll in Medigap?

Best Time to Enroll

• During your Medigap Open Enrollment Period
  • Starts when you’re 65 and enrolled in Part B
  • Lasts for 6 months
  • Guaranteed issue rights
  • No health questions
  • Best prices

Other Enrollment Opportunities

• Guaranteed issue rights in certain situations
• Moving to a new area
• Losing other coverage
• Medicare Advantage plan changes

How much does Medigap cost?

Factors Affecting Cost

1. Plan Type

   • More coverage = higher premium
   • Plan F and G typically cost more

2. Insurance Company

   • Same benefits, different prices
   • Compare multiple companies

3. Location

   • Prices vary by state
   • Some states have community rating

4. Age and Gender

   • Some states allow age-based pricing
   • Gender can affect rates

What are the different Medigap plans?

Most Popular Plans

1. Plan G

   • Most comprehensive coverage
   • You pay Part B deductible
   • No out-of-pocket limit

2. Plan N

   • Lower premium than Plan G
   • Small copays for some visits
   • You pay Part B deductible

3. High-Deductible Plan G

   • Lower monthly premium
   • Must meet deductible first
   • Same coverage as Plan G

How do I choose the right Medigap plan?

Consider These Factors

1. Your Health

   • Current medications
   • Expected medical needs
   • Family history

2. Your Budget

   • Monthly premium
   • Out-of-pocket costs
   • Long-term affordability

3. Your Lifestyle

   • Travel plans
   • Doctor preferences
   • Healthcare usage

Common Questions

Can I switch Medigap plans?

• Yes, but you may need to answer health questions
• Best to switch during Open Enrollment
• Some states have additional switching rights

Do I need Part D with Medigap?

• Yes, Medigap doesn’t cover prescriptions
• You’ll need a separate Part D plan
• Enroll in Part D when you first get Medicare

Can I have Medigap and Medicare Advantage?

• No, you can’t have both
• Must choose one or the other
• Can switch during certain periods

Need Help Choosing a Medigap Plan?

At MedStar Insurance Agency, we can help you:

• Compare Medigap plans in your area
• Find the best value for your needs
• Understand your options
• Navigate the enrollment process

Contact us today to get personalized help with your Medigap coverage. We’ll make sure you find the right plan at the best possible price!