Medigap: Medicare Supplemental Insurance

August 27, 2010

What is Medigap or Medicare Supplemental Insurance?
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in your Medicare Part A and Part B coverage: it helps pay some of the health care costs that Medicare doesn’t cover. If you have Medicare and a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. Generally, you must have both Medicare Part A and Part B to purchase a Medigap plan.

What does Medigap cover?
Medigap covers some of the things that are not covered by Medicare Parts A and B. There are 12 standard Medigap plans, called A through L, that offer very different levels of set benefits.

What services are not covered by Medicare Supplemental Insurance?

  • Long-term/custodial care at home or in a nursing home
  • Assisted living
  • Vision care
  • Dental care
  • Hearing aids
  • Private-duty nursing
  • Unlimited prescription medications (Some Medigap plans used to cover prescription drugs, however with the introduction of Medicare Part D, the Medicare Prescription Drug Plan, these benefits are no longer available.)

Who is eligible for Medigap?
Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You are not eligible for Medigap if you have Medicare Part C. Like Medicare Part B, you have a limited time to purchase a Medigap plan: you must do so within 6 months of enrolling in Medicare Part B or there is no guarantee you will be able to get coverage.

What does Medigap cost?
You will have to pay the monthly Medicare Part B premium and, in addition, you will have to pay a premium to the Medigap insurance company. The cost of your plan will depend on the coverage you select, the company providing the plan, your age, and the state you live in. As long as you pay your premium, your Medigap policy is guaranteed renewable. The less expensive the plan, the higher your out of pocket costs will be.

It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost.

Where can I buy a Medigap policy and how do I choose between them?
Medigap policies can be purchased from an insurance company. The policy must follow state and federal laws, which are designed to protect you from predatory insurance providers. You may want to ask your local agency on aging to recommend a reputable company.

Medicare.gov has a great guide to help you choose the policy that is right for you: 2017 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (PDF, will open in new window).

Who is covered under my Medigap policy?
You and your spouse must buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

Who can I contact for more information on Medigap?
You can call the Medicare Hot Line 1-800-633-4227 for more information on choosing the policy that’s right for you and your budget. You can also use our Resource Locator to find the State Health Insurance Assistance Program in your area.

WebMD, Medicare: What are Medigap Plans?: http://www.webmd.com/health-insurance/insurance-basics/medigap
Medicare.gov, Medigap Supplemental Insurance Policies: http://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html


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