What is Medigap?
A Medigap policy is private supplemental insurance that helps cover out-of-pocket costs not paid by Original Medicare (Parts A and B).
Medigap, also called Medicare Supplement Insurance, is sold by private insurance companies to fill the “gaps” in Original Medicare coverage, such as deductibles, copayments, and coinsurance. It is designed for people enrolled in Medicare Part A and Part B and works alongside Original Medicare, paying after Medicare has paid its share of covered services. Medigap policies do not replace Medicare.
How It All Works
Coverage & Benefits
Medigap plans vary, but they generally cover some or all of the following costs
- Hospital deductibles and coinsurance
- Doctor visit copayments
- Skilled nursing facility coinsurance
- Emergency care when traveling outside the U.S.
There are standardized plans labeled A, B, D, G, K, L, M, and N, with some older plans (C, F, E, H, I, J) no longer available to new enrolls. While benefits are standardized, premiums can vary between insurance companies.
How Medigap Works
When you have a Medigap policy…
- You pay your Medicare Part B premium and a monthly premium to the Medigap insurer.
- Medicare pays its share of covered services.
Your Medigap policy pays its share of the remaining costs.
Medigap policies are guaranteed renewable, meaning coverage continues as long as premiums are paid. Each person must have a separate policy; a spouse is not covered under your plan.
Enrollment & Consumer Protections
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period, which starts when you are 65 or older and enrolled in both Medicare Part A and Part B. During this period, insurers cannot deny coverage or charge higher premiums due to pre-existing conditions. Outside this window, medical underwriting may apply, potentially increasing costs or limiting eligibility.
Medigap policies are regulated at both federal and state levels, ensuring standardized benefits, consumer protections, and fair marketing practices. Some states may have additional rules, especially for individuals under 65 who qualify for Medicare due to disability.
Key Considerations
Medigap does not cover services not included in Original Medicare, such as routine dental, vision, or hearing care.
It is different from Medicare Advantage (Part C), which is an alternative way to receive Medicare benefits. Medigap strictly supplements Original Medicare.
Costs vary by plan, insurer, and location, so comparing options is important to find a plan that fits your medical and financial needs.
In summary, a Medigap policy provides financial protection against out-of-pocket costs in Original Medicare, offering peace of mind and predictable healthcare expenses for seniors and eligible Medicare beneficiaries.
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